Health Equity and Accountability Act of 2022
Bill: H.R.7585 | Sponsor: Rep. Kelly, Robin L. (D-IL)
Policy area: Health

Summary:
Health Equity and Accountability Act of 2022
This bill directs the Department of Health and Human Services (HHS) and others to undertake efforts to reduce health disparities.
For example, the bill (1) requires more detailed reporting of demographic and health disparities data, including related to public health emergencies; (2) directs certain components of HHS to support health workforce diversity; and (3) increases access to culturally and linguistically appropriate health care.
The bill also modifies eligibility and other requirements for Medicare, Medicaid, private health insurance, nutrition assistance, and other programs to reduce health disparities among vulnerable populations. The bill includes specific provisions with respect to
Additionally, the bill (1) revises health information technology programs to address health disparities, and (2) supports health impact assessments and other efforts pertaining to environmental justice and social determinants of health (i.e., nonmedical factors that influence health outcomes, such as income and educational attainment).
The bill also requires various studies and reports on issues related to health care and health disparities, including a report by the Government Accountability Office on health workforce diversity.

To improve the health of minority individuals, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Equity and Accountability Act 
of 2022''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
                 TITLE I--DATA COLLECTION AND REPORTING

Sec. 1001. Strengthening data collection, improving data analysis, and 
                            expanding data reporting.
Sec. 1002. Elimination of prerequisite of direct appropriations for 
                            data collection 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 
                            Islanders.
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.
 TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH 
                                  CARE

Sec. 2001. Definitions; findings.
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 appropriate 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.
Sec. 2009. Requirements for health programs or activities receiving 
                            Federal funds.
Sec. 2010. Report on Federal efforts to provide culturally and 
                            linguistically appropriate 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 universities, historically Black 
                            professional or graduate institutions, 
                            Asian American and Native American Pacific 
                            Islander-serving institutions, Tribal 
                            Colleges, regional community-based 
                            organizations, and national minority 
                            medical associations.
Sec. 3003. Loan repayment program of Centers for Disease Control and 
                            Prevention.
Sec. 3004. Allied health workforce diversity.
Sec. 3005. Cooperative agreements for online degree programs at schools 
                            of public health and schools of allied 
                            health.
Sec. 3006. National Health Care Workforce Commission.
Sec. 3007. Scholarship and fellowship programs.
Sec. 3008. McNair Postbaccalaureate Achievement Program.
Sec. 3009. Rules for determination of full-time equivalent residents 
                            for cost-reporting periods.
Sec. 3010. Developing and implementing strategies for local health 
                            equity.
Sec. 3011. Health Professions Workforce Fund.
Sec. 3012. Future advancement of academic nursing.
Sec. 3013. Findings; sense of Congress relating to graduate medical 
                            education.
Sec. 3014. Career support for skilled, internationally educated health 
                            professionals.
Sec. 3015. Study and report on strategies for increasing diversity.
Sec. 3016. Conrad State 30 program; physician retention.
Sec. 3017. National Hispanic Nurses Day.
Sec. 3018. Expanding medical education.
           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. Availability of basic assistance to lawfully present 
                            noncitizens.
Sec. 4004. Improve affordability and reduce premium costs of health 
                            insurance for consumers.
Sec. 4005. Removing citizenship and immigration barriers to access to 
                            affordable health care under the ACA.
Sec. 4006. Removing barriers to access to affordable health care for 
                            lawfully residing immigrants under Medicaid 
                            and CHIP.
Sec. 4007. Consistency in health insurance coverage for individuals 
                            with federally authorized presence, 
                            including deferred action.
Sec. 4008. Study on the uninsured.
Sec. 4009. Medicaid fallback coverage program for low-income adults in 
                            non-expansion States.
Sec. 4010. Increase and extension of temporary enhanced FMAP for States 
                            which begin to expend amounts for certain 
                            mandatory individuals.
                  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 
                            Hawaiian 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 
                            program.
Sec. 4111. Allow for suspension of Medicare benefits and premium 
                            liability for individuals who are 
                            incarcerated and provide a special 
                            enrollment period around the date of 
                            release.
Sec. 4112. Federal Employee Health Benefit 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 Department of Veterans Affairs.
Sec. 4211. Study of DSH payments to ensure hospital access for low-
                            income patients.
Sec. 4212. Reauthorization of the Native Hawaiian Health Care 
                            Improvement Act.
                             Part 2--Rural

Sec. 4221. Establishment of Rural Community Hospital (RCH) Program.
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.
Subtitle D--Advancing Health Equity Through Payment and Delivery Reform

Sec. 4301. Sense of Congress.
Sec. 4302. Centers for Medicare & Medicaid Services reporting and 
                            value-based programs.
Sec. 4303. Development and testing of disparity reducing delivery and 
                            payment models.
Sec. 4304. Diversity in Centers for Medicare and Medicaid consultation.
Sec. 4305. Supporting safety net and community-based providers to 
                            compete in value-based payment systems.
                  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. Findings.
Sec. 4502. Data collection and reporting.
Sec. 4503. Requiring equitable health care in the hospital value-based 
                            purchasing program.
Sec. 4504. Provision of inequitable health care as a basis for 
                            permissive exclusion from medicare and 
                            State health care programs.
Sec. 4505. Office for Civil Rights and Health Equity of the Department 
                            of Health and Human Services.
Sec. 4506. Prohibiting discrimination in health care.
Sec. 4507. Federal Health Equity Commission.
Sec. 4508. Grants for hospitals to promote equitable health care and 
                            outcomes.
                    Subtitle G--Investing in Equity

Sec. 4601. Definitions.
Sec. 4602. Strategy to incentivize health equity.
Sec. 4603. Pay for Equity Advisory Council.
  TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES

                         Subtitle A--In General

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. Mothers and Offspring Mortality and Morbidity Awareness.
Sec. 5202. MOMMIES.
Sec. 5203. Justice for Incarcerated Moms.
Sec. 5204. IMPACT to Save Moms Act.
Sec. 5205. Protecting moms and babies against climate change.
Sec. 5206. Tech to Save Moms.
Sec. 5207. Social Determinants for Moms.
Sec. 5208. Data to Save Moms.
Sec. 5209. Kira Johnson Act.
Sec. 5210. Moms Matter.
Sec. 5211. Taskforce Recommending Improvements for Unaddressed Mental 
                            Perinatal & Postpartum Health (TRIUMPH) for 
                            New Moms.
Sec. 5212. Protect Moms from Domestic Violence.
Sec. 5213. Perinatal workforce.
Sec. 5214. Midwives schools and programs expansion.
Sec. 5215. Gestational diabetes.
Sec. 5216. Consumer education campaign.
Sec. 5217. Bibliographic database of systematic reviews for care of 
                            childbearing individuals and newborns.
Sec. 5218. Development of interprofessional maternity care educational 
                            models and tools.
Sec. 5219. 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. Findings; sense of Congress on urgent barriers to abortion 
                            access and vital solutions.
Sec. 5402. Emergency contraception education and information programs.
Sec. 5403. Access to birth control duties of pharmacies to ensure 
                            provision of FDA-approved contraception.
Sec. 5404. Real Education and Access for Healthy Youth.
Sec. 5405. Compassionate assistance for rape emergencies.
Sec. 5406. Menstrual Equity For All Act of 2021.
Sec. 5407. Additional focus area for the Office on Women's Health.
Sec. 5408. Including services furnished by certain students, interns, 
                            and residents supervised by certified nurse 
                            midwives or certified midwives within 
                            inpatient hospital services under Medicare.
Sec. 5409. Grants to professional organizations and minority-serving 
                            institutions 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 2021.
Sec. 5503. Decreasing the risk factors for sudden unexpected infant 
                            death and sudden unexplained death in 
                            childhood.
          Subtitle G--Nutrition for Women, Children, Families

Sec. 5601. Removing barriers to health care and nutrition assistance 
                            for children, pregnant persons, and 
                            lawfully present individuals.
Sec. 5602. Closing the meal gap.
Sec. 5603. Repeal of denial of Supplemental Nutrition Assistance 
                            Program benefits.
               Subtitle H--Universal School Meals Program

Sec. 5701. Short title.
Sec. 5702. Effective date.
Sec. 5703. Free school breakfast program.
Sec. 5704. Apportionment to States.
Sec. 5705. Nutritional and other program requirements.
Sec. 5706. Special assistance program.
Sec. 5707. Price for a paid lunch.
Sec. 5708. Summer food service program for children.
Sec. 5709. Summer Electronic Benefit Transfer for Children Program.
Sec. 5710. Child and adult care food program.
Sec. 5711. Meals and supplements for children in afterschool care.
Sec. 5712. Access to local foods: farm to school program.
Sec. 5713. Fresh fruit and vegetable program.
Sec. 5714. Training, technical assistance, and Food Service Management 
                            Institute.
Sec. 5715. Reimbursement of school meal delinquent debt program.
Sec. 5716. Conforming amendments.
Sec. 5717. Measure of poverty.
Sec. 5718. Supplemental nutrition assistance program.
Sec. 5719. Higher Education Act of 1965.
Sec. 5720. Elementary and Secondary Education Act of 1965.
Sec. 5721. America COMPETES Act.
Sec. 5722. Workforce Innovation and Opportunity Act.
Sec. 5723. National Science Foundation Authorization Act of 2002.
Sec. 5724. Child care and development block grant.
Sec. 5725. Children's Health Act of 2000.
Sec. 5726. Juvenile justice and delinquency prevention.
                         Subtitle I--Elder Care

Sec. 5801. Expenses for household and elder care services necessary for 
                            gainful employment.
                  Subtitle J--Miscellaneous Provisions

Sec. 5901. Clarification supporting permissible use of funds for 
                            stillbirth prevention activities.
          TITLE VI--MENTAL HEALTH AND SUBSTANCE USE DISORDERS

Sec. 6001. Mental health findings.
Sec. 6002. Sense of Congress.
             Subtitle A--Access to Care and Funding Streams

Sec. 6011. Coverage of marriage and family therapist services, mental 
                            health counselor services, substance abuse 
                            counselor services, and peer support 
                            specialist services under part B of the 
                            Medicare program.
Sec. 6012. Reauthorization of Minority Fellowship Program.
Sec. 6013. Additional funds for National Institutes of Health.
Sec. 6014. Additional funds for National Institute on Minority Health 
                            and Health Disparities.
Sec. 6015. Grants for increasing racial and ethnic minority access to 
                            high-quality trauma support services and 
                            mental health care.
Sec. 6016. Grants for unarmed 9-1-1 response programs.
                   Subtitle B--Interprofessional Care

Sec. 6021. Health professions competencies to address racial and ethnic 
                            mental health inequities.
Sec. 6022. Interprofessional health care teams for behavioral health 
                            care.
Sec. 6023. Integrated Health Care Demonstration Program.
                   Subtitle C--Workforce Development

Sec. 6031. Building an effective workforce in mental health.
Sec. 6032. Pilot program to increase language access at Federally 
                            qualified health centers.
Sec. 6033. Health professions competencies to address racial and ethnic 
                            minority mental health disparities.
                  Subtitle D--Children's Mental Health

Sec. 6041. Pediatric behavioral health care.
Sec. 6042. Mental health in schools.
Sec. 6043. Additional support for youth and young adult mental health 
                            service provision.
Sec. 6044. Early intervention and prevention programs for transition-
                            age youth.
Sec. 6045. Strategies to increase access to telehealth under Medicaid 
                            and Children's Health Insurance Program.
Sec. 6046. Youth and young adult mental health promotion, prevention, 
                            intervention, and treatment.
Sec. 6047. Study on the Effects of Smartphone and Social Media Use on 
                            Adolescents.
                    Subtitle E--Community-Based Care

Sec. 6051. Mental health at the border.
Sec. 6052. Asian American, African American, Native Hawaiian, Pacific 
                            Islander, Indigenous, Middle Eastern and 
                            North African, and Hispanic and Latino 
                            behavioral and mental health outreach and 
                            education strategy.
                          Subtitle F--Reports

Sec. 6061. Addressing racial and ethnic mental health inequities 
                            research gaps.
Sec. 6062. Research on adverse health effects associated with 
                            interactions with law enforcement.
Sec. 6063. Geoaccess study.
Sec. 6064. Cooccurring conditions.
Sec. 6065. Technical correction.
                  Subtitle G--Miscellaneous Provisions

Sec. 6071. Children's Mental Health Infrastructure Act.
Sec. 6072. Mental Health for Latinos.
Sec. 6073. Strengthening Mental Health Supports for BIPOC Communities.
Sec. 6074. STRONG Support for Children.
Sec. 6075. Improving access to mental health.
Sec. 6076. Mental Health in Schools Excellence Program.
Sec. 6077. School Social Workers Improving Student Success.
Sec. 6078. Opioid grants to support caregivers, kinship care families, 
                            and kinship caregivers.
Sec. 6079. Advancing Student Services In Schools Today Act (ASSIST 
                            Act).
          TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES

                           Subtitle A--Cancer

Sec. 7001. Lung cancer mortality reduction.
Sec. 7002. Expanding prostate cancer research, outreach, screening, 
                            testing, access, and treatment 
                            effectiveness.
Sec. 7003. Prostate Research, Imaging, and Men's Education (PRIME).
Sec. 7004. Prostate cancer detection research and education.
Sec. 7005. National Prostate Cancer Council.
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 
                            racial minorities.
Sec. 7008. Reducing cancer disparities within Medicare.
  Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention

Sec. 7051. Viral hepatitis and liver cancer control and prevention.
Sec. 7052. Liver cancer and disease prevention, awareness, and patient 
                            tracking grants.
           Subtitle C--Acquired Bone Marrow Failure Diseases

Sec. 7101. Acquired bone marrow failure diseases.
Subtitle D--Cardiovascular Disease, Chronic Disease, Obesity, and Other 
                             Disease Issues

Sec. 7151. Guidelines for disease screening for minority patients.
Sec. 7152. CDC Wisewoman Screening Program.
Sec. 7153. Report on cardiovascular care for women and minorities.
Sec. 7154. Coverage of comprehensive tobacco cessation services in 
                            Medicaid, CHIP, and private health 
                            insurance.
Sec. 7155. Clinical research funding for oral health.
Sec. 7156. Guide on evidence-based strategies for public health 
                            department obesity prevention programs.
Sec. 7157. Stephanie Tubbs Jones Uterine Fibroid Research and Education 
                            Act.
                          Subtitle E--HIV/AIDS

Sec. 7201. Statement of policy.
Sec. 7202. Findings.
Sec. 7203. Additional funding for AIDS drug assistance program 
                            treatments.
Sec. 7204. Enhancing the national HIV surveillance system.
Sec. 7205. Evidence-based strategies for improving linkage to, and 
                            retention in, appropriate care.
Sec. 7206. Improving entry into, and retention in, care and 
                            antiretroviral adherence for persons with 
                            HIV.
Sec. 7207. Services to reduce HIV/AIDS in racial and ethnic minority 
                            communities.
Sec. 7208. Minority AIDS initiative.
Sec. 7209. Health care professionals treating individuals with HIV.
Sec. 7210. HIV/AIDS provider loan repayment program.
Sec. 7211. Dental education loan repayment program.
Sec. 7212. Reducing new HIV infections among injecting drug users.
Sec. 7213. Report on impact of HIV/AIDS in vulnerable populations.
Sec. 7214. National HIV/AIDS observance days.
Sec. 7215. Review of all Federal and State laws, policies, and 
                            regulations regarding the criminal 
                            prosecution of individuals for HIV-related 
                            offenses.
Sec. 7216. Expanding support for condoms in prisons.
Sec. 7217. Automatic reinstatement or enrollment in Medicaid for people 
                            who test positive for HIV before reentering 
                            communities.
Sec. 7218. Stop HIV in prison.
Sec. 7219. Transfer of funds for implementation of Ending the HIV 
                            Epidemic: A Plan for America.
Sec. 7220. PrEP access and coverage.
                          Subtitle F--Diabetes

Sec. 7251. Research, treatment, and education.
Sec. 7252. Research, education, and other activities.
Sec. 7253. Programs to educate health providers on the causes and 
                            effects of diabetes in minority 
                            populations.
Sec. 7254. Research, education, and other activities regarding diabetes 
                            in American Indian populations.
Sec. 7255. Updated report on health disparities.
                        Subtitle G--Lung Disease

Sec. 7301. National asthma burden.
Sec. 7302. Asthma-related activities of the Centers for Disease Control 
                            and Prevention.
Sec. 7303. Influenza and pneumonia vaccination campaign.
Sec. 7304. Chronic obstructive pulmonary disease.
                        Subtitle H--Tuberculosis

Sec. 7351. Elimination of all forms of tuberculosis.
Sec. 7352. Additional funding for States in combating and eliminating 
                            tuberculosis.
Sec. 7353. Strengthening clinical research funding for tuberculosis.
        Subtitle I--Osteoarthritis and Musculoskeletal Diseases

Sec. 7401. Findings.
Sec. 7402. Osteoarthritis and other musculoskeletal health-related 
                            activities of the Centers for Disease 
                            Control and Prevention.
Sec. 7403. Grants for comprehensive osteoarthritis and musculoskeletal 
                            disease health education within health 
                            professions schools.
            Subtitle J--Sleep and Circadian Rhythm Disorders

Sec. 7451. Short title; findings.
Sec. 7452. Sleep and circadian rhythm disorders research activities of 
                            the National Institutes of Health.
Sec. 7453. Sleep and circadian rhythm health disparities-related 
                            activities of the Centers for Disease 
                            Control and Prevention.
Sec. 7454. Grants for comprehensive sleep and circadian health 
                            education within health professions 
                            schools.
Sec. 7455. Report on impact of sleep and circadian health disorders in 
                            vulnerable and racial/ethnic populations.
  Subtitle K--Kidney Disease Research, Surveillance, Prevention, and 
                               Treatment

Sec. 7501. Kidney disease, research, surveillance, prevention, and 
                            treatment.
Sec. 7502. Kidney disease research in minority populations.
Sec. 7503. Kidney disease action plan.
Sec. 7504. Home dialysis and increasing end-stage renal disease 
                            treatment modalities in minority 
                            communities action plan.
Sec. 7505. Increasing kidney transplants in minority populations.
Sec. 7506. Environmental and occupational health programs.
Sec. 7507. Understanding the treatment patterns associated with 
                            providing care and treatment of kidney 
                            failure in minority populations.
Sec. 7508. Improving access in underserved areas.
Sec. 7509. The Jack Reynolds Memorial Medigap Expansion Act; Medigap 
                            coverage for beneficiaries with end-stage 
                            renal disease.
                Subtitle L--Diversity in Clinical Trials

Sec. 7551. FDA review of clinical trial best practices.
Sec. 7552. Diversifying Investigations Via Equitable Research Studies 
                            for Everyone Trials Act.
Sec. 7553. Clinical trial diversity.
Sec. 7554. Patient experience data.
   Subtitle M--Additional Provisions Addressing High Impact Minority 
                                Diseases

Sec. 7601. Medicare coverage of multi-cancer early detection screening 
                            tests.
Sec. 7602. Amputation Reduction and Compassion Act.
Sec. 7603. Eliminating the coinsurance requirement for certain 
                            colorectal cancer screening tests furnished 
                            under the Medicare program.
Sec. 7604. Expanding the availability of medical nutrition therapy 
                            services under the Medicare program.
Sec. 7605. Encouraging the development and use of DISARM antimicrobial 
                            drugs.
Sec. 7606. Treat and Reduce Obesity Act.
Sec. 7607. 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 communities.
Sec. 8103. Nondiscrimination and health equity in health information 
                            technology.
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 racial 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 minority-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 
                            facilities, long-term care facilities, and 
                            home health agencies.
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 services and research on the basis of 
                            sex (including sexual orientation, 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. Findings.
Sec. 10003. Health impact assessments.
Sec. 10004. Grant program to conduct environmental health improvement 
                            activities and to improve social 
                            determinants of health.
Sec. 10005. Additional research on the relationship between the built 
                            environment and the health of community 
                            residents.
Sec. 10006. Environment and public health restoration.
Sec. 10007. GAO report on health effects of Deepwater Horizon oil rig 
                            explosion in the Gulf Coast.
Sec. 10008. Establish an interagency counsel and grant programs on 
                            social determinants of health.
Sec. 10009. Correcting Hurtful and Alienating Names in Government 
                            Expression (CHANGE).
Sec. 10010. Andrew Kearse Accountability for Denial of Medical Care.
Sec. 10011. Investing in community healing.
Sec. 10012. Environmental justice mapping and data collection.
Sec. 10013. Antiracism in public health.
Sec. 10014. LGBTQ essential data.
Sec. 10015. Social determinants accelerator.
Sec. 10016. Improving social determinants of health.
                        Subtitle B--Gun Violence

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.

SEC. 3. FINDINGS.

    The Congress finds as follows:
            (1) The population of racial and ethnic minorities is 
        expected to increase over the next few decades, yet racial and 
        ethnic minorities have the poorest health status and face 
        substantial cultural, social, and economic barriers to 
        obtaining high-quality health care.
            (2) Health disparities are a function of not only access to 
        health care, but also the social determinants of health--
        including the environment, the physical structure of 
        communities, nutrition and food options, educational 
        attainment, employment, race, ethnicity, sex, geography, 
        language preference, immigrant or citizenship status, sexual 
        orientation, gender identity, socioeconomic status, or 
        disability status--that directly and indirectly affect the 
        health, health care, and wellness of individuals and 
        communities.
            (3) Over the next few decades, the United States will face 
        a shortage of health care providers and allied health workers.
            (4) All efforts to reduce health disparities and barriers 
        to high-quality health services require better and more 
        consistent data, and better and more consistent collection of 
        and access to data.
            (5) A full range of culturally and linguistically 
        appropriate health care and public health services must be 
        available and accessible in every community.
            (6) Racial and ethnic minorities and underserved 
        populations must be included early and equitably in health 
        reform innovations.
            (7) Efforts to improve minority health have been limited by 
        inadequate resources in funding, staffing, stewardship, and 
        accountability. Targeted investments that are focused on 
        disparities elimination must be made in providing care and 
        services that are community-based, including prevention and 
        policies addressing social determinants of health.
            (8) In 2011, the Department of Health and Human Services 
        developed the HHS Action Plan to Reduce Racial and Ethnic 
        Health Disparities and the National Stakeholder Strategy for 
        Achieving Health Equity, which are 2 strategic plans that 
        represent the first coordinated roadmap in the United States to 
        reducing health disparities. These comprehensive plans, along 
        with the National Prevention Strategy issued by the National 
        Prevention Council of the Department of Health and Human 
        Services, Healthy People 2030, and the National Quality 
        Strategy of the Agency for Healthcare Research and Quality, as 
        well as critical resources such as the 2012 National Healthcare 
        Quality and Disparities Reports, will work to increase the 
        number of people in the United States who are healthy at every 
        stage of life.
            (9) The Secretary of Health and Human Services has also 
        reviewed and advanced updated clinical guidelines and developed 
        other strategic planning documents to combat health disparities 
        with a high impact on minority populations and to provide high-
        quality family planning services. Such guidelines and documents 
        include the National HIV/AIDS Strategy, the Action Plan for the 
        Prevention, Care, and Treatment of Viral Hepatitis, and 
        recommendations of the Centers for Disease Control and 
        Prevention and the Office of Population Affairs.
            (10) The Patient Protection and Affordable Care Act (Public 
        Law 111-148), as amended by the Health Care and Education 
        Reconciliation Act (Public Law 111-152), represents the biggest 
        advancement for minority health in the 40 years immediately 
        preceding the enactment of this Act.
            (11) The Health Information Technology for Educational and 
        Clinical Health Act of 2009, part of the American Recovery and 
        Reinvestment Act of 2009 (Public Law 111-5), provides that the 
        nationwide health information exchange infrastructure be 
        developed and used to reduce health disparities, among other 
        purposes.

                 TITLE I--DATA COLLECTION AND REPORTING

SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROVING DATA ANALYSIS, AND 
              EXPANDING DATA REPORTING.

    (a) Amendments to the Public Health Service Act.--
            (1) Purpose.--The purpose of the amendments made by this 
        subsection is to promote culturally and linguistically 
        appropriate data collection, analysis, and reporting by race, 
        ethnicity, sex, primary 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;
                    (B) in paragraph (9), by striking the period 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) Office of minority health.--Section 1707(g)(1) of the 
        Public Health Service Act (42 U.S.C. 300u-6(g)(1)) is amended 
        by inserting ``Middle Easterners and North Africans;'' after 
        ``Blacks;''.
            (4) 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 following:
            ``(12) ensures the interoperability of health information 
        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 
                        ensuring the provision of equitable health 
                        services; improving public health; increasing 
                        prevention and coordination with community 
                        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.''.
            (5) Data collection, analysis, and quality.--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 inserting ``sexual orientation, 
                gender identity, age,'' before ``and disability 
                status'';
                    (B) in subsection (a)(1), by amending subparagraph 
                (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 inserting 
                                        ``is a minor, requires 
                                        assistance with communication 
                                        in speech or writing, or is 
                                        legally incapacitated''; and
                                            (bb) by striking the 
                                        semicolon at the end and 
                                        inserting ``; and''; and
                                    (III) by adding at the end the 
                                following:
                            ``(iii) collects data in a manner that is 
                        culturally and linguistically appropriate;'';
                            (ii) in subparagraph (D)(iii), by striking 
                        ``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 following:
                    ``(F) use, where practicable, the standards 
                developed by the Health and Medicine Division of the 
                National Academies of Sciences, Engineering, and 
                Medicine (formerly known as the `Institute of 
                Medicine') in the 2009 publication titled `Race, 
                Ethnicity, and Language Data: Standardization for 
                Health Care Quality Improvement'.''; and
                    (D) in subsection (a)(3), by amending subparagraph 
                (B) to read as follows:
                    ``(B) develop interoperability and security systems 
                for data management among federally conducted and 
                supported health care and public health programs, State 
                health agencies, and social service agencies.''.
    (b) Corollary Provisions.--
            (1) Recommendations by the data council.--The Data Council 
        of the Department of Health and Human Services, in consultation 
        with the Director of the National Center for Health Statistics, 
        the Deputy Assistant Secretary for Minority Health, the Deputy 
        Assistant Secretary for Women's Health, the Administrator of 
        the Centers for Medicare & Medicaid, the head of the Office of 
        the National Coordinator for Health Information Technology, and 
        other appropriate 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 administrative burdens of 
                data collection and reporting 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 collection, analysis, and 
                reporting by race, ethnicity, sex, primary language, 
                sexual orientation, gender identity, age, socioeconomic 
                status, and disability status is legal and necessary to 
                ensure equity and nondiscrimination in the quality of 
                health care services;
                    (C) ensure that future patient record systems 
                follow Federal standards promulgated under the HITECH 
                Act (42 U.S.C. 201 note) for the collection and 
                meaningful use of electronic health data on race, 
                ethnicity, sex, primary language, sexual orientation, 
                gender identity, 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, including exploring the feasibility of 
                enhancing collection efforts in States, counties, and 
                municipalities 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 
                orientation, gender identity, age, socioeconomic 
                status, and disability status data, subject to all 
                applicable privacy and confidentiality requirements, 
                including HIPAA privacy and security law as defined in 
                section 3009 of the Public Health Service Act (42 
                U.S.C. 300jj-19);
                    (F) ensure the cultural and linguistic competence 
                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)(5).
            (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 information; or
                    (B) diminish any requirements on health care 
                providers to collect data, including such requirements 
                in effect on or after the date of enactment of this 
                Act.
            (3) Technical assistance for the analysis of health 
        disparity data.--The Secretary of Health and Human Services, 
        acting through the Director of the Agency for Healthcare 
        Research and Quality, and in coordination with the Assistant 
        Secretary for Planning and Evaluation, the Administrator of the 
        Centers for Medicare & Medicaid Services, the Director of the 
        National Center for Health Statistics, the Director of the 
        National Institutes of Health, and the head of the Office of 
        the National Coordinator for Health Information Technology, 
        shall provide technical assistance 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 assurance 
                mechanisms to monitor for health disparities;
                    (B) specifying the clinical, diagnostic, or 
                therapeutic measures which should be monitored;
                    (C) developing new quality measures relating to 
                racial and ethnic disparities and their 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 organizations for 
                research and quality improvement purposes; and
                    (F) identifying and addressing issues relating to 
                the interoperability of Federal- and State-level health 
                information systems which undermine the ability of 
                health-related programs collecting data under this 
                section to achieve the purpose described in subsection 
                (a)(1).
            (4) References.--Except as otherwise specified, any 
        reference to the term ``racial and ethnic minority group'' in 
        any Federal regulation, guidance, order, or document for 
        establishment or implementation of any federally conducted or 
        supported health care or public health program, activity, or 
        survey shall be treated as having the definition given to such 
        term in section 1707(g) of the Public Health Service Act (42 
        U.S.C. 300u-6(g)).
            (5) Authorization of appropriations.--To carry out this 
        subsection, subsection (a), and the amendments made by 
        subsection (a), there are authorized to be appropriated such 
        sums as may be necessary for each of fiscal years 2023 through 
        2027.
    (c) Additions 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:

 ``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 
National Institutes of Health, the Assistant Secretary for Planning and 
Evaluation, the head of the Office of 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 of the Public 
Health Service Act.
    ``(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 orientation, sex, gender 
        identity, socioeconomic status, and disability status data;
            ``(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 collected data 
        subject to any applicable privacy and confidentiality 
        regulations;
            ``(4) develop educational programs to inform health plans, 
        health providers, health-related agencies, and the general 
        public that data collection and reporting by race, ethnicity, 
        primary language, sexual orientation, sex, gender identity, 
        disability status, 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 care organization, or 
health plan making a demonstrated effort to bring data collections into 
compliance with section 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 2023 through 2027.

``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 Department of Health and Human 
        Services as the Secretary determines appropriate, shall develop 
        and implement a sustainable national strategy for oversampling 
        underrepresented populations within the categories of race, 
        ethnicity, sex, primary language, sexual orientation, 
        disability status, gender identity, and socioeconomic status as 
        determined appropriate by the Secretary in Federal health 
        surveys and program data collections. Such national strategy 
        shall include a strategy for oversampling of Middle Easterners 
        and North Africans, Asian Americans, Native Hawaiians, and 
        Pacific Islanders.
            ``(2) Consultation.--In developing and implementing a 
        national strategy, as described in paragraph (1), not later 
        than 180 days after the date of the enactment of this section, 
        the Secretary shall--
                    ``(A) consult with representatives of community 
                groups, nonprofit organizations, nongovernmental 
                organizations, and government agencies working with 
                underrepresented populations;
                    ``(B) solicit the participation of representatives 
                from other Federal departments and agencies, including 
                subagencies of the Department of Health and Human 
                Services; and
                    ``(C) consult on, and use as models, the 2014 
                National Health Interview Survey oversample 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 System 
                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 include the national strategy required by 
subsection (a)(1).
    ``(c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2027.''.

SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT APPROPRIATIONS 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 PROGRAM.

    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:

             ``collection of data for the medicare program

    ``Sec. 1150D. 
    ``(a) Requirement.--
            ``(1) In general.--The Commissioner of Social Security, in 
        consultation with the Administrator of the Centers for Medicare 
        & Medicaid Services, shall collect data on the race, ethnicity, 
        sex, primary language, sexual orientation, gender identity, 
        socioeconomic status, and disability status of all applicants 
        for Social Security benefits under title II or Medicare 
        benefits under title XVIII.
            ``(2) Data collection standards.--In collecting data under 
        paragraph (1), the Commissioner of Social Security shall at 
        least use the standards for data collection developed under 
        section 3101 of the Public Health Service Act or the standards 
        developed by the Office of Management and Budget, whichever is 
        more disaggregated. In the event there are no standards for the 
        demographic groups listed under paragraph (1), the Commissioner 
        shall consult with stakeholder groups representing the various 
        identities as well as with the Office of Minority Health within 
        the Centers for Medicare & Medicaid Services to develop 
        appropriate standards.
            ``(3) Data for additional population groups.--Where 
        practicable, the information collected by the Commissioner of 
        Social Security under paragraph (1) shall include data for 
        additional population groups if such groups can be aggregated 
        into the race and ethnicity categories outlined by the data 
        collection standards described in paragraph (2).
            ``(4) Collection of data for minors and legally 
        incapacitated individuals.--With respect to the collection of 
        the data described in paragraph (1) of applicants who are under 
        18 years of age or otherwise legally incapacitated, the 
        Commissioner of Social Security shall require that--
                    ``(A) such data be collected from the parent or 
                legal guardian of such an applicant; and
                    ``(B) the primary language of the parent or legal 
                guardian of such an applicant or recipient be used in 
                collecting the data.
            ``(5) Quality of data.--The Commissioner of Social Security 
        shall periodically review the quality and completeness of the 
        data collected under paragraph (1) and make adjustments as 
        necessary to improve both.
            ``(6) Transmission of data.--Upon enrollment in Medicare 
        benefits under title XVIII, the Commissioner of Social Security 
        shall transmit an individual's demographic data as collected 
        under paragraph (1) to the Centers for Medicare & Medicaid 
        Services.
            ``(7) Analysis and reporting of data.--With respect to data 
        transmitted under paragraph (5), the Administrator of the 
        Centers for Medicare & Medicaid Services, in consultation with 
        the Commissioner of Social Security 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 analysis 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 researchers, 
                under the protections outlined in paragraph (7);
                    ``(D) provide opportunities to individuals enrolled 
                in Medicare to submit updated data; and
                    ``(E) ensure that the provision of assistance 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 Commissioner of Social 
        Security shall ensure (through the promulgation of regulations 
        or otherwise) that all data collected pursuant to subsection 
        (a) 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 Accountability 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 determinations 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 section shall be 
construed to permit the use of information collected under this section 
in a manner that would adversely affect any individual providing any 
such information.
    ``(c) Technical Assistance.--The Secretary of Health and Human 
Services may, either directly or by grant or contract, provide 
technical assistance to enable any entity to comply with the 
requirements 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 million for 2022 and $100 
million 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 race, ethnicity, and primary language in a health-related 
transaction) to require--
            (1) the use, at a minimum, of standards for data collection 
        on race, ethnicity, primary language, disability, sex, sexual 
        orientation, gender identity, and socioeconomic status 
        developed under section 3101 of the Public Health Service Act 
        (42 U.S.C. 300kk); and
            (2) in consultation with the Office of the National 
        Coordinator for Health Information Technology, 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 developed 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 standards.

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 
        ``2024'';
            (2) in paragraph (2), in the first sentence, by striking 
        ``2003'' and inserting ``2024''; and
            (3) in paragraph (3), by striking ``2002'' and inserting 
        ``2024''.

SEC. 1006. DISPARITIES DATA COLLECTED BY THE FEDERAL GOVERNMENT.

    (a) Repository of Government Data.--The Secretary of Health and 
Human Services, in coordination with the officials referenced in 
subsection (b), shall establish a centralized electronic repository of 
Government 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 
orientation, disability status, gender identity, age, or socioeconomic 
status during the preceding calendar year shall submit such data to the 
repository of Government data established under subsection (a).
    (c) Analysis; Public Availability; Reporting.--Not later than April 
30, 2021, 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 Director of the 
Agency for Healthcare Research and Quality, 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 Minority Health and Health Disparities, and the Deputy 
Assistant 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 outcomes, public health, the 
        provision of equitable health services, and other areas of 
        health and well-being by factors that include race, ethnicity, 
        sex, primary language, sexual orientation, disability status, 
        gender identity, and socioeconomic status;
            (2) ensure that these datasets are publicly identified 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 stakeholders.

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 National Institute on Minority Health and 
Health Disparities and the Deputy Assistant Secretary for Minority 
Health, 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 reduce and eliminate disparities in 
health and health care.
    (b) Eligible Entity.--In this section, the term ``eligible entity'' 
means an entity that has an accredited public health, health policy, or 
health services research program 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 fiscal years 2023 through 2027.

SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL AND 
              ETHNIC BACKGROUND.

    (a) In General.--Chapter V of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 351 et seq.) is amended 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 BACKGROUND.

    ``(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 evidence 
        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 subparagraph (A) 
        or (B) of paragraph (1) confirm that there is such a disparity, 
        the labeling of the drug or biological product shall include 
        appropriate information about the disparity.
    ``(b) Postmarket Studies.--
            ``(1) In general.--If there is evidence of a racial or 
        ethnic disparity in safety or effectiveness with respect to a 
        drug for which there is an approved application under section 
        505 of this Act or of a biological product for which there is 
        an approved license 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 appropriate 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, including the number of studies and study 
        participants, and the other demographic characteristics of the 
        study participants.
            ``(4) Modifications of study design.--The Secretary may, by 
        order and as necessary, modify any aspect of the design of a 
        postmarket study required in an order under paragraph (1) after 
        issuing such order.
            ``(5) Study results.--The results from a study required 
        under paragraph (1) shall be submitted 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 application 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 information relating to a disparity on the basis 
        of racial or ethnic background as to the safety or 
        effectiveness of the drug, whether derived from investigations 
        or studies required under this section or derived from other 
        sources, when the omitted information 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 information relating to a 
        disparity on the basis of racial or ethnic background as to the 
        safety or effectiveness of the drug include a statement of any 
        appropriate contraindications, warnings, or precautions related 
        to the disparity that the Secretary considers necessary.
    ``(d) Definition.--In this section, the term `evidence of a racial 
or ethnic disparity in safety or effectiveness', with respect to a drug 
or biological product, includes--
            ``(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 product;
            ``(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 determine 
        appropriate.''.
    (b) Enforcement.--Section 502 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 352) is amended by adding at the end the 
following:
    ``(gg) If it is a drug and the holder of the approved application 
under section 505 or license under section 351 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 section 317U the following:

``SEC. 317V. NATIVE HAWAIIAN AND PACIFIC ISLANDER HEALTH DATA.

    ``(a) Definitions.--In this section:
            ``(1) Insular area.--The term `insular area' means Guam, 
        the Commonwealth of Northern Mariana Islands, American Samoa, 
        the United States Virgin Islands, the Federated States of 
        Micronesia, the Republic of Palau, or the Republic of the 
        Marshall Islands.
            ``(2) Native hawaiians and pacific islanders (nhpi).--The 
        term `Native Hawaiians and Pacific Islanders' or `NHPI' means 
        people having origins 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 following:
                    ``(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 demonstrated history of addressing 
                NHPI issues, including a NHPI coalition.
                    ``(C) Designated organization.--An entity 
                established to represent NHPI populations and which has 
                statutory responsibilities to provide, or has community 
                support for providing, health care.
                    ``(D) Government representatives of nhpi 
                populations.--Representatives from 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 Marshall 
                Islands.
    ``(b) Preliminary Health Survey.--
            ``(1) In general.--The Secretary, acting through the 
        Director of 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 Marshall 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 implementing the 
                national strategy under subsection (c).
            ``(3) Methodology.--Methodology for the health survey 
        described in paragraph (1), including plans for designing 
        questions, implementation, sampling, and analysis, shall be 
        developed in consultation 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 2022.
    ``(c) National Strategy.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the National Center for Health Statistics (referred 
        to in this section as `NCHS') of the Centers for Disease 
        Control and Prevention, and other agencies 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 Northern Mariana Islands, the 
        Federated States of Micronesia, Guam, the Republic of Palau, 
        and the Republic of the Marshall Islands.
            ``(2) Consultation.--In developing and implementing a 
        national strategy, as described in paragraph (1), not later 
        than 180 days after the date of enactment of the Health Equity 
        and Accountability Act of 2022, the Secretary--
                    ``(A) shall consult with representatives of NHPI 
                stakeholder groups; and
                    ``(B) may solicit the participation of 
                representatives from other Federal agencies.
    ``(d) Progress Report.--Not later than 2 years after the date of 
enactment of the Health Equity and Accountability Act of 2022, the 
Secretary shall submit to Congress a progress report, which shall 
include the national strategy described in subsection (c)(1).
    ``(e) Study and Report by the Health and Medicine Division.--
            ``(1) In general.--The Secretary shall enter into an 
        agreement with the Health and Medicine 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 insular areas and the 
                appropriateness of such standards and definitions.
                    ``(B) The status and performance of health care 
                systems in insular areas, evaluated based upon 
                standards and definitions, as the Secretary determines 
                appropriate.
                    ``(C) The effectiveness of donor aid in addressing 
                health care needs and priorities in insular areas.
                    ``(D) The progress toward implementation of 
                recommendations of the Committee on Health Care 
                Services in the United States--Associated 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 enactment of the Health Equity and Accountability 
        Act of 2022, a report containing a description of the results 
        of the study conducted under paragraph (1), including 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 appropriated such sums as may be necessary 
for fiscal years 2023 through 2027.''.

SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE 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 requirement under paragraph (2) of section 
        421(e) of the Personal Responsibility and Work Opportunity 
        Reconciliation Act of 1996 (8 U.S.C. 1631(e)), notwithstanding 
        the requirement to include in that notification 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 exceptions 
        granted by the State agency under paragraph (1) of that 
        section.''.

SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PREPAREDNESS, TESTING, 
              INFECTIONS, AND DEATHS.

    (a) Skilled Nursing Facilities Quality Reporting.--Section 1819 of 
the Social Security Act (42 U.S.C. 1395i-3) is amended by adding at the 
end the following new subsection:
    ``(l) Requirements Relating to Reporting During 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 one 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 Regulations.
            ``(2) The age, race, ethnicity, sex, sexual orientation, 
        gender identity, socioeconomic status, disability status, and 
        preferred language of the residents of such skilled nursing 
        facility.''.
    (b) Transparency of Demographic Information in Certain Settings.--
            (1) Demographic information.--The Secretary 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, 
        assisted living facilities, prisons and jails, residential 
        behavioral health care and psychiatric facilities, and 
        facilities providing services for aging adults and people with 
        disabilities), and nursing facilities (as defined 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 the Social 
        Security Act (42 U.S.C. 1395i-3(i))), or a successor website, 
        aggregated by State:
                    (A) The age, race, ethnicity, sex, sexual 
                orientation, gender identity, socioeconomic status, 
                disability status, and preferred language of the 
                residents of such skilled nursing facilities, 
                congregate care settings (including skilled nursing 
                facilities, assisted living facilities, prisons and 
                jails, residential behavioral health care and 
                psychiatric facilities, and facilities providing 
                services for aging adults and people with 
                disabilities), and nursing facilities with suspected or 
                confirmed infections, including residents previously 
                treated for COVID-19.
                    (B) The age, race, ethnicity, sex, sexual 
                orientation, gender identity, socioeconomic status, 
                disability status, and preferred language relating to 
                total deaths and public health emergency-related deaths 
                among residents of such skilled nursing facilities, 
                congregate settings (including skilled nursing 
                facilities, assisted living facilities, prisons and 
                jails, residential behavioral health care and 
                psychiatric facilities, and facilities providing 
                services for aging adults and people with 
                disabilities), and nursing facilities.
            (2) Confidentiality.--Any information reported under this 
        subsection that is made available to the public shall be made 
        so available in a manner that protects the identity of 
        residents of skilled nursing facilities, congregate care 
        settings (including skilled nursing facilities, assisted living 
        facilities, prisons and jails, residential behavioral health 
        care and psychiatric facilities, and facilities providing 
        services for aging adults and people with disabilities), and 
        nursing facilities.
            (3) Implementation.--The Secretary 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 section 1003, is further amended by adding at the end the 
following new section:

``SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLOSURE 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 otherwise exists, subject to the succeeding 
subsections, the Secretary, acting through the Director of the Centers 
for Disease Control and Prevention and the Administrator of the Centers 
for Medicare & Medicaid Services and in consultation 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 Centers for Medicare & Medicaid Services, and update every day 
during a pandemic, data collected across all surveillance systems 
relating to a public health emergency declared under section 319 of the 
Public Health Service Act that is caused by a disease (as determined by 
the Secretary), disaggregated by race, ethnicity, sex, sexual 
orientation, gender identity, age, preferred language, socioeconomic 
status, disability status, and county, including the following:
            ``(1) Data relating to all testing for the pathogen 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 pathogen causing 
        the pandemic, including hospitalizations and intensive care 
        unit admissions.
            ``(3) Data relating to pandemic outcomes, including total 
        fatalities and case fatality rates (expressed as the proportion 
        of individuals who were infected with the pathogen causing the 
        pandemic and died from the pathogen).
            ``(4) In the case a vaccine is developed in response to a 
        pandemic, data relating to such vaccination, including--
                    ``(A) the number of vaccines administered;
                    ``(B) the number of vaccinations offered, accepted, 
                and refused;
                    ``(C) the most common reasons for refusal; and
                    ``(D) the percentage of vaccine doses allocated and 
                administered to each priority group.
    ``(b) Application of Certain Standards With Respect to Data 
Collection.--To the extent practicable, data collected under subsection 
(a) shall follow standards developed by the Department of Health and 
Human Services Office of Minority Health and be collected, 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 subsection (a), the 
Secretary shall take all necessary steps to protect the privacy of 
individuals whose information is included in such data, including--
            ``(1) complying with privacy protections provided under the 
        regulations promulgated under section 264(c) of the Health 
        Insurance and Accountability 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 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 summary of the 
        final statistics related to such emergency.
            (2) Report to congress.--Not later than 60 days after the 
        date on which the Secretary certifies that a public health 
        emergency declared under section 319 of the Public Health 
        Service Act has ended, the Secretary shall submit 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 
                language of patients associated with the pandemic 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 settings 
                (including skilled nursing facilities, assisted living 
                facilities, prisons and jails, residential behavioral 
                health care and psychiatric facilities, and facilities 
                providing services for aging adults and people with 
                disabilities) and noncongregate care settings (as such 
                terms are defined by the Secretary); and
                    (B) proposing evidenced-based response strategies 
                to safeguard the health of these communities 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 ``Secretary'') shall establish a commission, to be 
known as the ``Commission on Ensuring Data for Health Equity'' 
(referred to in this section as the ``Commission'') to provide clear 
and robust guidance to improve the collection, analysis, 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 Preparedness 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 Resources and 
                Services Administration;
                    (L) the Director of the Office of Minority Health;
                    (M) the Director of the Office of Women's Health;
                    (N) the Chairperson of the National Council on 
                Disability;
                    (O) at least 4 State, local, territorial, and 
                Tribal public health officials representing departments 
                of public health, or an Urban Indian health 
                representative, who shall represent jurisdictions 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 
                representation 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, language, ability, 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 promote health 
        equity across the United States and reduce racial, Tribal, and 
        other demographic disparities in health outcomes;
            (3) gather available data related to treatment of 
        individuals with disabilities during the COVID-19 pandemic and 
        other public health emergencies, including access to 
        vaccinations, denial of treatment for preexisting conditions, 
        removal or denial of disability related equipment (including 
        ventilators and continuous positive airway pressure (commonly 
        referred to as CPAP) machines), and data on completion of do-
        not-resuscitate orders, and 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 providers, State and local 
        agency officials, Tribal officials, and other experts on 
        barriers to, and best practices for, collecting demographic 
        data; and
            (5) recommend policy changes that the data indicates are 
        necessary to reduce demographic disparities 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 disparities in 
                COVID-19 mortality, including an analysis 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 disparately 
                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 individuals with 
        disabilities, including equity of access to treatment and 
        equipment and intersections of disability status with other 
        demographic factors, including 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 respect to--
                    (A) how to enhance State, local, territorial, and 
                Tribal capacity to conduct public health research on 
                COVID-19 and in future public health emergencies, with 
                a focus on expanded capacity to analyze data on 
                disparities correlated with race, ethnicity, income, 
                sex, sexual orientation, gender identity, age, 
                disability status, specific geographic areas, and other 
                relevant 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;
                    (C) how to improve demographic data collection 
                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 information concerning urban and rural Tribal 
                communities;
                    (D) how to improve transparency and equity of 
                treatment for individuals with disabilities during the 
                COVID-19 public health emergency and future 
                emergencies; and
                    (E) how to support State, local, and Tribal 
                capacity to eliminate barriers to vaccinations, 
                testing, and treatment during the COVID-19 pandemic and 
                future public health emergencies.
    (e) Staff of Commission.--
            (1) Additional staff.--The Chairperson of the Commission 
        may appoint and fix the pay of additional staff to the 
        Commission as the Chairperson considers appropriate.
            (2) Applicability of certain civil service laws.--The staff 
        of the Commission may be appointed without regard to the 
        provisions of title 5, United States Code, governing 
        appointments in the 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 employee 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 
        interruption.
    (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 ``Secretary'') shall establish a Task Force to be 
known as the ``Task Force on Preventing AI and Algorithmic Bias in 
Healthcare'' (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 expands access to health care services.
    (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;
                    (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 Resources and 
                Services Administration;
                    (L) the Director of the Office of Minority Health;
                    (M) the Director of the Office of Women's Health;
                    (N) the Chairperson of the National Council on 
                Disability;
                    (O) the National Coordinator for Health Information 
                Technology;
                    (P) at least 4 State, local, territorial, and 
                Tribal public health officials representing departments 
                of public health, or an Urban Indian health 
                representative, who shall represent jurisdictions from 
                different regions of the United States with relatively 
                high concentrations of historically marginalized 
                populations, to be appointed by the Secretary;
                    (Q) at least 3 independent individuals with 
                expertise on racially and ethnically diverse 
                representation 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, language, ability, sex, 
                sexual orientation, gender identity, or socioeconomic 
                status.
            (2) Chairperson.--The Chief Information Officer of the 
        Department of Health and Human Services (or the Chief 
        Information Officer's designee) shall serve as the Chairperson 
        of the Task Force.
    (c) Duties.--The Task Force shall--
            (1) examine where to place artificial intelligence and 
        algorithms in the health care service delivery process relative 
        to the use of autonomous human decision-makers;
            (2) identify the risks of health care system utilization of 
        artificial intelligence and algorithms in terms of civil 
        rights, civil liberties, and discriminatory bias in health care 
        access, quality, and outcomes; and
            (3) prepare and submit the report under subsection (d).
    (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 paragraph (1) and recommendations to Congress 
        with respect to implementation of artificial intelligence and 
        algorithms in health care delivery and mitigation of the risks 
        associated 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 
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 additional 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 appointed without regard to the 
        provisions of title 5, United States Code, governing 
        appointments in the 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 employee may be 
        detailed to the Task Force without reimbursement from the Task 
        Force, and the detailee shall retain the rights, status, and 
        privileges of his or her regular employment without 
        interruption.

 TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH 
                                  CARE

SEC. 2001. DEFINITIONS; FINDINGS.

    (a) Definitions.--In this title, the definitions in section 3400 of 
the Public Health Service Act, as added by section 2004, shall apply.
    (b) Findings.--Congress finds the following:
            (1) Effective communication is essential to meaningful 
        access to quality physical and mental health care.
            (2) Research indicates that the lack of appropriate 
        language services creates language barriers that result in 
        increased risk of misdiagnosis, ineffective treatment plans, 
        and poor health outcomes for individuals with limited English 
        proficiency and individuals with communication disabilities 
        such as cognitive, hearing, vision, or print impairments.
            (3) The number of limited English speaking residents in the 
        United States who speak English less than very well and, 
        therefore, cannot effectively communicate with health and 
        social service providers continues to increase significantly.
            (4) The responsibility to fund language services in the 
        provision of health care and health care-related services to 
        individuals with limited English proficiency and individuals 
        with communication disabilities such as cognitive hearing, 
        vision, or print impairments is a societal one that cannot 
        fairly be placed solely upon the health care, public health, or 
        social services community.
            (5) Title VI of the Civil Rights Act of 1964 (42 U.S.C. 
        2000d et seq.) prohibits discrimination based on the grounds of 
        race, color, or national origin by any entity receiving Federal 
        financial assistance. In order to avoid discrimination on the 
        grounds of national origin, all programs or activities 
        administered by the Federal Government must take adequate steps 
        to ensure that their policies and procedures do not deny or 
        have the effect of denying individuals with limited English 
        proficiency with equal access to benefits and services for 
        which such persons qualify.
            (6) Both the Americans with Disabilities Act of 1990 (42 
        U.S.C. 12101 et seq.) and the Rehabilitation Act of 1973 (29 
        U.S.C. 701 et seq.) prohibit discrimination on the basis of 
        disability and require the provision of appropriate auxiliary 
        aids and services necessary to ensure effective communication 
        with individuals with disabilities. The type of auxiliary aid 
        or service necessary to ensure effective communication will 
        vary in accordance with the method of communication used by the 
        individual; the nature, length, and complexity of the 
        communication involved; and the context in which the 
        communication is taking place. A public accommodation should 
        consult with individuals with disabilities whenever possible to 
        determine what type of auxiliary aid is needed to ensure 
        effective communication. The public accommodation should use 
        the individual's preferred method of communication whenever 
        possible, unless it would be an undue burden to the public 
        accommodation and an alternative would provide an equally 
        effective means of communication. The ultimate decision as to 
        what measures to take rests with the public accommodation, 
        provided that the method chosen results in effective 
        communication.
            (7) Section 1557 of the Patient Protection and Affordable 
        Care Act (42 U.S.C. 18116) builds on title VI of the Civil 
        Rights Act of 1964 (42 U.S.C. 2000d et seq.) and section 504 of 
        the Rehabilitation Act of 1973 (29 U.S.C. 794), prohibits 
        discrimination on the basis of race, color, national origin, 
        disability, sex, and age, requires the provision of language 
        services to ensure effective communication with individuals 
        with limited English proficiency, and requires the provision of 
        appropriate auxiliary aids and services necessary to ensure 
        effective communication with individuals with disabilities.
            (8) Linguistic diversity in the health care and health 
        care-related services workforce is important for providing all 
        patients the environment most conducive to positive health 
        outcomes.
            (9) All members of the health care and health care-related 
        services community should continue to educate their staff and 
        constituents about limited English proficient and disability 
        communication issues and help them identify resources to 
        improve access to quality care for individuals with limited 
        English proficiency and individuals with communication 
        disabilities such as cognitive, hearing, vision, or print 
        impairments.
            (10) Access to English as a second language, foreign 
        language, and sign language interpreters, translated and 
        alternative format documents, readers, and other auxiliary aids 
        and services, are essential to ensure effective communication 
        and eliminate the language barriers that impede access to 
        health care.
            (11) Culturally competent language services in health care 
        settings should be available as a matter of course.

SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS 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 regarding 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 fundamental mission of the agency;
            (3) to require each Federal agency to translate any English 
        language written material prepared for the general public 
        relating to a public health emergency, including vaccine 
        distribution and education, into the top 15 non-English 
        languages in the United States (according to the most recent 
        data from the American Community Survey or its replacement) not 
        later than 7 days after any such material is made available in 
        English;
            (4) to require each Federal agency to ensure that 
        recipients of Federal financial assistance provide culturally 
        competent services and meaningful access to applicants and 
        beneficiaries who are individuals with limited English 
        proficiency;
            (5) to ensure that recipients of Federal financial 
        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 culturally 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 Affordable Care Act (42 U.S.C. 18116) 
        (prohibiting health care providers and organizations from 
        discriminating in the provision of services).
    (b) Federally Conducted Programs and Activities.--
            (1) In general.--Not later than 120 days after the date of 
        enactment of this Act, each Federal agency providing financial 
        assistance to, or administering, a health program or activity 
        described in section 2003(a) shall prepare a plan or update a 
        plan to improve culturally and linguistically appropriate 
        access to such program or activity with respect to individuals 
        with limited English proficiency. Not later than 1 year after 
        the date of enactment of this title, 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 ensure that 
                individuals with limited English proficiency have 
                access to each health program or activity supported or 
                administered by the agency;
                    (B) the policies and procedures for identifying, 
                assessing, and meeting the culturally and 
                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 linguistically 
                appropriate by--
                            (i) providing a range of language 
                        assistance options;
                            (ii) giving notice to individuals with 
                        limited English proficiency of the right to 
                        competent language services;
                            (iii) training staff (at least annually); 
                        and
                            (iv) monitoring and assessing the quality 
                        of the language services (at least annually);
                    (D) the steps the agency will take for such program 
                or activity to provide reasonable accommodations 
                necessary for individuals with limited English 
                proficiency, including those individuals with a 
                communication disability, to understand communications 
                from the agency;
                    (E) the steps the agency will take to ensure that 
                applications, forms, and other significant 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 
                materials 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 appropriateness to 
                assist recipients of Federal funds to improve access to 
                health care-related programs and activities for 
                individuals with limited English proficiency;
                    (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 children, and friends 
                are not used to provide interpretation services, except 
                as permitted under section 1557 of the Patient 
                Protection and Affordable Care Act (42 U.S.C. 18116); 
                and
                    (I) the steps the agency will take and resources 
                the agency will provide to ensure that individuals know 
                their rights, including the ability to file a 
                complaint.
            (3) Submission of plan to doj.--Each agency that is 
        required to prepare a plan under paragraph (1) shall--
                    (A) consult with populations who are directly 
                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.

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 financial 
        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 Affordable Care Act (42 U.S.C. 18001 et seq.) 
        (or amendments made thereby).
    (b) Standards.--Each program or activity described 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 culturally and linguistically 
        appropriate health care to patient populations of the service 
        area of the program or activity;
            (2) shall educate and train governance, leadership, and 
        workforce at all levels and across all disciplines of the 
        program or activity in culturally and 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 communication needs, at no cost to the individual at all 
        points of contact, and during all hours of operation, to 
        facilitate 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 constitutes 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 available at a fifth grade reading level--
                    (A) easily understood patient-related materials, 
                including print and multimedia materials, in the 
                language of such language group;
                    (B) information or notices about termination of 
                benefits in such language;
                    (C) signage; and
                    (D) any other documents or types of documents 
                designated by the Secretary;
            (5) shall develop and implement clear goals, policies, 
        operational plans, and management, accountability, 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 activities and integrate valid 
        linguistic, competence-related National Standards for 
        Culturally and Linguistically Appropriate Services (CLAS) 
        measures into the internal audits, performance improvement 
        programs, patient satisfaction assessments, continuous quality 
        improvement activities, and outcomes-based evaluations of the 
        program or activity and develop ways to standardize 
        assessments;
            (7) shall ensure that, consistent with the privacy 
        protections provided for under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (42 U.S.C. 1320-2 note), data on an 
        individual required to be collected pursuant to section 3101, 
        including the individual's alternative format preferences and 
        policy modification needs, are--
                    (A) collected in health records;
                    (B) integrated into the management information 
                systems of the program or activity;
                    (C) reported in such a way as to be interoperable 
                with health information systems at the Federal and 
                State levels; and
                    (D) periodically updated;
            (8) shall maintain a current demographic, cultural, and 
        epidemiological profile of the community, conduct regular 
        assessments of community health assets and needs, and use the 
        results of such assessments to accurately plan for and 
        implement services that respond to the cultural and linguistic 
        characteristics 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 mechanisms to facilitate community and 
        patient involvement in designing, implementing, and evaluating 
        policies and practices to ensure culturally and linguistically 
        appropriate service-related activities;
            (10) shall ensure that conflict and grievance resolution 
        processes are culturally and linguistically appropriate and 
        capable of identifying, preventing, and resolving cross-
        cultural conflicts or complaints by patients;
            (11) shall annually make available to the public 
        information about their progress and successful innovations in 
        implementing the standards under this section, translated 
        materials of such information that is culturally and 
        linguistically appropriate to the communities served under this 
        section, and provide public notice in such communities about 
        the availability of this information; and
            (12) shall, if requested, regularly make available 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 
agency carrying out a program or activity described in subsection (a)--
            (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 submitted 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 APPROPRIATE 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 APPROPRIATE 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) Cultural.--The term `cultural' means relating to 
        integrated patterns of human behavior that include the 
        language, thoughts, communications, actions, customs, beliefs, 
        values, age, and institutions of racial, ethnic, religious, or 
        social groups, including lesbian, gay, bisexual, transgender, 
        queer, and questioning individuals, and individuals with 
        physical and mental disabilities.
            ``(3) Culturally and linguistically appropriate.--The term 
        `culturally and linguistically appropriate' means being 
        respectful of and responsive to the cultural and linguistic 
        needs of all individuals.
            ``(4) Effective communication.--The term `effective 
        communication' means an exchange of information between the 
        provider of health care or health care-related services and the 
        recipient of such services who is limited in English 
        proficiency, or has a communication impairment such as a 
        hearing, vision, speaking, or cognitive disability, that 
        enables access to, understanding of, and benefit from health 
        care or health care-related services, and full participation in 
        the development of their treatment plan.
            ``(5) Grievance resolution process.--The term `grievance 
        resolution process' means all aspects of dispute resolution 
        including filing complaints, grievance and appeal procedures, 
        and court action.
            ``(6) Health care group.--The term `health care group' 
        means a group of physicians organized, at least in part, for 
        the purposes of providing physician 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.
            ``(7) Health care.--The term `health care' includes all 
        health care needed throughout the life cycle and the end of 
        life.
            ``(8) 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.
            ``(9) Health care-related services.--The term `health care-
        related services' means human or social services programs or 
        activities that provide access, referrals, or links to health 
        care services.
            ``(10) Health educator.--The term `health educator' 
        includes a professional with a baccalaureate degree who is 
        responsible for designing, implementing, and evaluating 
        individual and population health promotion, health education 
        (including education on end-of-life care options), end-of-life 
        care, or chronic disease prevention programs.
            ``(11) Indian; indian tribe.--The terms `Indian' and 
        `Indian Tribe' have the meanings given such terms in section 4 
        of the Indian Self-Determination and Education Assistance Act.
            ``(12) Individual with a disability.--The term `individual 
        with a disability' means any individual who has a disability as 
        defined for the purpose of section 504 of the Rehabilitation 
        Act of 1973.
            ``(13) 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'.
            ``(14) 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 care settings (including any skilled 
        nursing facilities, assisted living facilities, prisons and 
        jails, residential behavioral health care and psychiatric 
        facilities, and facilities providing services for aging adults 
        and people with disabilities), ambulatory surgery centers, 
        rehabilitation centers, and employed, independent, or 
        contracted physicians.
            ``(15) 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.
            ``(16) 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.
            ``(17) Language assistance services.--The term `language 
        assistance services' includes--
                    ``(A) oral language assistance, including 
                interpretation in non-English languages provided in-
                person or remotely by a qualified interpreter for an 
                individual with limited English proficiency, and the 
                use of qualified bilingual or multilingual staff to 
                communicate directly with individuals with limited 
                English proficiency;
                    ``(B) written translation, performed by a qualified 
                translator, of written content in paper or electronic 
                form into languages other than English; and
                    ``(C) taglines.
            ``(18) Minority.--
                    ``(A) In general.--The terms `minority' and 
                `minorities' refer to individuals from a minority 
                group.
                    ``(B) Populations.--The term `minority', with 
                respect to populations, refers to racial and ethnic 
                minority groups, members of sexual and gender minority 
                groups, and individuals with a disability.
            ``(19) Minority group.--The term `minority group' means a 
        racial and ethnic minority group as defined in this section.
            ``(20) Onsite interpretation.--The term `onsite 
        interpretation' means a method of interpreting 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 disability.--The term 
        `qualified individual with a disability' means, with respect to 
        a health program or activity, an individual with a disability 
        who, with or without reasonable modifications to policies, 
        practices, or procedures, the removal of architectural, 
        communication, or transportation barriers, or the provision of 
        auxiliary aids and services, meets the essential eligibility 
        requirements for the receipt of aids, benefits, or services 
        offered or provided by the health program or activity.
            ``(22) Qualified interpreter for an individual 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 individual who 
                by means of a remote interpreting service or an onsite 
                appearance--
                            ``(i) adheres to generally accepted 
                        interpreter ethics principles, including client 
                        confidentiality; and
                            ``(ii) is able to interpret effectively, 
                        accurately, and impartially, both receptively 
                        and expressively, using any necessary 
                        specialized vocabulary, terminology, and 
                        phraseology; and
                    ``(B) may include--
                            ``(i) sign language interpreters;
                            ``(ii) oral transliterators, which are 
                        individuals who represent or spell in the 
                        characters of another alphabet; and
                            ``(iii) cued language transliterators, 
                        which are individuals who represent or spell by 
                        using a small number of handshapes.
            ``(23) Qualified interpreter for an individual 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 interpreter 
                ethics principles, including client confidentiality;
                    ``(B) has demonstrated proficiency in speaking and 
                understanding both spoken English and one or more other 
                spoken languages; and
                    ``(C) is able to interpret effectively, accurately, 
                and impartially, both receptively and expressly, to and 
                from such languages and English, using any necessary 
                specialized vocabulary, terminology, and phraseology.
            ``(24) Qualified translator.--The term `qualified 
        translator' means a translator who--
                    ``(A) adheres to generally accepted translator 
                ethics principles, including client confidentiality;
                    ``(B) has demonstrated proficiency in writing and 
                understanding both written English and one or more 
                other written non-English languages; and
                    ``(C) is able to translate effectively, accurately, 
                and impartially to and from such languages and English, 
                using any necessary specialized vocabulary, 
                terminology, and phraseology.
            ``(25) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' means Indians and Alaska Natives, 
        African Americans (including Caribbean Blacks, Africans, and 
        other Blacks), Asian Americans, Hispanics (including Latinos), 
        Middle Easterners and North Africans, and Native Hawaiians and 
        other Pacific Islanders.
            ``(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' encompasses lesbian, gay, bisexual, 
        and transgender populations, as well as those whose sexual 
        orientation, gender identity and expression, or reproductive 
        development varies from traditional, societal, 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 format 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 respect 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 telephone.
            ``(31) Translation.--The term `translation' means the 
        transmission of a written message in one language into a 
        written or signed message in another language, and includes 
        translation into another language or alternative format, such 
        as large print font, Braille, audio recording, or CD.
            ``(32) Underserved communities.--The term `underserved 
        communities' means populations sharing a particular 
        characteristic, as well as geographic communities, who have 
        been systematically denied a full opportunity to participate in 
        aspects of economic, social, and civic life, such as--
                    ``(A) Black, Latino, and Indigenous and Native 
                American persons, Asian Americans and Pacific 
                Islanders, Middle Easterners and North Africans, and 
                other persons of color;
                    ``(B) members of religious minorities;
                    ``(C) lesbian, gay, bisexual, transgender, and 
                queer persons;
                    ``(D) persons with disabilities;
                    ``(E) persons who live in rural areas; and
                    ``(F) persons otherwise adversely affected by 
                persistent poverty or inequality as defined in 
                Executive Order 13985.
            ``(33) Underserved populations.--The term `underserved 
        populations' means populations sharing a particular 
        characteristic, as well as geographic communities, who have 
        been systematically denied a full opportunity to participate in 
        aspects of economic, social, and civic life, as defined in 
        Executive Order 13985.
            ``(34) Video remote interpreting services.--The term `video 
        remote interpreting services' means the provision, in health 
        care services or health 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-bandwidth video 
                connection or wireless connection that delivers high-
                quality video images that do not produce lags, choppy, 
                blurry, or grainy images, or irregular pauses in 
                communication; and
                    ``(B) in a sharply delineated image that is large 
                enough to display.
            ``(35) Vital document.--The term `vital document' includes 
        applications for government programs that provide health care 
        services, medical or financial consent forms, financial 
        assistance documents, letters containing important information 
        regarding 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 benefits, notices of the right to 
        appeal such actions, and notices advising individuals with 
        limited English proficiency with communication disabilities of 
        the availability 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 individual', the term 
`handicapped individual' in such provision shall have the same meaning 
as the term `individual with a disability' as defined in subsection 
(a).

       ``Subtitle A--Resources and Innovation for Culturally and 
                 Linguistically Appropriate Health Care

``SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE HEALTH CARE.

    ``(a) Establishment.--The Secretary shall establish and support a 
center to be known as the `Robert T. Matsui Center for Culturally and 
Linguistically Appropriate 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 provide 
                resources via the internet to identify and link health 
                care providers to competent and qualified interpreter 
                and translation services.
                    ``(B) Training.--For purposes of providing the 
                services described in subparagraph (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 providers and in a timely and reasonable 
                manner, vital documents--
                            ``(i) which may be submitted by covered 
                        entities (as defined in section 92.4 of title 
                        45, Code of Federal Regulations, as in effect 
                        on May 18, 2016) for translation into non-
                        English languages or alternative formats at a 
                        fifth-grade reading level; and
                            ``(ii) from competent translation services, 
                        the quality of which shall be monitored and 
                        reported publicly.
                    ``(B) Forms.--For each form developed or revised by 
                the Secretary that will be used by individuals 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 form from the Office of Management and 
                Budget--
                            ``(i) translate the form, at a minimum, 
                        into the top 15 non-English languages 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.
            ``(3) Toll-free customer service telephone 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 provided 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 Children'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, entities receiving 
                assistance under title X, and public health 
                departments;
                    ``(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 services.
            ``(4) Health information clearinghouse.--
                    ``(A) In general.--The Center shall develop and 
                maintain, and make available on the internet and in 
                print, an information clearinghouse that includes the 
                information described in subparagraphs (B) through 
                (F)--
                            ``(i) to facilitate the provision of 
                        language services by providers of health care 
                        services and health care-related services to 
                        reduce medical errors;
                            ``(ii) to improve medical outcomes, improve 
                        cultural competence, reduce health care costs 
                        caused by miscommunication with individuals 
                        with limited English proficiency; and
                            ``(iii) to reduce or eliminate the 
                        duplication of efforts to translate materials.
                    ``(B) Document templates.--The Center shall collect 
                and evaluate for accuracy, develop, and make available 
                templates for standard documents that are necessary for 
                patients and consumers to access and make educated 
                decisions about their health care, including templates 
                for each of the following:
                            ``(i) Administrative and legal documents, 
                        including--
                                    ``(I) intake forms;
                                    ``(II) forms related to the 
                                Medicare program under title XVIII of 
                                the Social Security Act, the Medicaid 
                                program under title XIX of such Act, 
                                and the State Children's Health 
                                Insurance Program under title XXI of 
                                such Act, including eligibility 
                                information for such programs;
                                    ``(III) forms informing patients of 
                                the compliance and consent requirements 
                                pursuant to the regulations under 
                                section 264(c) of the Health Insurance 
                                Portability and Accountability Act of 
                                1996 (42 U.S.C. 1320-2 note); and
                                    ``(IV) documents concerning 
                                informed consent, advanced directives, 
                                and waivers of rights.
                            ``(ii) Clinical information, such as how to 
                        take medications, how to prevent transmission 
                        of a contagious disease, and other prevention 
                        and treatment instructions.
                            ``(iii) Public health, patient education, 
                        and outreach materials, such as immunization 
                        notices, health warnings, or screening notices.
                            ``(iv) Additional health or health care-
                        related materials as determined appropriate by 
                        the Director of the Center.
                    ``(C) Structure of forms.--In operating 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 documents 
                        before dissemination in order to ensure that 
                        the documents are understandable and culturally 
                        and linguistically appropriate for the target 
                        populations;
                            ``(iii) allow health care providers to 
                        customize the documents for their use;
                            ``(iv) facilitate access to such documents;
                            ``(v) provide technical assistance with 
                        respect to the access and use of such 
                        information; and
                            ``(vi) carry out any other activities the 
                        Secretary determines to be useful to fulfill 
                        the purposes of the clearinghouse.
                    ``(D) Language assistance programs.--The Center 
                shall provide for the collection and dissemination of 
                information on current examples of language assistance 
                programs and strategies to improve language services 
                for individuals with limited English proficiency, 
                including 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 linguistically appropriate health care 
                for minority populations residing in the United States, 
                including--
                            ``(i) tenets of culturally and 
                        linguistically appropriate care;
                            ``(ii) culturally and linguistically 
                        appropriate self-assessment tools;
                            ``(iii) culturally and linguistically 
                        appropriate training tools;
                            ``(iv) strategic plans to increase cultural 
                        and linguistic appropriateness in different 
                        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 
                        appropriate information for educators, 
                        practitioners, students, and researchers.
                    ``(F) Translation glossaries.--The Center shall--
                            ``(i) develop and publish on its website 
                        translation glossaries that provide 
                        standardized translations of commonly used 
                        terms and phrases utilized in documents 
                        translated by the Center; and
                            ``(ii) make such glossaries available--
                                    ``(I) free of charge;
                                    ``(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 
                                request.
                    ``(G) Information about progress.--The Center 
                shall--
                            ``(i) regularly collect and make publicly 
                        available information about the progress of 
                        entities receiving grants under section 3402 
                        regarding successful innovations in 
                        implementing the requirements of this 
                        subsection; and
                            ``(ii) provide public notice in the 
                        entities' 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.
    ``(c) Availability of Language Access.--The Director of the Center 
shall collaborate with the Deputy Assistant Secretary for Minority 
Health, the Administrator of the Centers for Medicare & Medicaid 
Services, and the Administrator of the Health Resources and Services 
Administration to notify health care providers and health care 
organizations about the availability of language access 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 impairments, health professionals, graduate schools, 
community health centers, social service providers, and community-based 
organizations about--
            ``(1) Federal and State laws and guidelines governing 
        access to language services;
            ``(2) the value of using trained and competent interpreters 
        and the risks associated with using family members, friends, 
        minors, and untrained bilingual staff;
            ``(3) funding sources for developing and implementing 
        language services; and
            ``(4) promising practices to effectively provide language 
        services.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2023 through 2027.

``SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUISTICALLY 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-effective programs to improve 
        culturally and linguistically appropriate access to health care 
        services for individuals with limited English proficiency and 
        communication 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 participation of, other agencies including the 
        Health Resources 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--
            ``(1) a city, county, Indian Tribe, State, or subdivision 
        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 Secretary.
    ``(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 Secretary may reasonably require.
    ``(d) Use of Funds.--An entity shall use funds received 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;
            ``(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 accurately plan for 
        and implement language services needed in the service area of 
        the entity;
            ``(4) develop a strategic plan to implement language 
        services;
            ``(5) develop participatory, collaborative partnerships 
        with communities encompassing the patient populations of 
        individuals with limited English proficiency served by the 
        grant to gain input in designing and implementing language 
        services;
            ``(6) develop and implement grievance resolution 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 for bilingual 
        health care staff who are asked to provide interpretation 
        services in the workplace;
            ``(8) develop formal training programs, including continued 
        professional development and education programs as well as 
        supervision, for individuals interested in becoming dedicated 
        health care interpreters and culturally and linguistically 
        appropriate providers;
            ``(9) provide staff language training instruction, which 
        shall include information on the practical limitations of such 
        instruction for nonnative speakers;
            ``(10) develop policies that address compensation in salary 
        for staff who receive training to become 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 promulgated under section 
        264(c) of the Health Insurance Portability and Accountability 
        Act of 1996 and any applicable State privacy laws, data on the 
        individual patient or recipient's race, ethnicity, and primary 
        language are collected (and periodically updated) in health 
        records and integrated into the organization'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 section, the 
Secretary shall give priority to entities that primarily engage in 
providing direct care and that have developed 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 Secretary an evaluation that 
        describes, in the manner and to the extent required by the 
        Secretary, the activities 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 Appropriate 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 organizations to evaluate projects funded 
        under this section.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2023 through 2027.

``SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COMPETENCE.

    ``(a) In General.--The Secretary shall expand research 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 research.
    ``(c) Use of Funds.--Research conducted under this section shall be 
designed to do one or more of the following:
            ``(1) To identify the barriers to mental and behavioral 
        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 delivering 
        language access.
            ``(4) To identify best practices for data collection, 
        including--
                    ``(A) the collection by providers of health care 
                services and health care-related services of data on 
                the race, ethnicity, and primary language of recipients 
                of such services, taking into account existing research 
                conducted by the Government or private sector;
                    ``(B) the development and implementation of data 
                collection and reporting systems; and
                    ``(C) effective privacy safeguards for collected 
                data.
            ``(5) To develop a minimum data collection set for primary 
        language.
            ``(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 consideration, 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 2023 through 2027.''.

SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DEVELOPMENT OF STATE 
              MEDICAL INTERPRETING SERVICES.

    (a) Grants Authorized.--The Secretary of Health and Human Services 
shall award 1 grant in accordance with this section to each of 3 States 
(to be selected by the Secretary) to assist each such State in 
designing, implementing, 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 beginning on October 1, 2023, and 
ending on September 30, 2026.
    (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 population of 
        individuals with limited English proficiency, as determined by 
        the Secretary; and
            (4) that has a population of qualified LEP enrollees that 
        is linguistically diverse, requiring interpreter services in at 
        least 200 non-English languages.
    (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 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 interpreter 
                        services for qualified LEP enrollees;
                            (ii) procuring and scheduling interpreter 
                        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 
                        organizations representing LEP consumers, 
                        interpreters, and health care providers; and
            (3) develop mechanisms to establish, improve, and 
        strengthen the competency of the medical interpretation 
        workforce that serves qualified LEP enrollees in the State, 
        including a national certification process that is valid, 
        credible, and vendor-neutral.
    (e) Application.--To receive a grant under this section, 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 Medicaid 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 consumers 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 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 meaning given the 
        term in section 1101(a)(1) of the Social Security Act (42 
        U.S.C. 1301(a)(1)), for purposes 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 directly pay for language services in 
Medicaid for all Medicaid 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 appropriated pursuant 
        to the authorization in paragraph (1) are authorized to remain 
        available without fiscal year limitation.
            (3) Increased federal financial participation.--Section 
        1903(a)(2)(E) of the Social Security 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 2003 of the Health 
        Equity and Accountability Act of 2022, 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.

SEC. 2006. TRAINING TOMORROW'S DOCTORS FOR CULTURALLY AND 
              LINGUISTICALLY APPROPRIATE CARE: GRADUATE MEDICAL 
              EDUCATION.

    (a) Direct Graduate Medical Education.--Section 1886(h)(4) of the 
Social Security Act (42 U.S.C. 1395ww(h)(4)) is amended by adding at 
the end the following 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 subsection, 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 underserved 
                populations (as defined in section 330(b)(3) of the 
                Public Health Service Act).''.
    (b) Indirect Medical Education.--Section 1886(d)(5)(B) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
            (1) by redesignating the clause (x) added by section 
        5505(b) of the Patient Protection and Affordable Care Act as 
        clause (xi) and moving the left margin of such clause and each 
        subclause and item therein 2 ems to the left; and
            (2) by adding at the end the following new clause:
            ``(xii) The provisions of subparagraph (L) of subsection 
        (h)(4) shall apply under this subparagraph 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 payments made to hospitals on or after the 
date that is one year after the date of the enactment of this Act.

SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES 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 Services, acting through the Centers 
                for Medicare & Medicaid Services and in consultation 
                with the Center for Medicare and Medicaid Innovation 
                (as referred to in section 1115A of the Social Security 
                Act (42 U.S.C. 1315a)), shall establish a demonstration 
                program under which the Secretary shall award grants to 
                eligible Medicare service providers to provide 
                culturally and linguistically appropriate services to 
                Medicare beneficiaries who are limited English 
                proficient, including beneficiaries who live in diverse 
                and underserved communities.
                    (B) Application of innovation rules.--The 
                demonstration project under subparagraph (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 under 
                paragraph (2)(D), each grant awarded under this 
                subsection shall be for a 3-year period.
            (2) Eligibility requirements.--To be eligible for a grant 
        under this subsection, an entity must meet the following 
        requirements:
                    (A) Medicare provider.--The entity must be--
                            (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 organization 
                        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 prescription 
                        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 respect to necessary language 
                services for improving access and utilization of health 
                care among individuals with limited English 
                proficiency, is disproportionally underserved.
                    (C) Application.--The entity must prepare and 
                submit to the Secretary an application, at such time, 
                in such manner, and accompanied by such additional 
                information as the Secretary may require.
                    (D) Reporting.--In the case of a grantee that 
                received a grant under this subsection in a previous 
                year, such grantee is only eligible for continued 
                payments under a grant under this subsection if the 
                grantee met the reporting requirements under paragraph 
                (9) for such year. If a grantee fails to meet the 
                requirement 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 services 
                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 described 
                in paragraph (2)(A)(iii); and
                    (D) at least 10 grants to sponsors described in 
                paragraph (2)(A)(iv).
            (4) Considerations in awarding grants.--
                    (A) Variation among grantees.--In awarding grants 
                under this subsection, the Secretary shall select 
                grantees to ensure the following:
                            (i) The grantees provide many different 
                        types of language services.
                            (ii) The grantees serve Medicare 
                        beneficiaries 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 settings.
                            (iv) The grantees represent each Centers 
                        for Medicare & Medicaid Services region, as 
                        defined by the Secretary.
                            (v) The grantees serve Medicare 
                        beneficiaries in at least two large 
                        metropolitan statistical areas with racial, 
                        ethnic, sexual, gender, disability, and 
                        economically diverse populations.
                    (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--
                            (i) a community organization; or
                            (ii) a consortia of community 
                        organizations, State agencies, and local 
                        agencies,
                that has experience in providing language services.
            (5) Use of funds for competent language services.--
                    (A) In general.--Subject to subparagraph (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 with limited English proficiency.
                    (B) Competent language services defined.--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 currently in 
                                        effect; or
                                            (bb) if the grantee 
                                        operates in a State that does 
                                        not have statewide health care 
                                        interpreter standards, utilizes 
                                        competent interpreters who 
                                        follow the National Council on 
                                        Interpreting in Health Care's 
                                        Code of Ethics and Standards of 
                                        Practice and comply with the 
                                        requirements of section 1557 of 
                                        the Patient Protection and 
                                        Affordable Care Act (42 U.S.C. 
                                        18116) as published in the 
                                        Federal Register on May 18, 
                                        2016; and
                                    (II) that, in the case of 
                                interpreter services, are provided 
                                through--
                                            (aa) onsite interpretation;
                                            (bb) telephonic 
                                        interpretation; or
                                            (cc) video interpretation; 
                                        and
                            (ii) the direct provision of health care or 
                        health care-related services by a competent 
                        bilingual health care provider.
                    (C) Exceptions.--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 beneficiary 
                        who is limited English proficient, if--
                                    (I) such beneficiary has been 
                                informed, in the beneficiary'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
                                    (II) the grantee documents such 
                                request in the beneficiary's medical 
                                record; or
                            (ii) in the case of a medical emergency 
                        where the delay directly associated with 
                        obtaining a competent interpreter or 
                        translation services would jeopardize the 
                        health of the patient.
                Clause (ii) shall not be construed to exempt emergency 
                rooms or similar entities that regularly provide health 
                care services in medical emergencies to patients who 
                are individuals with limited English proficiency from 
                any applicable legal or regulatory requirements related 
                to providing competent interpreter and translation 
                services without undue delay.
                    (D) Medicare advantage organizations and pdp 
                sponsors.--A grantee that is an MA organization or 
                prescription drug 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 purpose of providing support for 
                such providers to provide competent language services 
                to Medicare beneficiaries who are individuals with 
                limited English proficiency.
                    (E) Administrative and reporting costs.--A grantee 
                may use up to 10 percent of the grant funds to pay for 
                administrative costs associated with the provision of 
                competent language services and for reporting required 
                under 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 beneficiaries who are limited 
                English proficiency 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 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 beneficiaries that the 
                        grantee serves and the Secretary determines 
                        that the data is accurate and shows a greater 
                        number of individuals with limited English 
                        proficiency 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 Secretary, based on changes in 
                the data under subparagraph (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 subsection 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 delivery;
                    (B) ensure the linguistic competence of bilingual 
                providers;
                    (C) offer and provide appropriate language services 
                at no additional charge to each patient who is limited 
                English proficient for all points of contact between 
                the patient and the grantee, in a timely manner during 
                all hours of operation;
                    (D) notify Medicare beneficiaries of their right to 
                receive language services in their primary 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 collected for 
                        recipients of language services and such data 
                        are consistent with standards 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 
                        protections provided under the regulations 
                        promulgated pursuant to section 264(c) of the 
                        Health Insurance Portability and Accountability 
                        Act of 1996 (42 U.S.C. 1320d-2 note), if the 
                        recipient of language services is a minor or is 
                        incapacitated, primary language 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 language services provided under 
        this demonstration program.
            (9) Reporting requirements for grantees.--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 provided, disaggregated 
                by age and entitlement basis (on the basis of age, 
                disability, or determination of end stage renal 
                disease).
                    (B) The primary languages of those Medicare 
                beneficiaries.
                    (C) The types of language services provided to such 
                beneficiaries.
                    (D) Whether such language services were provided by 
                employees of the grantee or through a contract with 
                external contractors or agencies.
                    (E) The types of interpretation services provided 
                to such beneficiaries, and the approximate length of 
                time such service is provided to such beneficiaries.
                    (F) The costs of providing competent language 
                services.
                    (G) An account of the training or accreditation of 
                bilingual staff, interpreters, and translators 
                providing services funded by the grant under this 
                subsection.
            (10) Evaluation and report to congress.--Not later than 1 
        year after the completion of a 3-year grant under this 
        subsection, the Secretary shall conduct an evaluation of the 
        demonstration 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 with limited English proficiency 
                participating in the project as compared to such 
                outcomes and costs for such Medicare beneficiaries not 
                participating, based on the data provided under 
                paragraph (9) and any other information available to 
                the Secretary.
                    (B) The effect of delivering language services on--
                            (i) Medicare beneficiary access to care and 
                        utilization of services;
                            (ii) the efficiency and cost effectiveness 
                        of health care delivery;
                            (iii) patient satisfaction with respect to 
                        both health service delivery and language 
                        assistance;
                            (iv) health outcomes; and
                            (v) the provision of culturally appropriate 
                        services provided to such beneficiaries.
                    (C) The extent to which bilingual staff, 
                interpreters, and translators providing services under 
                such demonstration were trained or accredited 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 
                interpretation, translation, or other language services 
                to Medicare beneficiaries if such services are expanded 
                pursuant to section 1115A(c) of the Social Security Act 
                (42 U.S.C. 1315a(c)).
                    (D) Recommendations, if any, regarding the 
                extension of such project to the entire Medicare 
                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 section 1817 of the Social Security 
        Act (42 U.S.C. 1395i) and the Federal Supplementary Medical 
        Insurance 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 defined.--In this 
        subsection, the term ``limited English proficient'' refers to 
        individuals who self-identify 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 (B), by striking 
                        ``and'' at the end;
                            (ii) by adding ``and'' at the end of 
                        subparagraph (C); and
                            (iii) by inserting after subparagraph (C) 
                        the following new subparagraph:
            ``(D) language assistance services as defined in subsection 
        (lll),''; and
                    (B) by adding at the end the following new 
                subsection:

            ``Language Assistance Services and Related Terms

    ``(lll) 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 proficiency' 
(as defined in such section 3400).''.
            (2) Coverage.--Section 1832(a)(2) of the Social Security 
        Act (42 U.S.C. 1395k(a)(2)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (I);
                    (B) by striking the period at the end of 
                subparagraph (J) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(K) language assistance services (as defined in 
                section 1861(lll)).''.
            (3) Payment.--Section 1833(a) of the Social Security Act 
        (42 U.S.C. 1395l(a)) is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (9);
                    (B) by striking the period at the end of paragraph 
                (10) and inserting ``; and''; and
                    (C) by inserting after paragraph (10) the following 
                new paragraph:
            ``(11) in the case of language assistance services (as 
        defined in section 1861(lll)), 100 percent of the reasonable 
        charges for such services, as determined in consultation with 
        the Medicare Payment Advisory Commission.''.
            (4) Waiver of budget neutrality.--For the 3-year period 
        beginning on the date of enactment 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(lll) of such Act).
    (c) Medicare Parts C and D.--
            (1) In general.--Medicare Advantage plans under part C of 
        title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et 
        seq.) and prescription drug plans under part D of such title 
        (42 U.S.C. 1395q-101) shall comply 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 Affordable Care Act (42 U.S.C. 
        18116) to provide effective language services to enrollees of 
        such plans.
            (2) Medicare advantage plans and prescription drug plans 
        reporting requirement.--Section 1857(e) of the Social Security 
        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 organization (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 recruitment and retention efforts directed to 
        workforce diversity and linguistically and culturally 
        appropriate provision of services in each of the following 
        contexts:
                    ``(A) The collection of data in a manner that meets 
                the requirements of title I of the Health Equity and 
                Accountability Act of 2022, regarding the enrollee 
                population.
                    ``(B) Education of staff and contractors who have 
                routine contact with enrollees regarding the various 
                needs of the diverse enrollee population.
                    ``(C) Evaluation of the language services programs 
                and services offered by the organization (or sponsor) 
                with respect to the enrollee population, such as 
                through analysis of complaints or satisfaction survey 
                results.
                    ``(D) Methods by which the plan provides to the 
                Secretary information regarding the ethnic diversity of 
                the enrollee population.
                    ``(E) The periodic provision of educational 
                information to plan enrollees on the language services 
                and programs offered by the organization (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
                    (C) striking ``children of families'' and inserting 
                ``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 (31)''.
            (3) Definition of medical assistance.--Section 1905(a) of 
        the Social Security Act (42 U.S.C. 1396d(a)) is amended--
                    (A) in paragraph (29), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (31) as paragraph 
                (32); and
                    (C) by inserting after paragraph (30) the following 
                new paragraph:
            ``(31) language assistance services, as such term is 
        defined in section 1861(lll), 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 sharing.--Section 1916(a)(2) 
        of the Social Security Act (42 U.S.C. 1396o(a)(2)) is amended--
                    (A) in subparagraph (G), by inserting at the end 
                ``, and''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(H) language assistance services described in 
                section 1905(a)(31);''.
            (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 ``(7), and (8)'' and 
                inserting ``(7), (8), (9), (10), (11), and (12)'';
                    (B) in subsection (c), by adding at the end the 
                following new paragraph:
            ``(12) Language assistance services.--The child health 
        assistance provided to a targeted low-income child shall 
        include coverage of language assistance services, as such term 
        is defined in section 1861(l), provided in a timely manner to 
        individuals with limited English proficiency (as defined in 
        section 3400 of the Public Health Service Act).''; and
                    (C) in subsection (e)(2)--
                            (i) in the heading, by striking 
                        ``preventive'' and inserting ``certain''; and
                            (ii) by inserting ``language assistance 
                        services described in subsection (c)(12),'' 
                        before ``visits described in''.
            (6) Definition of child health assistance.--Section 
        2110(a)(27) of the Social Security Act (42 U.S.C. 
        1397jj(a)(27)) is amended by striking ``translation'' and 
        inserting ``language assistance services as described in 
        section 2103(c)(12)''.
            (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 receiving 
                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.
            (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 subparagraph 
                        (A), by striking ``75'' and inserting ``95''; 
                        and
                            (ii) in subparagraph (D)(iv), by striking 
                        ``translation or interpretation services'' and 
                        inserting ``language assistance services''; 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 subparagraph (B), the 
                Secretary of Health and Human Services (referred to in 
                this subsection as the ``Secretary'') shall make 
                payments (on a quarterly basis) directly to eligible 
                entities to support the provision of language 
                assistance services to individuals with limited English 
                proficiency in an amount equal to an eligible entity'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 of Health and Human Services such sums as may 
                be necessary for each of fiscal years 2022 through 
                2026.
                    (C) Relation to medicaid dsh.--Payments under this 
                subsection shall not offset or reduce payments under 
                section 1923 of the Social Security Act (42 U.S.C. 
                1396r-4), nor shall payments under such section be 
                considered when determining uncompensated costs 
                associated with the provision of language assistance 
                services for the purposes of this section.
            (2) Methodology for payment of claims.--
                    (A) In general.--The Secretary shall establish a 
                methodology to determine the average per person cost of 
                language assistance services.
                    (B) Different entities.--In establishing such 
                methodology, the Secretary may establish different 
                methodologies for different types of eligible entities.
                    (C) No individual claims.--The Secretary may not 
                require eligible entities to submit individual claims 
                for language assistance services for individual 
                patients as a requirement for payment under this 
                subsection.
            (3) Data collection instrument.--For purposes of this 
        subsection, the Secretary shall create a standard data 
        collection instrument that is consistent with any existing 
        reporting requirements by the Secretary or relevant accrediting 
        organizations regarding the number of individuals to whom 
        language access is provided.
            (4) Guidelines.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary shall establish and 
        distribute guidelines concerning the implementation of this 
        subsection.
            (5) Reporting requirements.--
                    (A) Report to secretary.--Entities receiving 
                payment under this subsection shall provide the 
                Secretary with a quarterly report on how the entity 
                used such funds. Such report shall contain aggregate 
                (and may not contain individualized) data collected 
                using the instrument 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 product of--
                            (i) the average per person cost of language 
                        assistance services, determined according to 
                        the methodology devised under paragraph (2); 
                        and
                            (ii) the number individuals with limited 
                        English proficiency who are provided language 
                        assistance services by the entity and for whom 
                        no reimbursement is available for such services 
                        under the 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 application 
                        to the Secretary, at such time, in such manner, 
                        and accompanied by such information 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(kkk)(1) 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 
Federal 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, or other laws that protect the civil rights of individuals.
    (g) Effective Date.--
            (1) In general.--Except as otherwise provided and subject 
        to paragraph (2), the amendments made by this section shall 
        take effect on January 1, 2023.
            (2) Exception if state legislation required.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.) or a State plan 
        for child health assistance under title XXI of such Act (42 
        U.S.C. 1397aa et seq.) which the Secretary of Health and Human 
        Services determines requires State legislation (other than 
        legislation appropriating funds) in order for the plan to meet 
        the additional requirement imposed by the amendments made by 
        this section, such State plan shall not be regarded as failing 
        to comply with the requirements of such title solely on the 
        basis of its failure to meet this additional requirement before 
        the first day of the first calendar quarter beginning after the 
        close of the first regular session of the State legislature 
        that begins after the date of the enactment of this Act. For 
        purposes of the previous sentence, in the case of a State that 
        has a 2-year legislative session, each year of such session 
        shall be deemed to be a separate regular session of the State 
        legislature.

SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROVING HEALTH LITERACY.

    (a) In General.--The Secretary, in consultation with the Director 
of the National Institute on Minority Health and Health Disparities and 
the Deputy Assistant Secretary for Minority Health, shall award grants 
to eligible entities to improve health care for patient populations 
that have low health literacy.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be a hospital, health center or clinic, health plan, or 
        other health entity (including a nonprofit minority health 
        organization or association); and
            (2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may reasonably require.
    (c) Use of Funds.--
            (1) Agency for healthcare research and quality.--A grant 
        under subsection (a) that is awarded through the Director of 
        the Agency for Healthcare Research and Quality shall be used--
                    (A) to define and increase the understanding of 
                health literacy across all areas of health care, 
                including end of life care;
                    (B) to investigate the correlation between low 
                health literacy and health and health care;
                    (C) to clarify which aspects of health literacy 
                have an effect on health outcomes; and
                    (D) for any other activity determined appropriate 
                by the Director.
            (2) Health resources and services administration.--A grant 
        under subsection (a) that is awarded through the Administrator 
        of the Health Resources and Services Administration shall be 
        used to conduct demonstration projects for interventions for 
        patients with low health literacy that may include--
                    (A) the development of new disease management and 
                end of life care programs for patients with low health 
                literacy;
                    (B) the tailoring of disease management programs 
                and end of life care addressing mental, physical, oral, 
                and behavioral health conditions for patients with low 
                health literacy;
                    (C) the translation of written health materials for 
                patients with low health literacy;
                    (D) the identification, implementation, and testing 
                of low health literacy screening tools;
                    (E) the conduct of educational campaigns for 
                patients and providers about low health literacy;
                    (F) the conduct of educational campaigns concerning 
                health directed specifically at patients with mental 
                disabilities, including those with cognitive and 
                intellectual disabilities, designed to reduce the 
                incidence of low health literacy among these 
                populations, which shall have instructional materials 
                in the plain language standards promulgated under the 
                Plain Writing Act of 2010 (5 U.S.C. 301 note) for 
                Federal agencies; and
                    (G) other activities determined appropriate by the 
                Administrator.
    (d) Definitions.--In this section:
            (1) Low health literacy.--The term ``low health literacy'' 
        means the inability of an individual to obtain, process, and 
        understand basic health information and services needed to make 
        appropriate health decisions.
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services--
                    (A) acting through the Director of the Agency for 
                Healthcare Research and Quality, with respect to grants 
                under subsection (c)(1); and
                    (B) acting through the Administrator of the Health 
                Resources and Services Administration with respect to 
                grants under subsection (c)(2).
    (e) 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 2023 through 2027.

SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR ACTIVITIES RECEIVING 
              FEDERAL FUNDS.

    (a) Covered Entity; Covered Program or Activity.--In this section--
            (1) the term ``covered entity'' has the meaning given such 
        term in section 92.4 of title 45, Code of Federal Regulations, 
        as in effect on May 18, 2016 (81 Fed. Reg. 31466); and
            (2) the term ``health program or activity'' has the meaning 
        given such term in section 92.4 of title 45, Code of Federal 
        Regulations, as in effect on May 18, 2016 (81 Fed. Reg. 31466).
    (b) Requirements.--A covered entity, in order to ensure the right 
of individuals with limited English proficiency to receive access to 
high-quality health care through the covered program or activity, 
shall--
            (1) ensure that appropriate clinical and support staff 
        receive ongoing education and training in culturally and 
        linguistically appropriate service delivery at least annually;
            (2) offer and provide appropriate language assistance 
        services at no additional charge to each patient that is an 
        individual with limited English proficiency at all points of 
        contact, in a timely manner during all hours of operation;
            (3) notify patients of their right to receive language 
        services in their primary language; and
            (4) utilize only qualified interpreters for an individual 
        with limited English proficiency or qualified translators, 
        except as provided in subsection (c).
    (c) Exemptions.--The requirements of subsection (b)(4) shall not 
apply as follows:
            (1) When a patient requests the use of family, friends, or 
        other persons untrained in interpretation or translation if 
        each of the following conditions are met:
                    (A) The interpreter requested by the patient is 
                over the age of 18.
                    (B) The covered entity informs the patient in the 
                primary language of the patient that he or she has the 
                option of having the entity provide to the patient an 
                interpreter and translation services without charge.
                    (C) The covered entity informs the patient that the 
                entity may not require an individual with a limited 
                English proficiency to use a family member or friend as 
                an interpreter.
                    (D) The covered entity evaluates whether the person 
                the patient wishes to use as an interpreter is 
                competent. If the covered entity has reason to believe 
                that such person is not competent as an interpreter, 
                the entity provides its own interpreter to protect the 
                covered entity from liability if the patient's 
                interpreter is later found not competent.
                    (E) If the covered entity has reason to believe 
                that there is a conflict of interest between the 
                interpreter and patient, the covered entity may not use 
                the patient's interpreter.
                    (F) The covered entity has the patient sign a 
                waiver, witnessed by at least 1 individual not related 
                to the patient, that includes the information stated in 
                subparagraphs (A) through (E) and is translated into 
                the patient's primary language.
            (2) When a medical emergency exists and the delay directly 
        associated with obtaining competent interpreter or translation 
        services would jeopardize the health of the patient, but only 
        until a competent interpreter or translation service is 
        available.
    (d) Rule of Construction.--Subsection (c)(2) shall not be construed 
to mean that emergency rooms or similar entities that regularly provide 
health care services in medical emergencies are exempt from legal or 
regulatory requirements related to competent interpreter services.

SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND 
              LINGUISTICALLY APPROPRIATE HEALTH CARE SERVICES.

    (a) Report.--Not later than 1 year after the date of enactment of 
this Act, and annually thereafter, the Secretary of Health and Human 
Services shall enter into a contract with the National Academy of 
Medicine for the preparation and publication of a report that describes 
Federal efforts to ensure that all individuals with limited English 
proficiency have meaningful access to health care services and health 
care-related services that are culturally and linguistically 
appropriate. Such report shall include--
            (1) a description and evaluation of the activities carried 
        out under this Act;
            (2) a description and analysis of best practices, model 
        programs, guidelines, and other effective strategies for 
        providing access to culturally and linguistically appropriate 
        health care services;
            (3) recommendations on the development and implementation 
        of policies and practices by providers of health care services 
        and health care-related services for individuals with limited 
        English proficiency, including people with cognitive, hearing, 
        vision, or print impairments;
            (4) recommend guidelines or standards for health literacy 
        and plain language, informed consent, discharge instructions, 
        and written communications, and for improvement of health care 
        access;
            (5) a description of the effect of providing language 
        services on quality of health care and access to care; and
            (6) a description of the costs associated with or savings 
        related to the provision of language services.
    (b) 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 2023 through 2027.

SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH LIMITED ENGLISH 
              PROFICIENCY.

    (a) Grants Authorized.--The Secretary of Education is authorized to 
provide grants to eligible entities for the provision of English as a 
second language (in this section referred to as ``ESL'') instruction to 
individuals with limited English proficiency, including health care-
related English instruction, and shall determine, after consultation 
with appropriate stakeholders, the mechanism for administering and 
distributing such grants.
    (b) Eligible Entity.--In this section, the term ``eligible entity'' 
means--
            (1) a State; or
            (2) a community-based organization that predominantly 
        employs and serves racial and ethnic minority groups (as 
        defined in section 1707(g) of the Public Health Service Act (42 
        U.S.C. 300u-6(g)).
    (c) Application.--An eligible entity that desires to receive a 
grant under this section shall apply by submitting to the Secretary of 
Education an application at such time, in such manner, and containing 
such information as the Secretary may require.
    (d) Use of Grant.--An eligible entity shall use grant funds 
provided under this section to--
            (1) develop and implement a plan for assuring the 
        availability of ESL instruction, free of charge, to the 
        community served by the eligible entity, that effectively 
        integrates information about the nature of the United States 
        health care system, how to access care, and any special 
        language skills that may be required for individuals with 
        limited English proficiency to access and regularly negotiate 
        the health care system effectively;
            (2) develop a plan for making ESL instruction available 
        free to charge to individuals with limited English proficiency 
        in the community served by the eligible entity who are seeking 
        instruction, including, where appropriate, through the use of 
        public-private partnerships; and
            (3) provide ESL instruction to individuals with limited 
        English proficiency in the community served by the eligible 
        entity.
    (e) Supplement, Not Supplant.--An eligible entity awarded a grant 
under this section shall use funds made available under this section to 
supplement, and not supplant, other Federal, State, and local funds 
that would otherwise be expended to carry out activities under this 
section.
    (f) Duties of the Secretary.--The Secretary of Education shall--
            (1) collect and make publicly available annual data on how 
        much Federal, State, and local governments spend annually on 
        ESL instruction;
            (2) collect data from eligible entities awarded a grant 
        under this section to identify the unmet needs of individuals 
        with limited English proficiency for appropriate ESL 
        instruction, including--
                    (A) the preferred written and spoken language of 
                such individuals;
                    (B) the availability of enrollment in ESL 
                instruction programs in the communities served by each 
                eligible entity awarded a grant under this section, 
                including the extent of waiting lists for ESL 
                instruction, how many programs maintain waiting lists, 
                and, for programs that do not have waiting lists, the 
                reasons why such a list is unnecessary or otherwise not 
                maintained;
                    (C) the availability of programs to geographically 
                isolated communities;
                    (D) the impact of course enrollment policies, 
                including open enrollment, on the availability of ESL 
                instruction;
                    (E) the number of individuals with limited English 
                proficiency and the number of individuals enrolled in 
                ESL instruction programs in the communities served by 
                each eligible entity awarded a grant under this 
                section;
                    (F) the effectiveness of the ESL instruction 
                provided through grants awarded under this section in 
                meeting the needs of individuals receiving such 
                instruction; and
                    (G) an assessment of the need for programs that 
                integrate job training and ESL instruction, to assist 
                individuals with limited English proficiency in 
                obtaining better jobs;
            (3) determine the cost and most appropriate methods of 
        making ESL instruction available to all individuals with 
        limited English proficiency in the United States who are 
        seeking instruction; and
            (4) not later than 1 year after the date of enactment of 
        this Act, issue a report to Congress that--
                    (A) assesses the information collected in 
                paragraphs (1), (2), and (3) and makes recommendations 
                on steps that should be taken to realize the goal of 
                making ESL instruction available to all individuals 
                with limited English proficiency in the United States 
                who are seeking instruction; and
                    (B) evaluates the impact of the grant program 
                authorized under this section on the accessibility of, 
                and ability to effectively negotiate, the health care 
                system for individuals with limited English proficiency 
                who have received ESL instruction funded by a grant 
                under this section.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Education $250,000,000 for each of 
fiscal years 2023 through 2027 to carry out this section.

SEC. 2012. IMPLEMENTATION.

    (a) General Provisions.--
            (1) Immunity.--A person injured by a violation of this 
        title (including an amendment made by this title) by a State 
        may bring a civil action in the appropriate Federal court for 
        such injury in accordance with this section.
            (2) Remedies.--In a civil action under this section for a 
        violation of this title, such remedies shall be available as 
        would be available in a civil action for such violation against 
        any party other than a State.
    (b) Rule of Construction.--Nothing in this title may be construed 
to limit otherwise existing obligations of recipients of Federal 
financial assistance under title VI of the Civil Rights Act of 1964 (42 
U.S.C. 2000d et seq.) or any other Federal statute.

SEC. 2013. LANGUAGE ACCESS SERVICES.

    (a) Essential Benefits.--Section 1302(b)(1) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended 
by adding at the end the following:
                    ``(K) Language access services, including oral 
                interpretation and written translations.''.
    (b) Employer-Sponsored Minimum Essential Coverage.--
            (1) In general.--Section 36B(c)(2)(C) of the Internal 
        Revenue Code of 1986 is amended by redesignating clauses (iii) 
        and (iv) as clauses (iv) and (v), respectively, and by 
        inserting after clause (ii) the following new clause:
                            ``(iii) Coverage must include language 
                        access and services.--Except as provided in 
                        clause (iv), an employee shall not be treated 
                        as eligible for minimum essential coverage if 
                        such coverage consists of an eligible employer-
                        sponsored plan (as defined in section 
                        5000A(f)(2)) and the plan does not provide 
                        coverage for language access services, 
                        including oral interpretation and written 
                        translations.''.
            (2) Conforming amendments.--
                    (A) Section 36B(c)(2)(C) of such Code is amended by 
                striking ``clause (iii)'' each place it appears in 
                clauses (i) and (ii) and inserting ``clause (iv)''.
                    (B) Section 36B(c)(2)(C)(iv) of such Code, as 
                redesignated by this subsection, is amended by striking 
                ``(i) and (ii)'' and inserting ``(i), (ii), and 
                (iii)''.
    (c) Quality Reporting.--Section 2717(a)(1) of the Public Health 
Service Act (42 U.S.C. 300gg-17(a)(1)) is amended--
            (1) by striking ``and'' at the end of subparagraph (C);
            (2) by striking the period at the end of subparagraph (D) 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(E) reduce health disparities through the 
                provision of language access services, including oral 
                interpretation and written translations.''.
    (d) Regulations Regarding Internal Claims and Appeals and External 
Review Processes for Health Plans and Health Insurance Issuers.--The 
Secretary of the Treasury, the Secretary of Labor, and the Secretary of 
Health and Human Services shall amend the regulations in section 
54.9815-2719(e) of title 26, Code of Federal Regulations, section 
2590.715- 2719(e) of title 29, Code of Federal Regulations, and section 
147.136(e) of title 45, Code of Federal Regulations (or a successor 
regulation), respectively, to require group health plans and health 
insurance issuers offering group or individual health insurance 
coverage to which such sections apply--
            (1) to provide oral interpretation services without any 
        threshold requirements;
            (2) to provide in the English versions of all notices a 
        statement prominently displayed in not less than 15 non-English 
        languages clearly indicating how to access the language 
        services provided by the plan or issuer; and
            (3) with respect to the requirements for providing relevant 
        notices in a culturally and linguistically appropriate manner 
        in the applicable non-English languages, to apply a threshold 
        that 5 percent of the population, or not less than 500 
        individuals, in the county is literate only in the same non-
        English language in order for the language to be considered an 
        applicable non-English language.
    (e) Data Collection and Reporting.--The Secretary of Health and 
Human Services shall--
            (1) amend the single streamlined application form developed 
        pursuant to section 1413 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18083) to collect the preferred 
        spoken and written language for each household member applying 
        for coverage under a qualified health plan through an Exchange 
        under title I of such Act (42 U.S.C. 18001 et seq.);
            (2) require navigators, certified application counselors, 
        and other individuals assisting with enrollment to collect and 
        report requests for language assistance; and
            (3) require the toll-free telephone hotlines established 
        pursuant to section 1311(d)(4)(B) of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18031(d)(4)(B)) to submit an 
        annual report documenting the number of language assistance 
        requests, the types of languages requested, the range and 
        average wait time for a consumer to speak with an interpreter, 
        the number of complaints and any steps the hotline, and any 
        entity contracting with the Secretary to provide language 
        services, have taken to actively address some of the consumer 
        complaints.
    (f) Effective Date.--The amendments made by this section shall not 
apply to plans beginning prior to the date of the enactment of this 
Act.

SEC. 2014. MEDICALLY UNDERSERVED POPULATIONS.

    Section 330(b)(3) of the Public Health Service Act (42 U.S.C. 
254b(b)(3)) is amended to read as follows:
            ``(3) Medically underserved.--The term `medically 
        underserved', with respect to a population, refers to--
                    ``(A) the population of an urban or rural area 
                designated by the Secretary as--
                            ``(i) an area with a shortage of personal 
                        health services; or
                            ``(ii) a population group having a shortage 
                        of such services; or
                    ``(B) a population of individuals, not confined to 
                a particular urban or rural area, who are designated by 
                the Secretary as having a shortage of personal health 
                services due to a specific demographic trait.''.

                 TITLE III--HEALTH WORKFORCE DIVERSITY

SEC. 3001. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title XXXIV of the Public Health Service Act, as added by section 
2004, is amended by adding at the end the following:

          ``Subtitle B--Diversifying the Health Care Workplace

``SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Workforce of the Health Resources and Services Administration, 
shall award a grant to an entity determined appropriate by the 
Secretary for the establishment of a national working group on 
workforce diversity.
    ``(b) Representation.--In establishing the national working group 
under subsection (a):
            ``(1) The grantee shall ensure that the group has 
        representatives of each of the following:
                    ``(A) The Health Resources and Services 
                Administration.
                    ``(B) The Department of Health and Human Services 
                Data Council.
                    ``(C) The Office of Minority Health of the 
                Department of Health and Human Services.
                    ``(D) The Substance Abuse and Mental Health 
                Services Administration.
                    ``(E) The Bureau of Labor Statistics of the 
                Department of Labor.
                    ``(F) The National Institute on Minority Health and 
                Health Disparities.
                    ``(G) The Agency for Healthcare Research and 
                Quality.
                    ``(H) The Institute of Medicine Study Committee for 
                the 2004 workforce diversity report.
                    ``(I) The Indian Health Service.
                    ``(J) The Department of Education.
                    ``(K) Minority-serving academic institutions.
                    ``(L) Consumer organizations.
                    ``(M) Health professional associations, including 
                those that represent underrepresented minority 
                populations.
                    ``(N) Researchers in the area of health workforce.
                    ``(O) Health workforce accreditation entities.
                    ``(P) Private (including nonprofit) foundations 
                that have sponsored workforce diversity initiatives.
                    ``(Q) Local and State health departments.
                    ``(R) Representatives of community members to be 
                included on admissions committees for health profession 
                schools pursuant to subsection (c)(9).
                    ``(S) National community-based organizations that 
                serve as a national intermediary to their urban 
                affiliate members and have demonstrated capacity to 
                train health care professionals.
                    ``(T) The Veterans Health Administration.
                    ``(U) Other entities determined appropriate by the 
                Secretary.
            ``(2) The grantee shall ensure that, in addition to the 
        representatives under paragraph (1), the working group has not 
        less than 5 health professions students representing various 
        health profession fields and levels of training.
    ``(c) Activities.--The working group established under subsection 
(a) shall convene at least twice each year to complete the following 
activities:
            ``(1) Review public and private health workforce diversity 
        initiatives.
            ``(2) Identify successful health workforce diversity 
        programs and practices.
            ``(3) Examine challenges relating to the development and 
        implementation of health workforce diversity initiatives.
            ``(4) Draft a national strategic work plan for health 
        workforce diversity, including recommendations for public and 
        private sector initiatives.
            ``(5) Develop a framework and methods for the evaluation of 
        current and future health workforce diversity initiatives.
            ``(6) Develop recommended standards for workforce diversity 
        that could be applicable to all health professions programs and 
        programs funded under this Act.
            ``(7) Develop guidelines to train health professionals to 
        care for a diverse population.
            ``(8) Develop a workforce data collection or tracking 
        system to identify where racial and ethnic minority health 
        professionals practice.
            ``(9) Develop a strategy for the inclusion of community 
        members on admissions committees for health profession schools.
            ``(10) Help with monitoring and implementation of standards 
        for diversity, equity, and inclusion.
            ``(11) Other activities determined appropriate by the 
        Secretary.
    ``(d) Annual Report.--Not later than 1 year after the establishment 
of the working group under subsection (a), and annually thereafter, the 
working group shall prepare and make available to the general public 
for comment, an annual report on the activities of the working group. 
Such report shall include the recommendations of the working group for 
improving health workforce diversity.
    ``(e) Coordination With Other Efforts.--In providing for the 
establishment of the working group under subsection (a), the Secretary 
shall take such steps as may be necessary to ensure that the work of 
the working group does not overlap with, or otherwise duplicate, other 
Federal Government efforts with respect to ensuring health equity in 
data collection in public health emergencies.
    ``(f) 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 2023 through 2027.

``SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Deputy 
Assistant Secretary for Minority Health, and in collaboration with the 
Bureau of Health Workforce within the Health Resources and Services 
Administration and the National Institute on Minority Health and Health 
Disparities, shall establish a technical clearinghouse on health 
workforce diversity within the Office of Minority Health and coordinate 
current and future clearinghouses related to health workforce 
diversity.
    ``(b) Information and Services.--The clearinghouse established 
under subsection (a) shall offer the following information and 
services:
            ``(1) Information on the importance of health workforce 
        diversity.
            ``(2) Statistical information relating to underrepresented 
        minority representation in health and allied health professions 
        and occupations.
            ``(3) Model health workforce diversity practices and 
        programs, including integrated models of care.
            ``(4) Admissions policies that promote health workforce 
        diversity and are in compliance with Federal and State laws.
            ``(5) Retainment policies that promote completion of health 
        profession degrees for underserved populations.
            ``(6) Lists of scholarship, loan repayment, and loan 
        cancellation grants as well as fellowship information for 
        underserved populations for health professions schools.
            ``(7) Foundation and other large organizational initiatives 
        relating to health workforce diversity.
    ``(c) Consultation.--In carrying out this section, the Secretary 
shall consult with non-Federal entities which may include minority 
health professional associations and minority sections of major health 
professional associations to ensure the adequacy and accuracy of 
information.
    ``(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 2023 through 2027.

``SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY, 
              EQUITY, AND INCLUSION.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and the Director of 
the Centers for Disease Control and Prevention, shall award grants to 
eligible entities that demonstrate a commitment to health workforce 
diversity.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an educational institution or entity that 
        historically produces or trains meaningful numbers of 
        underrepresented minority health professionals, including--
                    ``(A) part B institutions, as defined in section 
                322 of the Higher Education Act of 1965;
                    ``(B) historically Black professional or graduate 
                institutions eligible for grants under section 326 of 
                the Higher Education Act of 1965;
                    ``(C) Hispanic-serving health professions schools;
                    ``(D) Hispanic-serving institutions, as defined in 
                section 502 of such Act;
                    ``(E) Tribal Colleges or Universities, as defined 
                in section 316 of such Act;
                    ``(F) Asian American and Native American Pacific 
                Islander-serving institutions, as defined in section 
                371(c) of such Act;
                    ``(G) institutions that have programs to recruit 
                and retain underrepresented minority health 
                professionals, in which a significant number of the 
                enrolled participants are underrepresented minorities;
                    ``(H) health professional associations, which may 
                include underrepresented minority health professional 
                associations; and
                    ``(I) institutions, including national and regional 
                community-based organizations with demonstrated 
                commitment to a diversified workforce--
                            ``(i) located in communities with 
                        predominantly underrepresented minority 
                        populations;
                            ``(ii) with whom partnerships have been 
                        formed for the purpose of increasing workforce 
                        diversity; and
                            ``(iii) in which at least 20 percent of the 
                        enrolled participants are underrepresented 
                        minorities; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant under 
subsection (a) shall be used to expand existing workforce diversity 
programs, implement new workforce diversity programs, or evaluate 
existing or new workforce diversity programs, including with respect to 
mental health care professions. Such programs shall enhance diversity 
by considering minority status as part of an individualized 
consideration of qualifications. Possible activities may include--
            ``(1) educational outreach programs relating to 
        opportunities in the health professions;
            ``(2) scholarship, fellowship, grant, loan repayment, and 
        loan cancellation programs;
            ``(3) postbaccalaureate programs;
            ``(4) academic enrichment programs, particularly targeting 
        those who would not be competitive for health professions 
        schools;
            ``(5) supporting workforce diversity in kindergarten 
        through 12th grade and other health pipeline programs;
            ``(6) mentoring programs;
            ``(7) internship or rotation programs involving hospitals, 
        health systems, health plans, and other health entities;
            ``(8) community partnership development for purposes 
        relating to workforce diversity; or
            ``(9) leadership training.
    ``(d) Reports.--Not later than 1 year after receiving a grant under 
this section, and annually for the term of the grant, a grantee shall 
submit to the Secretary a report that summarizes and evaluates all 
activities conducted under the grant.
    ``(e) 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 2023 through 2027.

``SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND RESEARCHERS.

    ``(a) In General.--The Secretary, acting through the Director of 
the National Institutes of Health, the Director of the Centers for 
Disease Control and Prevention, the Commissioner of Food and Drugs, the 
Director of the Agency for Healthcare Research and Quality, and the 
Administrator of the Health Resources and Services Administration, 
shall award grants that expand existing opportunities for scientists 
and researchers and promote the inclusion of underrepresented 
minorities in the health professions.
    ``(b) Research Funding.--The head of each agency listed in 
subsection (a) shall establish or expand existing programs to provide 
research funding to scientists and researchers in training. Under such 
programs, the head of each such entity shall give priority in 
allocating research funding to support health research in traditionally 
underserved communities, including underrepresented minority 
communities, and research classified as community or participatory.
    ``(c) Data Collection.--The head of each agency listed in 
subsection (a) shall collect data on the number (expressed as an 
absolute number and a percentage) of underrepresented minority and 
nonminority applicants who receive and are denied agency funding at 
every stage of review. Such data shall be reported annually to the 
Secretary and the appropriate committees of Congress.
    ``(d) Student Loan Reimbursement.--The Secretary shall establish a 
student loan reimbursement program to provide student loan 
reimbursement assistance to researchers who focus on racial and ethnic 
disparities in health. The Secretary shall promulgate regulations to 
define the scope and procedures for the program under this subsection.
    ``(e) Student Loan Cancellation.--The Secretary shall establish a 
student loan cancellation program to provide student loan cancellation 
assistance to researchers who focus on racial and ethnic disparities in 
health. Students participating in the program shall make a minimum 5-
year commitment to work at an accredited health profession school. The 
Secretary shall promulgate additional regulations to define the scope 
and procedures for the program under this subsection.
    ``(f) 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 2023 through 2027.

``SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, the Assistant Secretary 
for Mental Health and Substance Use, the Administrator of the Health 
Resources and Services Administration, and the Administrator of the 
Centers for Medicare & Medicaid Services, shall establish a program to 
award grants to universities and other institutions to enter into 
agreements with eligible individuals under which--
            ``(1) the university or institution supports the eligible 
        individual's career in a nonresearch-related health and 
        wellness profession; and
            ``(2) the eligible individual commits to performing a 
        period of obligated service in such a career to serve, or to 
        work on health issues affecting, underserved communities, such 
        as racial and ethnic minority communities.
    ``(b) Eligible Individuals.--To be an eligible individual for 
purposes of subsection (a), an individual shall be a student in a 
health professions school, a graduate of such a school who is working 
in a health profession, an individual working in a health or wellness 
profession (including mental and behavioral health), or a faculty 
member of such a school.
    ``(c) Application.--To seek a grant under this section, a 
university or other institution shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require.
    ``(d) Use of Funds.--A university or other institution receiving a 
grant under this section shall use the grant for agreements described 
in subsection (a). Such agreements may--
            ``(1) support an eligible individual's health activities or 
        projects that involve underserved communities, including racial 
        and ethnic minority communities;
            ``(2) support an eligible individual's health-related 
        career advancement activities;
            ``(3) pay, or reimburse for payment of, student loans or 
        training or credentialing costs for eligible individuals who 
        are health professionals and are focused on health issues 
        affecting underserved communities, including racial and ethnic 
        minority communities; and
            ``(4) establish and promote leadership training programs 
        for eligible individuals to decrease health disparities and to 
        increase cultural competence with the goal of increasing 
        diversity in leadership positions.
    ``(e) Definition.--In this section, the term `career in a 
nonresearch-related health and wellness profession' means employment or 
intended employment in the field of public health, health policy, 
health management, health administration, medicine, nursing, pharmacy, 
psychology, social work, psychiatry, other mental and behavioral 
health, allied health, community health, social work, or other fields 
determined appropriate by the Secretary, other than in a position that 
involves research.
    ``(f) 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 2023 through 2027.

``SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DIVERSITY ON QUALITY.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality (in this section referred to as the `Director'), 
in collaboration with the Deputy Assistant Secretary for Minority 
Health and the Director of the National Institute on Minority Health 
and Health Disparities, shall award grants to eligible entities to 
expand research on the link between health workforce diversity and 
quality health care.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a clinical, public health, or health services 
        research entity or other entity determined appropriate by the 
        Director; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant awarded under 
subsection (a) shall be used to support research that investigates the 
effect of health workforce diversity on--
            ``(1) language access;
            ``(2) cultural competence;
            ``(3) patient satisfaction;
            ``(4) timeliness of care;
            ``(5) safety of care;
            ``(6) effectiveness of care;
            ``(7) efficiency of care;
            ``(8) patient outcomes;
            ``(9) community engagement;
            ``(10) resource allocation;
            ``(11) organizational structure;
            ``(12) compliance of care; or
            ``(13) other topics determined appropriate by the Director.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give individualized consideration to all relevant 
aspects of the applicant's background. Consideration of prior research 
experience involving the health of underserved communities shall be 
such a factor.
    ``(e) 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 2023 through 2027.

``SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the Office of 
Minority Health, in collaboration with the National Institute on 
Minority Health and Health Disparities, the Office for Civil Rights, 
the Centers for Disease Control and Prevention, the Centers for 
Medicare & Medicaid Services, the Health Resources and Services 
Administration, and other appropriate public and private entities, 
shall establish and coordinate a health and health care disparities 
education program to support, develop, and implement educational 
initiatives and outreach strategies that inform health care 
professionals and the public about the existence of and methods to 
reduce racial and ethnic disparities in health and health care.
    ``(b) Activities.--The Secretary, through the education program 
established under subsection (a), shall, through the use of public 
awareness and outreach campaigns targeting the general public and the 
medical community at large--
            ``(1) disseminate scientific evidence for the existence and 
        extent of racial and ethnic disparities in health care, 
        including disparities that are not otherwise attributable to 
        known factors such as access to care, patient preferences, or 
        appropriateness of intervention, as described in the 2002 
        Institute of Medicine Report entitled `Unequal Treatment: 
        Confronting Racial and Ethnic Disparities in Health Care', as 
        well as the impact of disparities related to age, disability 
        status, socioeconomic status, sex, gender identity, and sexual 
        orientation on racial and ethnic minorities;
            ``(2) disseminate new research findings to health care 
        providers and patients to assist them in understanding, 
        reducing, and eliminating health and health care disparities;
            ``(3) disseminate information about the impact of 
        linguistic and cultural barriers on health care quality and the 
        obligation of health providers who receive Federal financial 
        assistance to ensure that individuals with limited English 
        proficiency have access to language access services;
            ``(4) disseminate information about the importance and 
        legality of racial, ethnic, disability status, socioeconomic 
        status, sex, gender identity, and sexual orientation, and 
        primary language data collection, analysis, and reporting;
            ``(5) design and implement specific educational initiatives 
        to health care providers relating to health and health care 
        disparities;
            ``(6) assess the impact of the programs established under 
        this section in raising awareness of health and health care 
        disparities and providing information on available resources; 
        and
            ``(7) design and implement specific educational initiatives 
        to educate the health care workforce relating to unconscious 
        bias.
    ``(c) 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 2023 through 2027.''.

SEC. 3002. HISPANIC-SERVING INSTITUTIONS, HISTORICALLY BLACK COLLEGES 
              AND UNIVERSITIES, HISTORICALLY BLACK PROFESSIONAL OR 
              GRADUATE INSTITUTIONS, ASIAN AMERICAN AND NATIVE AMERICAN 
              PACIFIC ISLANDER-SERVING INSTITUTIONS, TRIBAL COLLEGES, 
              REGIONAL COMMUNITY-BASED ORGANIZATIONS, AND NATIONAL 
              MINORITY MEDICAL ASSOCIATIONS.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by adding at the end the following:

``SEC. 742. HISPANIC-SERVING INSTITUTIONS, HISTORICALLY BLACK COLLEGES 
              AND UNIVERSITIES, HISTORICALLY BLACK PROFESSIONAL OR 
              GRADUATE INSTITUTIONS, ASIAN AMERICAN AND NATIVE AMERICAN 
              PACIFIC ISLANDER-SERVING INSTITUTIONS, AND TRIBAL 
              COLLEGES.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Secretary of Education, shall award grants to Hispanic-serving 
institutions, historically Black colleges and universities, 
historically Black professional or graduate institutions eligible for 
grants under section 326 of the Higher Education Act of 1965, Asian 
American and Native American Pacific Islander-serving institutions, 
Tribal Colleges or Universities, regional community-based 
organizations, and national minority medical associations, for 
counseling, mentoring, and providing information on financial 
assistance to prepare underrepresented minority individuals to enroll 
in and graduate from health professional schools and to increase 
services for underrepresented minority students including--
            ``(1) mentoring with underrepresented health professionals;
            ``(2) providing financial assistance information for 
        continued education and applications to health professional 
        schools; and
            ``(3) retaining existing enrolled underrepresented minority 
        students in a health professions school.
    ``(b) Definitions.--In this section:
            ``(1) Asian american and native american pacific islander-
        serving institution.--The term `Asian American and Native 
        American Pacific Islander-serving institution' has the meaning 
        given such term in section 320(b) of the Higher Education Act 
        of 1965.
            ``(2) Hispanic-serving institution.--The term `Hispanic-
        serving institution' means an entity that--
                    ``(A) is a school or program for which there is a 
                definition under section 799B;
                    ``(B) has an enrollment of full-time equivalent 
                students that is made up of at least 9 percent Hispanic 
                students;
                    ``(C) has been effective in carrying out programs 
                to recruit Hispanic individuals to enroll in and 
                graduate from the school;
                    ``(D) has been effective in recruiting and 
                retaining Hispanic faculty members;
                    ``(E) has a significant number of graduates who are 
                providing health services to medically underserved 
                populations or to individuals in health professional 
                shortage areas; and
                    ``(F) is a Hispanic Center of Excellence in Health 
                Professions Education designated under section 
                736(d)(2) of the Public Health Service Act (42 U.S.C. 
                293(d)(2)).
            ``(3) Historically black college and university.--The term 
        `historically Black college and university' has the meaning 
        given the term `part B institution' as defined in section 322 
        of the Higher Education Act of 1965.
            ``(4) Tribal college or university.--The term `Tribal 
        College or University' has the meaning given such term in 
        section 316(b) of the Higher Education Act of 1965.
    ``(c) Certain Loan Repayment Programs.--In carrying out the 
National Health Service Corps Loan Repayment Program established under 
subpart III of part D of title III and the loan repayment program under 
section 317F, the Secretary shall ensure, notwithstanding such subpart 
or section, that loan repayments of not less than $50,000 per year per 
person are awarded for repayment of loans incurred for enrollment or 
participation of underrepresented minority individuals in health 
professional schools and other health programs described in this 
section.
    ``(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 2023 through 2027.''.

SEC. 3003. LOAN REPAYMENT PROGRAM OF CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    Section 317F(c)(1) of the Public Health Service Act (42 U.S.C. 
247b-7(c)(1)) is amended by striking ``$500,000 for fiscal year 1994, 
and such sums as may be necessary for each of the fiscal years 1995 
through 2002'' and inserting ``such sums as may be necessary for each 
of fiscal years 2023 through 2027''.

SEC. 3004. ALLIED HEALTH WORKFORCE DIVERSITY.

    (a) Increasing Workforce Diversity in the Professions of Physical 
Therapy, Occupational Therapy, Respiratory Therapy, Audiology, and 
Speech-Language Pathology.--Title VII of the Public Health Service Act 
is amended--
            (1) by redesignating part G (42 U.S.C. 295j et seq.) as 
        part H; and
            (2) by inserting after part F (42 U.S.C. 295h) the 
        following new part:

``PART G--INCREASING WORKFORCE DIVERSITY IN THE PROFESSIONS OF PHYSICAL 
  THERAPY, OCCUPATIONAL THERAPY, RESPIRATORY THERAPY, AUDIOLOGY, AND 
                       SPEECH-LANGUAGE PATHOLOGY

``SEC. 783. SCHOLARSHIPS AND STIPENDS.

    ``(a) In General.--The Secretary may award grants and contracts to 
eligible entities to increase educational opportunities in the 
professions of physical therapy, occupational therapy, respiratory 
therapy, audiology, and speech-language pathology for eligible 
individuals by--
            ``(1) providing student scholarships or stipends, including 
        for--
                    ``(A) completion of an accelerated degree program;
                    ``(B) completion of an associate's, bachelor's, 
                master's, or doctoral degree program; and
                    ``(C) entry by a diploma or associate's degree 
                practitioner into a bridge or degree completion 
                program;
            ``(2) providing assistance for completion of prerequisite 
        courses or other preparation necessary for acceptance for 
        enrollment in the eligible entity; and
            ``(3) carrying out activities to increase the retention of 
        students in one or more programs in the professions of physical 
        therapy, occupational therapy, respiratory therapy, audiology, 
        and speech-language pathology.
    ``(b) Consideration of Recommendations.--In carrying out subsection 
(a), the Secretary shall take into consideration the recommendations of 
national organizations representing the professions of physical 
therapy, occupational therapy, respiratory therapy, audiology, and 
speech-language pathology, including the American Physical Therapy 
Association, the American Occupational Therapy Association, the 
American Speech-Language-Hearing Association, the American Association 
for Respiratory Care, the American Academy of Audiology, and the 
Academy of Doctors of Audiology.
    ``(c) Required Information and Conditions for Award Recipients.--
            ``(1) In general.--The Secretary may require recipients of 
        awards under this section to report to the Secretary concerning 
        the annual admission, retention, and graduation rates for 
        eligible individuals in programs of the recipient leading to a 
        degree in any of the professions of physical therapy, 
        occupational therapy, respiratory therapy, audiology, and 
        speech-language pathology.
            ``(2) Falling rates.--If any of the rates reported by a 
        recipient under paragraph (1) fall below the average for such 
        recipient over the two years preceding the year covered by the 
        report, the recipient shall provide the Secretary with plans 
        for immediately improving such rates.
            ``(3) Ineligibility.--A recipient described in paragraph 
        (2) shall be ineligible for continued funding under this 
        section if the plan of the recipient fails to improve the rates 
        within the 1-year period beginning on the date such plan is 
        implemented.
    ``(d) Definitions.--In this section:
            ``(1) Eligible entities.--The term `eligible entity' means 
        an accredited education program that is carrying out a program 
        for recruiting and retaining students underrepresented in the 
        professions of physical therapy, occupational therapy, 
        respiratory therapy, audiology, and speech-language pathology 
        (including racial or ethnic minorities, or students from 
        disadvantaged backgrounds).
            ``(2) Eligible individual.--The term `eligible individual' 
        means an individual who--
                    ``(A) is a member of a class of persons who are 
                underrepresented in the professions of physical 
                therapy, occupational therapy, respiratory therapy, 
                audiology, and speech-language pathology, including 
                individuals who are--
                            ``(i) racial or ethnic minorities;
                            ``(ii) from disadvantaged backgrounds; or
                            ``(iii) individuals with a disability (as 
                        defined in section 3(1) of the Americans with 
                        Disabilities Act of 1990), or who have an 
                        individualized education program (as defined in 
                        section 602 of the Individuals with 
                        Disabilities Education Act), are covered under 
                        section 504 of the Rehabilitation Act of 1973, 
                        or have other documentation establishing the 
                        student's disability (as such term is defined 
                        in section 3(1) of the Americans with 
                        Disabilities Act of 1990);
                    ``(B) has a financial need for a scholarship or 
                stipend; and
                    ``(C) is enrolled (or accepted for enrollment) at 
                an audiology, speech-language pathology, respiratory 
                therapy, physical therapy, or occupational therapy 
                program as a full-time student at an eligible entity.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $8,000,000 for the first fiscal 
year commencing after the date of enactment of the Health Equity and 
Accountability Act of 2022 and each of the 4 succeeding fiscal 
years.''.
    (b) Eligibility Clarification Regarding Students Supported Through 
Mental and Behavioral Health Education and Training Grants.--Section 
756(a)(1) of the Public Health Service Act (42 U.S.C. 294e-1(a)(1)) is 
amended by inserting after ``occupational therapy'' the following: 
``(which may include master's and doctoral level programs)''.

SEC. 3005. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS AT SCHOOLS 
              OF PUBLIC HEALTH AND SCHOOLS OF ALLIED HEALTH.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by inserting after section 755 of such Act (42 
U.S.C. 294e) the following:

``SEC. 755A. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS.

    ``(a) Cooperative Agreements.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, in 
consultation with the Director of the Centers for Disease Control and 
Prevention, the Director of the Agency for Healthcare Research and 
Quality, and the Deputy Assistant Secretary for Minority Health, shall 
enter into cooperative agreements with schools of public health and 
schools of allied health to design and implement online degree 
programs.
    ``(b) Priority.--In entering into cooperative agreements under this 
section, the Secretary shall give priority to any school of public 
health or school of allied health that has an established track record 
of serving medically underserved communities.
    ``(c) Requirements.--As a condition of entering into a cooperative 
agreement with the Secretary under this section, a school of public 
health or school of allied health shall agree to design and implement 
an online degree program that meets the following restrictions:
            ``(1) Enrollment of individuals who have obtained a 
        secondary school diploma or its recognized equivalent.
            ``(2) Maintaining a significant enrollment of 
        underrepresented minority or disadvantaged students.
            ``(3) Achieving a high completion rate of enrolled 
        underrepresented minority or disadvantaged students.
    ``(d) Period of Cooperative Agreements.--The period during which 
payments are made through a cooperative agreement entered into under 
this section may not exceed 3 years.
    ``(e) 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 2023 through 2027.''.

SEC. 3006. NATIONAL HEALTH CARE WORKFORCE COMMISSION.

    (a) Sense of Congress.--It is the sense of Congress that the 
National Health Care Workforce Commission established by section 5101 
of the Patient Protection and Affordable Care Act (42 U.S.C. 294q) 
should, in carrying out its assigned duties under that section, give 
attention to the needs of racial and ethnic minorities, individuals 
with lower socioeconomic status, individuals with mental, 
developmental, and physical disabilities, lesbian, gay, bisexual, 
transgender, queer, and questioning populations, and individuals who 
are members of multiple minority or special population groups.
    (b) Reauthorization.--Section 5101(h)(2) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 294q(h)(2)) is amended by striking 
``such sums as may be necessary'' and inserting ``$3,000,000 for each 
of fiscal years 2023 through 2025''.

SEC. 3007. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.

    Subtitle B of title XXXIV of the Public Health Service Act, as 
added by section 3001, is further amended by inserting after section 
3417 the following:

``SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Administrator of the Health 
Resources and Services Administration and the Deputy Assistant 
Secretary for Minority Health, shall award grants to eligible entities 
to increase awareness among secondary and postsecondary students of 
career opportunities in the health professions.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a clinical, public health, or health services 
        organization, community-based or nonprofit entity, or other 
        entity determined appropriate by the Director of the Centers 
        for Disease Control and Prevention;
            ``(2) serve a health professional shortage area, as 
        determined by the Secretary;
            ``(3) work with students, including those from racial and 
        ethnic minority backgrounds, that have expressed an interest in 
        the health professions; and
            ``(4) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Grant awards under subsection (a) shall be 
used to support internships that will increase awareness among students 
of non-research-based, career opportunities in the following health 
professions:
            ``(1) Medicine.
            ``(2) Nursing.
            ``(3) Public health.
            ``(4) Pharmacy.
            ``(5) Health administration and management.
            ``(6) Health policy.
            ``(7) Psychology.
            ``(8) Dentistry.
            ``(9) International health.
            ``(10) Social work.
            ``(11) Allied health.
            ``(12) Psychiatry.
            ``(13) Hospice care.
            ``(14) Community health, patient navigation, and peer 
        support.
            ``(15) Other professions determined appropriate by the 
        Director of the Centers for Disease Control and Prevention.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Centers for Disease Control and Prevention shall give 
priority to those entities that--
            ``(1) serve a high proportion of individuals from 
        disadvantaged backgrounds;
            ``(2) have experience in health disparity elimination 
        programs;
            ``(3) facilitate the entry of disadvantaged individuals 
        into institutions of higher education; and
            ``(4) provide counseling or other services designed to 
        assist disadvantaged individuals in successfully completing 
        their education at the postsecondary level.
    ``(e) Stipends.--
            ``(1) In general.--Subject to paragraph (2), an entity 
        receiving a grant under this section may use the funds made 
        available through such grant to award stipends for educational 
        and living expenses to students participating in the internship 
        supported by the grant.
            ``(2) Limitations.--A stipend awarded under paragraph (1) 
        to an individual--
                    ``(A) may not be provided for a period that exceeds 
                6 months; and
                    ``(B) may not exceed $20 per day for an individual 
                (notwithstanding any other provision of law regarding 
                the amount of a stipend).
    ``(f) 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 2023 through 2027.

``SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Deputy Assistant Secretary 
for Minority Health, shall award scholarships to eligible individuals 
under subsection (b) who seek a career in public health.
    ``(b) Eligibility.--To be eligible to receive a scholarship under 
subsection (a), an individual shall--
            ``(1) have interest, knowledge, or skill in public health 
        research or public health practice, or other health professions 
        as determined appropriate by the Director of the Centers for 
        Disease Control and Prevention;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) demonstrate promise for becoming a leader in public 
        health;
            ``(4) secure admission to a 4-year institution of higher 
        education; and
            ``(5) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become public health professionals.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give priority to those students that--
            ``(1) are from disadvantaged backgrounds;
            ``(2) have secured admissions to a minority-serving 
        institution; and
            ``(3) have identified a health professional as a mentor at 
        their school or institution and an academic advisor to assist 
        in the completion of their baccalaureate degree.
    ``(e) Scholarships.--The Secretary may approve payment of 
scholarships under this section for such individuals for any period of 
education in student undergraduate tenure, except that such a 
scholarship may not be provided to an individual for more than 4 years, 
and such a scholarship may not exceed $10,000 per academic year for an 
individual (notwithstanding any other provision of law regarding the 
amount of a scholarship).
    ``(f) 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 2023 through 2027.

``SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH FELLOWSHIP PROGRAM.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Deputy Assistant Secretary 
for Minority Health, the Assistant Secretary for Mental Health and 
Substance Use, and the Director of the Indian Health Service, shall 
award research fellowships to eligible individuals under subsection (b) 
to conduct research that will examine gender and health disparities and 
to pursue a career in the health professions.
    ``(b) Eligibility.--To be eligible to receive a fellowship under 
subsection (a), an individual shall--
            ``(1) have experience in health research or public health 
        practice;
            ``(2) reside in a health professional shortage area 
        designated by the Secretary under section 332;
            ``(3) have expressed an interest in the health professions;
            ``(4) demonstrate promise for becoming a leader in the 
        field of women's sexual and reproductive health, including 
        family planning;
            ``(5) secure admission to a health professions school or 
        graduate program with an emphasis in gender studies; and
            ``(6) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--A fellowship awarded under subsection (a) to 
an eligible individual shall be used to support an opportunity for the 
individual to become a researcher and advance the research base on the 
intersection between gender and health.
    ``(d) Priority.--In awarding fellowships under subsection (a), the 
Director of the Centers for Disease Control and Prevention shall give 
priority to those applicants that--
            ``(1) are from disadvantaged backgrounds; and
            ``(2) have identified a mentor and academic advisor who 
        will assist in the completion of their graduate or professional 
        degree and have secured a research assistant position with a 
        researcher working in the area of gender and health.
    ``(e) Fellowships.--The Director of the Centers for Disease Control 
and Prevention may approve fellowships for individuals under this 
section for any period of education in the student's graduate or health 
profession tenure, except that such a fellowship may not be provided to 
an individual for more than 3 years, and such a fellowship may not 
exceed $18,000 per academic year for an individual (notwithstanding any 
other provision of law regarding the amount of a fellowship).
    ``(f) 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 2023 through 2027.

``SEC. 3421. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP 
              PROGRAM.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Deputy Assistant 
Secretary for Minority Health, shall award research fellowships to 
eligible individuals under subsection (b) to advance their 
understanding of international health.
    ``(b) Eligibility.--To be eligible to receive a fellowship under 
subsection (a), an individual shall--
            ``(1) have educational experience in the field of 
        international health;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) demonstrate promise for becoming a leader in the 
        field of international health;
            ``(4) be a college senior or recent graduate of a 4-year 
        institution of higher education; and
            ``(5) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--A fellowship awarded under subsection (a) to 
an eligible individual shall be used to support an opportunity for the 
individual to become a health professional and to advance the knowledge 
of the individual about international issues relating to health care 
access and quality.
    ``(d) Priority.--In awarding fellowships under subsection (a), the 
Director shall give priority to eligible individuals that--
            ``(1) are from a disadvantaged background; and
            ``(2) have identified a mentor at a health professions 
        school or institution, an academic advisor to assist in the 
        completion of their graduate or professional degree, and an 
        advisor from an international health non-governmental 
        organization, private volunteer organization, or other 
        international institution or program that focuses on increasing 
        health care access and quality for residents in developing 
        countries.
    ``(e) Fellowships.--A fellowship awarded under this section may 
not--
            ``(1) be provided to an eligible individual for more than a 
        period of 6 months;
            ``(2) be awarded to a graduate of a 4-year institution of 
        higher education that has not been enrolled in such institution 
        for more than 1 year; or
            ``(3) exceed $4,000 per academic year (notwithstanding any 
        other provision of law regarding the amount of a fellowship).
    ``(f) 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 2023 through 2027.

``SEC. 3422. EDWARD R. ROYBAL HEALTH SCHOLAR PROGRAM.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, the Administrator of the Centers for Medicare & 
Medicaid Services, and the Administrator of the Health Resources and 
Services Administration, in collaboration with the Deputy Assistant 
Secretary for Minority Health, shall award grants to eligible entities 
to expose entering graduate students to the health professions.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a clinical, public health, or health services 
        organization, community-based, academic, or nonprofit entity, 
        or other entity determined appropriate by the Director of the 
        Agency for Healthcare Research and Quality;
            ``(2) serve in a health professional shortage area 
        designated by the Secretary under section 332;
            ``(3) work with students obtaining a degree in the health 
        professions; and
            ``(4) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant awarded under 
subsection (a) shall be used to support opportunities that expose 
students to non-research-based health professions, including--
            ``(1) public health policy;
            ``(2) health care and pharmaceutical policy;
            ``(3) health care administration and management;
            ``(4) health economics; and
            ``(5) other professions determined appropriate by the 
        Director of the Agency for Healthcare Research and Quality, the 
        Administrator of the Centers for Medicare & Medicaid Services, 
        or the Administrator of the Health Resources and Services 
        Administration.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Agency for Healthcare Research and Quality, the 
Administrator of the Centers for Medicare & Medicaid Services, and the 
Administrator of the Health Resources and Services Administration, in 
collaboration with the Deputy Assistant Secretary for Minority Health, 
shall give priority to entities that--
            ``(1) have experience with health disparity elimination 
        programs;
            ``(2) facilitate training in the fields described in 
        subsection (c); and
            ``(3) provide counseling or other services designed to 
        assist students in successfully completing their education at 
        the postsecondary level.
    ``(e) Stipends.--
            ``(1) In general.--Subject to paragraph (2), an entity 
        receiving a grant under this section may use the funds made 
        available through such grant to award stipends for educational 
        and living expenses to students participating in the 
        opportunities supported by the grant.
            ``(2) Limitations.--A stipend awarded under paragraph (1) 
        to an individual--
                    ``(A) may not be provided for a period that exceeds 
                2 months; and
                    ``(B) may not exceed $100 per day (notwithstanding 
                any other provision of law regarding the amount of a 
                stipend).
    ``(f) 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 2023 through 2027.

``SEC. 3423. LEADERSHIP FELLOWSHIP PROGRAMS.

    ``(a) In General.--The Secretary shall award grants to national 
minority medical or health professional associations to develop 
leadership fellowship programs for underrepresented health 
professionals in order to--
            ``(1) assist such professionals in becoming future leaders 
        in public health and health care delivery institutions; and
            ``(2) increase diversity in decision-making positions that 
        can improve the health of underserved communities.
    ``(b) Use of Funds.--A leadership fellowship program supported 
under this section shall--
            ``(1) focus on training mid-career physicians and health 
        care executives who have documented leadership experience and a 
        commitment to public health services in underserved 
        communities; and
            ``(2) support Federal public health policy and budget 
        programs, and priorities that impact health equity, through 
        activities such as didactic lectures and leader site visits.
    ``(c) Period of Grants.--The period during which payments are made 
under a grant awarded under subsection (a) may not exceed 3 years.
    ``(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 2023 through 2027.''.

SEC. 3008. MCNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM.

    Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a-
15) is amended by striking subsection (g) and inserting the following:
    ``(g) Collaboration in Health Profession Diversity Training 
Programs.--The Secretary shall coordinate with the Secretary of Health 
and Human Services to ensure that there is collaboration between the 
goals of the program under this section and programs of the Health 
Resources and Services Administration that promote health workforce 
diversity. The Secretary of Education shall take such measures as may 
be necessary to encourage students participating in projects assisted 
under this section to consider health profession careers.
    ``(h) Funding.--From amounts appropriated pursuant to the authority 
of section 402A(g), the Secretary shall, to the extent practicable, 
allocate funds for projects authorized by this section in an amount 
that is not less than $31,000,000 for each of the fiscal years 2023 
through 2027.''.

SEC. 3009. RULES FOR DETERMINATION OF FULL-TIME EQUIVALENT RESIDENTS 
              FOR COST-REPORTING PERIODS.

    (a) DGME Determinations.--Section 1886(h)(4) of the Social Security 
Act (42 U.S.C. 1395ww(h)(4)), as amended by section 2006(a), is 
amended--
            (1) in subparagraph (E), by striking ``Subject to 
        subparagraphs (J) and (K), such rules'' and inserting ``Subject 
        to subparagraphs (J), (K), and (M), such rules'';
            (2) in subparagraph (J), by striking ``Such rules'' and 
        inserting ``Subject to subparagraph (M), such rules'';
            (3) in subparagraph (K), by striking ``In determining'' and 
        inserting ``Subject to subparagraph (M), in determining''; and
            (4) by adding at the end the following new subparagraph:
                    ``(M) Treatment of certain residents and interns.--
                For purposes of cost-reporting periods beginning on or 
                after October 1, 2021, in determining the hospital's 
                number of full-time equivalent residents for purposes 
                of this paragraph, all time spent by an intern or 
                resident in an approved medical residency training 
                program shall be counted toward the determination of 
                full-time equivalency if the hospital--
                            ``(i) is recognized as a subsection (d) 
                        hospital;
                            ``(ii) is recognized as a subsection (d) 
                        Puerto Rico hospital;
                            ``(iii) is reimbursed under a reimbursement 
                        system authorized under section 1814(b)(3); or
                            ``(iv) is a provider-based hospital 
                        outpatient department.''.
    (b) IME Determinations.--Section 1886(d)(5)(B)(xi) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(B)(xi)), as redesignated by 
section 2006(b), is amended--
            (1) in subclause (II), by striking ``In determining'' and 
        inserting ``Subject to subclause (IV), in determining'';
            (2) in subclause (III), by striking ``In determining'' and 
        inserting ``Subject to subclause (IV), in determining''; and
            (3) by inserting after subclause (III) the following new 
        subclause:
                    ``(IV) For purposes of cost-reporting periods 
                beginning on or after October 1, 2021, the provisions 
                of subparagraph (M) of subsection (h)(4) shall apply 
                under this subparagraph in the same manner as they 
                apply under such subsection.''.

SEC. 3010. DEVELOPING AND IMPLEMENTING STRATEGIES FOR LOCAL HEALTH 
              EQUITY.

    (a) Grants.--The Secretary of Health and Human Services, acting 
jointly with the Secretary of Education and the Secretary of Labor, 
shall make grants to an eligible institution of higher education for 
the purposes of--
            (1) in accordance with subsection (b), developing 
        capacity--
                    (A) to build an evidence base for successful 
                strategies for increasing local health equity; and
                    (B) to serve as national models of driving local 
                health equity; and
            (2) in accordance with subsection (c), developing a 
        strategic partnership with the community in which the 
        institution is located.
    (b) Developing Capacity for Increasing Local Health Equity.--As a 
condition on receipt of a grant under subsection (a), an institution of 
higher education shall agree to use such grant to build an evidence 
base for successful strategies for increasing local health equity, and 
to serve as a national model of driving local health equity, by 
supporting--
            (1) resources to strengthen institutional metrics and 
        capacity to execute institution-wide health workforce goals 
        that can serve as models for increasing health equity in 
        communities across the United States;
            (2) collaborations among a cohort of institutions in 
        implementing systemic change, partnership development, and 
        programmatic efforts supportive of health equity goals across 
        disciplines and populations; and
            (3) enhanced or newly developed data systems and research 
        infrastructure capable of informing current and future 
        workforce efforts and building a foundation for a broader 
        research agenda targeting urban health disparities.
    (c) Strategic Partnerships.--As a condition on receipt of a grant 
under subsection (a), an institution of higher education shall agree to 
use the grant to develop a strategic partnership with the community in 
which such institution is located for the purposes of--
            (1) strengthening connections between such institution and 
        the community--
                    (A) to improve evaluation of, and address, the 
                health and health workforce needs of such community; 
                and
                    (B) to engage such community in health workforce 
                development;
            (2) developing, enhancing, or accelerating innovative 
        undergraduate and graduate programs in the biomedical sciences 
        and health professions; and
            (3) strengthening pipeline programs in the biomedical 
        sciences and health professions, including by developing 
        partnerships between institutions of higher education and 
        elementary schools and secondary schools to recruit the next 
        generation of health professionals earlier in the pipeline to a 
        health care career.
    (d) Eligible Institution of Higher Education Defined.--For purposes 
of this section, an ``eligible institution of higher education'' 
includes--
            (1) a program authorized under section 317(a) of the Higher 
        Education Act of 1965 (20 U.S.C. 1059d(a)); or
            (2) a professional or graduate institution described in 
        section 326 of such Act.
    (e) 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 2023 through 2027.

SEC. 3011. HEALTH PROFESSIONS WORKFORCE FUND.

    (a) Establishment.--There is established in the Health Resources 
and Services Administration of the Department of Health and Human 
Services a Health Professions Workforce Fund to provide for expanded 
and sustained national investment in the health professions and nursing 
workforce development programs under title VII and title VIII of the 
Public Health Service Act (42 U.S.C. 292 et seq.; 42 U.S.C. 296 et 
seq.).
    (b) Funding.--
            (1) In general.--There is authorized to be appropriated, 
        and there is appropriated, out of any monies in the Treasury 
        not otherwise appropriated, to the Health Professions Workforce 
        Fund--
                    (A) $392,000,000 for fiscal year 2023;
                    (B) $412,000,000 for fiscal year 2024;
                    (C) $432,000,000 for fiscal year 2025;
                    (D) $454,000,000 for fiscal year 2026;
                    (E) $476,000,000 for fiscal year 2027;
                    (F) $500,000,000 for fiscal year 2028;
                    (G) $525,000,000 for fiscal year 2029; and
                    (H) $552,000,000 for fiscal year 2030.
            (2) Health professions education programs.--For the purpose 
        of carrying out health professions education programs 
        authorized under title VII of the Public Health Service Act (42 
        U.S.C. 292 et seq.), in addition to any other amounts 
        authorized to be appropriated for such purpose, there is 
        authorized to be appropriated out of any monies in the Health 
        Professions Workforce Fund, the following:
                    (A) $265,000,000 for fiscal year 2023.
                    (B) $278,000,000 for fiscal year 2024.
                    (C) $292,000,000 for fiscal year 2025.
                    (D) $307,000,000 for fiscal year 2026.
                    (E) $322,000,000 for fiscal year 2027.
                    (F) $338,000,000 for fiscal year 2028.
                    (G) $355,000,000 for fiscal year 2029.
                    (H) $373,000,000 for fiscal year 2030.
            (3) Nursing workforce development programs.--For the 
        purpose of carrying out nursing workforce development programs 
        authorized under title VIII of the Public Health Service Act 
        (42 U.S.C. 296 et seq.), in addition to any other amounts 
        authorized to be appropriated for such purpose, there is 
        authorized to be appropriated out of any monies in the Health 
        Professions Workforce Fund, the following:
                    (A) $127,000,000 for fiscal year 2023.
                    (B) $134,000,000 for fiscal year 2024.
                    (C) $140,000,000 for fiscal year 2025.
                    (D) $147,000,000 for fiscal year 2026.
                    (E) $154,000,000 for fiscal year 2027.
                    (F) $162,000,000 for fiscal year 2028.
                    (G) $170,000,000 for fiscal year 2029.
                    (H) $179,000,000 for fiscal year 2030.

SEC. 3012. FUTURE ADVANCEMENT OF ACADEMIC NURSING.

    (a) Support for Nursing Education and the Future Nursing 
Workforce.--Part D of title VIII of the Public Health Service Act (42 
U.S.C. 296p et seq.) is amended by adding at the end the following:

``SEC. 832. NURSING EDUCATION ENHANCEMENT AND MODERNIZATION GRANTS IN 
              UNDERSERVED AREAS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may award grants 
to schools of nursing (as defined in section 801) for--
            ``(1) increasing the number of faculty and students at such 
        schools in order to enhance the preparedness of the United 
        States for, and the ability of the United States to address and 
        quickly respond to, public health emergencies declared under 
        section 319 and pandemics; or
            ``(2) the enhancement and modernization of nursing 
        education programs.
    ``(b) Priority.--In selecting grant recipients under this section, 
the Secretary shall give priority to schools of nursing that--
            ``(1) are located in a medically underserved community;
            ``(2) are located in a health professional shortage area as 
        defined under section 332(a); or
            ``(3) are institutions of higher education listed under 
        section 371(a) of the Higher Education Act of 1965.
    ``(c) Consideration.--In awarding grants under this section, the 
Secretary, to the extent practicable, may ensure equitable distribution 
of awards among the geographic regions of the United States.
    ``(d) Use of Funds.--A school of nursing that receives a grant 
under this section may use the funds awarded through such grant for 
activities that include--
            ``(1) enhancing enrollment and retention of students at 
        such school, with a priority for students from disadvantaged 
        backgrounds (including racial or ethnic groups underrepresented 
        in the nursing workforce), individuals from rural and 
        underserved areas, low-income individuals, and first generation 
        college students (as defined in section 402A(h)(3) of the 
        Higher Education Act of 1965);
            ``(2) creating, supporting, or modernizing educational 
        programs and curriculum at such school;
            ``(3) retaining current faculty, and hiring new faculty, 
        with an emphasis on faculty from racial or ethnic groups who 
        are underrepresented in the nursing workforce;
            ``(4) modernizing infrastructure at such school, including 
        audiovisual or other equipment, personal protective equipment, 
        simulation and augmented reality resources, telehealth 
        technologies, and virtual and physical laboratories;
            ``(5) partnering with a health care facility, nurse-managed 
        health clinic, community health center, or other facility that 
        provides health care in order to provide educational 
        opportunities for the purpose of establishing or expanding 
        clinical education;
            ``(6) enhancing and expanding nursing programs that prepare 
        nurse researchers and scientists;
            ``(7) establishing nurse-led intradisciplinary and 
        interprofessional educational partnerships; and
            ``(8) other activities that the Secretary determines 
        further the development, improvement, and expansion of schools 
        of nursing.
    ``(e) Reports From Entities.--Each school of nursing awarded a 
grant under this section shall submit an annual report to the Secretary 
on the activities conducted under such grant, and other information as 
the Secretary may require.
    ``(f) Report to Congress.--Not later than 5 years after the date of 
the enactment of this section, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the Senate and 
the Committee on Energy and Commerce of the House of Representatives a 
report that provides a summary of the activities and outcomes 
associated with grants made under this section. Such report shall 
include--
            ``(1) a list of schools of nursing receiving grants under 
        this section, including the primary geographic location of any 
        school of nursing that was improved or expanded through such a 
        grant;
            ``(2) the total number of students who are enrolled at or 
        who have graduated from any school of nursing that was improved 
        or expanded through a grant under this section, which such 
        statistic shall--
                    ``(A) to the extent such information is available, 
                be deidentified and disaggregated by race, ethnicity, 
                age, sex, geographic region, disability status, and 
                other relevant factors; and
                    ``(B) include an indication of the number of such 
                students who are from racial or ethnic groups 
                underrepresented in the nursing workforce, such 
                students who are from rural or underserved areas, such 
                students who are low-income students, and such students 
                who are first generation college students (as defined 
                in section 402A(h)(3) of the Higher Education Act of 
                1965);
            ``(3) to the extent such information is available, the 
        effects of the grants awarded under this section on retaining 
        and hiring of faculty, including any increase in diverse 
        faculty, the number of clinical education partnerships, the 
        modernization of nursing education infrastructure, and other 
        ways this section helps address and quickly respond to public 
        health emergencies and pandemics;
            ``(4) recommendations for improving the grants awarded 
        under this section; and
            ``(5) any other considerations as the Secretary determines 
        appropriate.
    ``(g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $1,000,000,000, to remain 
available until expended.''.
    (b) Strengthening Nurse Education.--The heading of part D of title 
VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is 
amended by striking ``basic''.

SEC. 3013. FINDINGS; SENSE OF CONGRESS RELATING TO GRADUATE MEDICAL 
              EDUCATION.

    (a) Findings.--Congress finds the following:
            (1) Projections by the Association of American Medical 
        Colleges and other expert entities, such as the Health 
        Resources and Services Administration, have indicated a 
        nationwide shortage of up to 121,900 physicians, split evenly 
        between primary care and specialists, by 2032.
            (2) Primarily due to the growing and aging population, over 
        the next decade, physician demand is expected to grow up to 17 
        percent.
            (3) The United States Census Bureau estimates that the 
        United States population will grow from 321,000,000 in 2015 to 
        347,000,000 in 2025. Further, the number of Medicare 
        beneficiaries is estimated to increase from 47,800,000 in 2015 
        to approximately 66,000,000 in 2025.
            (4) Approximately 36 percent of practicing physicians are 
        over the age of 55 and are likely to retire within the next 
        decade.
            (5) A nationwide physician shortage will result in many 
        individuals in the United States waiting longer and traveling 
        farther for health care; seeking nonemergent care in emergency 
        departments; and delaying treatment until the health care needs 
        of such individuals become more serious, complex, and costly.
            (6) Changing demographics (such as an aging population), 
        new health care delivery models (such as medical homes), and 
        other factors (such as disaster preparedness) are contributing 
        to a shortage of both generalist and specialist physicians.
            (7) These shortages will have the most severe impact on 
        vulnerable and underserved populations, including racial and 
        ethnic minorities and the approximately 20 percent of people in 
        the United States who live in rural or inner-city locations 
        designated as health professional shortage areas.
            (8) The health care utilization equity model of the 
        Association of American Medical Colleges estimates that if 
        racial and ethnic minorities and individuals from rural areas 
        utilized health care in a similar way to their Caucasian 
        counterparts living in metropolitan areas, the physician 
        shortage would require an additional 96,000 physicians.
            (9) To address the physician shortage in rural and 
        medically underserved areas, medical education and training 
        need to be accessible to underrepresented minorities (including 
        individuals who are African American, Hispanic, Native 
        American, or Native Hawaiian), and need to increase pathway 
        programs for such underrepresented minorities who make up less 
        than 12 percent of individuals enrolled in graduate medical 
        education and for international students who make up 25 percent 
        of individuals enrolled in graduate medical education. 
        Immigration pathways like student, exchange-visitor, and 
        employment visas, and programs like the National Interest 
        Waiver and Conrad 30 J-1 Visa Waiver, help improve health 
        access across the United States.
            (10) United States medical school enrollment was expected 
        to grow by 30 percent from 2018 to 2019 to help reduce the 
        shortage of quality physicians in the United States.
            (11) An increase in United States medical school graduates 
        must be accompanied by an increase of 4,000 graduate medical 
        education training positions each year.
            (12) Graduate medical education programs and teaching 
        hospitals provide venues in which the next generation of 
        physicians learns to work collaboratively with other physicians 
        and health professionals, adopt more efficient care delivery 
        models (such as care coordination and medical homes), 
        incorporate health information technology and electronic health 
        records in every aspect of their work, apply new methods of 
        assuring quality and safety, and participate in groundbreaking 
        clinical and public health research.
            (13) The Medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.) (having more 
        beneficiaries than any other health care program), supports its 
        ``fair share'' of the costs associated with graduate medical 
        education.
            (14) In general, the level of support of graduate medical 
        education by the Medicare program has been capped since 1997 
        and has not been increased to support the expansion of graduate 
        medical education programs needed to avert the projected 
        physician shortage or to accommodate the increase in United 
        States medical school graduates.
    (b) Sense of Congress.--It is the sense of Congress that 
eliminating the limit of the number of residency positions that receive 
some level of Medicare support under section 1886(h) of the Social 
Security Act (42 U.S.C. 1395ww(h)), also referred to as the Medical 
graduate medical education cap, is critical to--
            (1) ensuring an appropriate supply of physicians to meet 
        the health care needs in the United States;
            (2) facilitating equitable access for all who seek health 
        care;
            (3) increasing the racial and ethnic diversity of 
        physicians in the United States; and
            (4) mitigating disparities in health and health care.

SEC. 3014. CAREER SUPPORT FOR SKILLED, INTERNATIONALLY EDUCATED HEALTH 
              PROFESSIONALS.

    (a) Findings.--Congress finds the following:
            (1) According to a 2018 study, the State and local public 
        health workforce has shrunk by more than 50,000 individuals 
        since the beginning of the 2008 Great Recession, and almost one 
        quarter of individuals comprising the governmental public 
        health workforce plan to leave or retire in the coming years.
            (2) Shortages are projected for other health professions, 
        including within the fields of nursing (500,000 by 2025), 
        dentistry (15,000 by 2025), pharmacy (38,000 by 2030), mental 
        and behavioral health (236,880 by 2025), and primary care 
        (46,000 by 2025).
            (3) A nationwide health workforce shortage will result in 
        serious health threats and more severe and costly health care 
        needs, due to, in part, a delayed response to food-borne 
        outbreaks, emerging infectious diseases, natural disasters, 
        fewer cancer screenings, and delayed treatment.
            (4) Vulnerable and underserved populations and health 
        professional shortage areas will be most severely impacted by 
        the health workforce shortage.
            (5) According to the Migration Policy Institute, more than 
        2,000,000 college-educated immigrants in the United States 
        today are unemployed or underemployed in low- or semi-skilled 
        jobs that fail to draw on their education and expertise.
            (6) Approximately 2 out of every 5 internationally educated 
        immigrants are unemployed or underemployed.
            (7) According to the Drexel University Center for Labor 
        Markets and Policy, underemployment for internationally 
        educated immigrant women is 28 percent higher than for their 
        male counterparts.
            (8) According to the Drexel University Center for Labor 
        Markets and Policy, the mean annual earnings of underemployed 
        immigrants were $32,000, or 43 percent less than United States 
        born college graduates employed in the college labor market.
            (9) According to Upwardly Global and the Welcome Back 
        Initiative, with proper guidance and support, underemployed 
        skilled immigrants typically increase their income by 215 
        percent to 900 percent.
            (10) According to the Brookings Institution and the 
        Partnership for a New American Economy, immigrants working in 
        the health workforce are, on average, better educated than 
        United States-born workers in the health workforce.
    (b) Grants to Eligible Entities.--
            (1) Authority to provide grants.--The Secretary of Health 
        and Human Services acting through the Bureau of Health 
        Workforce within the Health Resources and Services 
        Administration, the National Institute on Minority Health and 
        Health Disparities, or the Office of Minority Health (in this 
        section referred to as the ``Secretary'') may award grants to 
        eligible entities to carry out activities described in 
        subsection (c).
            (2) Eligibility.--To be eligible to receive a grant under 
        this section, an entity shall--
                    (A) be a clinical, public health, or health 
                services organization, a community-based or nonprofit 
                entity, an academic institution, a faith-based 
                organization, a State, county, or local government, an 
                area health education center, or another entity 
                determined appropriate by the Secretary; and
                    (B) submit to the Secretary an application at such 
                time, in such manner, and containing such information 
                as the Secretary may require.
    (c) Authorized Activities.--A grant awarded under this section 
shall be used--
            (1) to provide services to assist unemployed and 
        underemployed skilled immigrants, residing in the United 
        States, who have legal, permanent work authorization and who 
        are internationally educated health professionals, enter into 
        the health workforce of the United States with employment 
        matching their health professional skills and education, and 
        advance in employment to positions that better match their 
        health professional education and expertise;
            (2) to provide training opportunities to reduce barriers to 
        entry and advancement in the health workforce for skilled, 
        internationally educated immigrants;
            (3) to educate employers regarding the abilities and 
        capacities of internationally educated health professionals;
            (4) to assist in the evaluation of foreign credentials;
            (5) to support preceptorships for international medical 
        graduates in hospital primary care training; and
            (6) to facilitate access to contextualized and accelerated 
        courses on English as a second language.

SEC. 3015. STUDY AND REPORT ON STRATEGIES FOR INCREASING DIVERSITY.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study on strategies for increasing the diversity of the 
health professional workforce. Such study shall include an analysis of 
strategies for increasing the number of health professionals from 
rural, lower income, and underrepresented minority communities, 
including which strategies are most effective for achieving such goal.
    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Comptroller General shall submit to Congress a report on 
the study conducted under subsection (a), together with recommendations 
for such legislation and administrative action as the Comptroller 
General determines appropriate.

SEC. 3016. CONRAD STATE 30 PROGRAM; PHYSICIAN RETENTION.

    (a) Conrad State 30 Program Extension.--Section 220(c) of the 
Immigration and Nationality Technical Corrections Act of 1994 (Public 
Law 103-416; 8 U.S.C. 1182 note) is amended by striking ``September 30, 
2015'' and inserting ``September 30, 2022''.
    (b) Retaining Physicians Who Have Practiced in Medically 
Underserved Communities.--Section 201(b)(1) of the Immigration and 
Nationality Act (8 U.S.C. 1151(b)(1)) is amended by adding at the end 
the following:
                    ``(F)(i) Alien physicians who have completed 
                service requirements for a national interest waiver 
                requested under section 203(b)(2)(B)(ii), including--
                            ``(I) alien physicians who completed such 
                        service before the date of the enactment of the 
                        Health Equity and Accountability Act of 2022; 
                        and
                            ``(II) the spouse or children of an alien 
                        physician described in subclause (I).
                    ``(ii) Nothing in this subparagraph may be 
                construed--
                            ``(I) to prevent the filing of a petition 
                        with the Secretary of Homeland Security for 
                        classification under section 204(a) or the 
                        filing of an application for adjustment of 
                        status under section 245 by an alien physician 
                        described in clause (i) before the date on 
                        which such alien physician completes the 
                        service described in section 214(l) or worked 
                        full-time as a physician for an aggregate of 5 
                        years at the location identified in the waiver 
                        of the 2-year foreign residence requirement 
                        under section 214(l) or in an area or areas 
                        designated by the Secretary of Health and Human 
                        Services as having a shortage of health care 
                        professionals; or
                            ``(II) to permit the Secretary of Homeland 
                        Security to grant a petition or application 
                        described in subclause (I) until the alien has 
                        satisfied all of the requirements of the waiver 
                        received under section 214(l).''.
    (c) Employment Protections for Physicians.--
            (1) Exceptions to 2-year foreign residency requirement.--
        Section 214(l)(1) of the Immigration and Nationality Act (8 
        U.S.C. 1184(l)(1)) is amended--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``Attorney General shall not'' and inserting 
                ``Secretary of Homeland Security may not'';
                    (B) in subparagraph (A), by striking ``Director of 
                the United States Information Agency'' and inserting 
                ``Secretary of State'';
                    (C) in subparagraph (B), by inserting ``, except as 
                provided in paragraphs (7) and (8)'' before the 
                semicolon at the end;
                    (D) in subparagraph (C), by amending clauses (i) 
                and (ii) to read as follows:
                            ``(i) the alien demonstrates a bona fide 
                        offer of full-time employment at a health 
                        facility or health care organization, which 
                        employment has been determined by the Secretary 
                        of Homeland Security to be in the public 
                        interest; and
                            ``(ii) the alien--
                                    ``(I) has accepted employment with 
                                the health facility or health care 
                                organization in a geographic area or 
                                areas which are designated by the 
                                Secretary of Health and Human Services 
                                as having a shortage of health care 
                                professionals;
                                    ``(II) begins employment by the 
                                later of the date that is--
                                            ``(aa) 120 days after 
                                        receiving such waiver;
                                            ``(bb) 120 days after 
                                        completing graduate medical 
                                        education or training under a 
                                        program approved pursuant to 
                                        section 212(j)(1); or
                                            ``(cc) 120 days after 
                                        receiving nonimmigrant status 
                                        or employment authorization, if 
                                        the alien or the alien's 
                                        employer petitions for such 
                                        nonimmigrant status or 
                                        employment authorization not 
                                        later than 120 days after the 
                                        date on which the alien 
                                        completes his or her graduate 
                                        medical education or training 
                                        under a program approved 
                                        pursuant to section 212(j)(1); 
                                        and
                                    ``(III) agrees to continue to work 
                                for a total of not less than 3 years in 
                                the status authorized for such 
                                employment under this subsection, 
                                except as provided in paragraph (8); 
                                and''; and
                    (E) in subparagraph (D), in the matter preceding 
                clause (i), by inserting ``, subject to paragraph 
                (8),'' before ``in the case''.
            (2) Allowable visa status for physicians fulfilling waiver 
        requirements in medically underserved areas.--Section 
        214(l)(2)(A) of such Act (8 U.S.C. 1184(l)(2)(A)) is amended to 
        read as follows:
                    ``(A) Upon the request of an interested Federal 
                agency or an interested State agency for recommendation 
                of a waiver under this section by a physician who is 
                maintaining valid nonimmigrant status under section 
                101(a)(15)(J) and received a favorable recommendation 
                by the Secretary of State, the Secretary of Homeland 
                Security may change the status of such physician to any 
                status authorized for employment under this Act. The 
                numerical limitations set forth in subsection (g)(1)(A) 
                shall not apply to any alien whose status is changed 
                under this subparagraph.''.
            (3) Violation of agreements.--Section 214(l)(3)(A) of such 
        Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting 
        ``substantial requirement of an'' before ``agreement entered 
        into''.
            (4) Physician employment in underserved areas.--Section 
        214(l) of such Act (8 U.S.C. 1184(l)), as amended by this 
        section, is further amended by adding at the end the following:
            ``(4)(A) If an interested State agency denies the 
        application for a waiver under paragraph (1)(B) from a 
        physician pursuing graduate medical education or training 
        pursuant to section 101(a)(15)(J) because the State has 
        requested the maximum number of waivers permitted for that 
        fiscal year, the physician's nonimmigrant status shall be 
        extended for up to 6 months if the physician agrees to seek a 
        waiver under this subsection (except for paragraph (1)(D)(ii)) 
        to work for an employer described in paragraph (1)(C) in a 
        State that has not yet requested the maximum number of waivers.
            ``(B) A physician described in subparagraph (A) may only 
        work for the employer referred to in subparagraph (A) during 
        the period beginning on the date on which a new waiver 
        application is filed with such State and ending on the earlier 
        of--
                    ``(i) the date on which the Secretary of Homeland 
                Security denies such waiver; or
                    ``(ii) the date on which the Secretary approves an 
                application for change of status under paragraph (2)(A) 
                pursuant to the approval of such waiver.''.
            (5) Contract requirements.--Section 214(l) of such Act, as 
        amended by this section, is further amended by adding at the 
        end the following:
            ``(5) An alien granted a waiver under paragraph (1)(C) 
        shall enter into an employment agreement with the contracting 
        health facility or health care organization that--
                    ``(A) specifies the maximum number of on-call hours 
                per week (which may be a monthly average) that the 
                alien will be expected to be available and the 
                compensation the alien will receive for on-call time;
                    ``(B) specifies--
                            ``(i) whether the contracting facility or 
                        organization will pay the alien's malpractice 
                        insurance premiums;
                            ``(ii) whether the employer will provide 
                        malpractice insurance; and
                            ``(iii) the amount of such insurance that 
                        will be provided;
                    ``(C) describes all of the work locations that the 
                alien will work including a statement that the 
                contracting facility or organization will not add 
                additional work locations without the approval of the 
                Federal agency or State agency that requested the 
                waiver; and
                    ``(D) does not include a non-compete provision.
            ``(6) An alien granted a waiver under this subsection whose 
        employment relationship with a health facility or health care 
        organization terminates under paragraph (1)(C)(ii) during the 
        3-year service period required under paragraph (1) shall be 
        considered to be maintaining lawful status in an authorized 
        period of stay during the 120-day period referred to in items 
        (aa) and (bb) of subclause (III) of paragraph (1)(C)(ii) or the 
        45-day period referred to in subclause (III)(cc) of such 
        paragraph.''.
            (6) Recapturing waiver slots lost to other states.--Section 
        214(l) of such Act, as amended by this section, is further 
        amended by adding at the end the following:
            ``(7) If a recipient of a waiver under this subsection 
        terminates the recipient's employment with a health facility or 
        health care organization pursuant to paragraph (1)(C)(ii), 
        including termination of employment because of circumstances 
        described in paragraph (1)(C)(ii)(III), and accepts new 
        employment with such a facility or organization in a different 
        State, the State from which the alien is departing may be 
        accorded an additional waiver by the Secretary of State for use 
        in the fiscal year in which the alien's employment was 
        terminated.''.
            (7) Exception to 3-year work requirement.--Section 214(l) 
        of such Act, as amended by this section, is further amended by 
        adding at the end the following:
            ``(8) The 3-year work requirement set forth in 
        subparagraphs (C) and (D) of paragraph (1) shall not apply if--
                    ``(A)(i) the Secretary of Homeland Security 
                determines that extenuating circumstances, including 
                violations by the employer of the employment agreement 
                with the alien or of labor and employment laws, exist 
                that justify a lesser period of employment at such 
                facility or organization; and
                    ``(ii) not later than 120 days after the employment 
                termination date (unless the Secretary determines that 
                extenuating circumstances would justify an extension), 
                the alien demonstrates another bona fide offer of 
                employment at a health facility or health care 
                organization in a geographic area or areas which are 
                designated by the Secretary of Health and Human 
                Services as having a shortage of health care 
                professionals, for the remainder of such 3-year period;
                    ``(B)(i) the interested State agency that requested 
                the waiver attests that extenuating circumstances, 
                including violations by the employer of the employment 
                agreement with the alien or of labor and employment 
                laws, exist that justify a lesser period of employment 
                at such facility or organization; and
                    ``(ii) the alien demonstrates, not later than 120 
                days after the employment termination date (unless the 
                Secretary determines that extenuating circumstances 
                would justify an extension), another bona fide offer of 
                employment at a health facility or health care 
                organization in a geographic area or areas which are 
                designated by the Secretary of Health and Human 
                Services as having a shortage of health care 
                professionals, for the remainder of such 3-year period; 
                or
                    ``(C) the alien--
                            ``(i) elects not to pursue a determination 
                        of extenuating circumstances pursuant to 
                        subparagraph (A) or (B);
                            ``(ii) terminates the alien's employment 
                        relationship with the health facility or health 
                        care organization at which the alien was 
                        employed;
                            ``(iii) not later than 45 days after the 
                        employment termination date, demonstrates 
                        another bona fide offer of employment at a 
                        health facility or health care organization in 
                        a geographic area or areas, in the State that 
                        requested the alien's waiver, which are 
                        designated by the Secretary of Health and Human 
                        Services as having a shortage of health care 
                        professionals; and
                            ``(iv) agrees to be employed for the 
                        remainder of such 3-year period, and 1 
                        additional year for each termination under 
                        clause (ii).''.
    (d) Allotment of CONRAD 30 Waivers.--
            (1) In general.--Section 214(l) of the Immigration and 
        Nationality Act (8 U.S.C. 1184(l)), as amended by subsection 
        (c), is further amended by adding at the end the following:
    ``(9)(A)(i) All States shall be allotted 35 waivers under paragraph 
(1)(B) for each fiscal year if 90 percent of the waivers available to 
the States receiving at least 5 waivers were used in the previous 
fiscal year.
    ``(ii) When an allotment occurs under clause (i), all States shall 
be allotted an additional 5 waivers under paragraph (1)(B) for each 
subsequent fiscal year if 90 percent of the waivers available to the 
States receiving at least 5 waivers were used in the previous fiscal 
year. If the States are allotted 45 or more waivers for a fiscal year, 
the States will only receive an additional increase of 5 waivers the 
following fiscal year if 95 percent of the waivers available to the 
States receiving at least 1 waiver were used in the previous fiscal 
year.
    ``(B) Any increase in allotments under subparagraph (A) shall be 
maintained indefinitely, unless in a fiscal year the total number of 
such waivers granted is 5 percent lower than in the last year in which 
there was an increase in the number of waivers allotted pursuant to 
this paragraph. In such case--
            ``(i) the number of waivers allotted beginning in the next 
        fiscal year shall be decreased by 5 for all States; and
            ``(ii) each additional 5 percent decrease in such waivers 
        granted from the last year in which there was an increase in 
        the allotment, shall result in an additional decrease of 5 
        waivers allotted for all States, provided that the number of 
        waivers allotted for all States shall not drop below 30.''.
            (2) Academic medical centers.--Section 214(l)(1)(D) of such 
        Act, as amended by subsection (c)(1)(E), is further amended--
                    (A) in clause (ii), by striking ``and'' at the end;
                    (B) in clause (iii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(iv) in the case of a request by an interested 
                State agency--
                            ``(I) the head of such agency determines 
                        that the alien is to practice medicine in, or 
                        be on the faculty of a residency program at, an 
                        academic medical center (as defined in section 
                        411.355(e)(2) of title 42, Code of Federal 
                        Regulations), without regard to whether such 
                        facility is located within an area designated 
                        by the Secretary of Health and Human Services 
                        as having a shortage of health care 
                        professionals; and
                            ``(II) the head of such agency determines 
                        that--
                                    ``(aa) the alien physician's work 
                                is in the public interest; and
                                    ``(bb) subject to paragraph (6), 
                                the grant of such waiver would not 
                                cause the number of the waivers granted 
                                on behalf of aliens for such State for 
                                a fiscal year to exceed 3, within the 
                                limitation under subparagraph (B).''.
    (e) Amendments to the Procedures, Definitions, and Other Provisions 
Related to Physician Immigration.--
            (1) Dual intent for physicians seeking graduate medical 
        training.--Section 214(b) of the Immigration and Nationality 
        Act (8 U.S.C. 1184(b)) is amended by striking ``and other than 
        a nonimmigrant described in any provision of section 
        101(a)(15)(H)(i) except subclause (b1) of such section)'' and 
        inserting ``a nonimmigrant described in any provision of 
        section 101(a)(15)(H)(i) (except subclause (b1) of such 
        section), and an alien coming to the United States to receive 
        graduate medical education or training as described in section 
        212(j) or to take examinations required to receive graduate 
        medical education or training as described in section 
        212(j))''.
            (2) Physician national interest waiver clarifications.--
                    (A) Practice and geographic area.--Section 
                203(b)(2)(B)(ii)(I) of the Immigration and Nationality 
                Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by 
                striking items (aa) and (bb) and inserting the 
                following:
                            ``(aa) the alien physician agrees to work 
                        on a full-time basis practicing primary care, 
                        specialty medicine, or a combination thereof, 
                        in an area or areas designated by the Secretary 
                        of Health and Human Services as having a 
                        shortage of health care professionals, or at a 
                        health care facility under the jurisdiction of 
                        the Secretary of Veterans Affairs; or
                            ``(bb) the alien physician is pursuing such 
                        waiver based upon service at a facility or 
                        facilities that serve patients who reside in a 
                        geographic area or areas designated by the 
                        Secretary of Health and Human Services as 
                        having a shortage of health care professionals 
                        (without regard to whether such facility or 
                        facilities are located within such an area) and 
                        a Federal agency, or a local, county, regional, 
                        or State department of public health determines 
                        the alien physician's work was or will be in 
                        the public interest.''.
                    (B) Five-year service requirement.--Section 
                203(b)(2)(B)(ii) of such Act is amended--
                            (i) by moving subclauses (II), (III), and 
                        (IV) 4 ems to the left; and
                            (ii) in subclause (II)--
                                    (I) by inserting ``(aa)'' after 
                                ``(II)''; and
                                    (II) by adding at the end the 
                                following:
                            ``(bb) The 5-year service requirement 
                        described in item (aa) shall begin on the date 
                        on which the alien physician begins work in the 
                        shortage area in any legal status and not on 
                        the date on which an immigrant visa petition is 
                        filed or approved. Such service shall be 
                        aggregated without regard to when such service 
                        began and without regard to whether such 
                        service began during or in conjunction with a 
                        course of graduate medical education.
                            ``(cc) An alien physician shall not be 
                        required to submit an employment contract with 
                        a term exceeding the balance of the 5-year 
                        commitment yet to be served or an employment 
                        contract dated within a minimum time period 
                        before filing a visa petition under this 
                        subsection.
                            ``(dd) An alien physician shall not be 
                        required to file additional immigrant visa 
                        petitions upon a change of work location from 
                        the location approved in the original national 
                        interest immigrant petition.''.
            (3) Technical clarification regarding advanced degree for 
        physicians.--Section 203(b)(2)(A) of such Act is amended by 
        adding at the end the following: ``An alien physician holding a 
        foreign medical degree that has been deemed sufficient for 
        acceptance by an accredited United States medical residency or 
        fellowship program shall be considered a member of the 
        professions holding an advanced degree or its equivalent for 
        purposes of this paragraph.''.
            (4) Short-term work authorization for physicians completing 
        their residencies.--
                    (A) In general.--A physician completing graduate 
                medical education or training described in section 
                212(j) of the Immigration and Nationality Act (8 U.S.C. 
                1182(j)) as a nonimmigrant described in section 
                101(a)(15)(H)(i) of such Act (8 U.S.C. 
                1101(a)(15)(H)(i))--
                            (i) shall have such nonimmigrant status 
                        automatically extended until October 1 of the 
                        fiscal year for which a petition for a 
                        continuation of such nonimmigrant status has 
                        been submitted in a timely manner and the 
                        employment start date for the beneficiary of 
                        such petition is October 1 of that fiscal year; 
                        and
                            (ii) shall be authorized to be employed 
                        incident to status during the period between 
                        the filing of such petition and October 1 of 
                        such fiscal year.
                    (B) Termination.--The status and employment 
                authorization of a physician described in subparagraph 
                (A) shall terminate on the date that is 30 days after 
                the date on which a petition described in clause (i)(I) 
                is rejected, denied or revoked.
                    (C) Automatic extension.--The status and employment 
                authorization of a physician described in subparagraph 
                (A) will automatically extend to October 1 of the next 
                fiscal year if all of the visas described in section 
                101(a)(15)(H)(i) of the Immigration and Nationality Act 
                (8 U.S.C. 1101(a)(15)(H)(i)) that were authorized to be 
                issued for the fiscal year have been issued.
            (5) Applicability of section 212(e) to spouses and children 
        of j-1 exchange visitors.--A spouse or child of an exchange 
        visitor described in section 101(a)(15)(J) of the Immigration 
        and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be 
        subject to the requirements under section 212(e) of such Act (8 
        U.S.C. 1182(e)).

SEC. 3017. NATIONAL HISPANIC NURSES DAY.

    (a) Findings.--Congress finds the following:
            (1) A special group of nurses in the Nation are the 
        Hispanic nurses.
            (2) Hispanic nurses provide culturally and ethnically 
        competent care and are educated to be sensitive to regional and 
        community customs of persons needing care.
            (3) Hispanic nurses are well-positioned to provide 
        leadership to eliminate health care disparities that exist in 
        the Nation.
            (4) Since 1975, the National Association of Hispanic Nurses 
        (NAHN) has represented Hispanic nurses (RNs/LPNs) in the United 
        States and is the only nursing organization for Hispanic nurses 
        whose mission is to advance the health in Hispanic communities 
        and to lead, promote, and advocate for educational, 
        professional, and leadership opportunities for Hispanic nurses.
            (5) Since September is the month that has been set aside to 
        honor the contributions of Hispanics, it is only fitting that 
        Hispanic nurses be recognized and honored during this time for 
        their outstanding contributions to their community and country.
            (6) The designation of an observation day will help to 
        raise awareness of the accomplishments of Hispanic nurses and 
        pave the way for the important work that they must continue to 
        carry out.
            (7) Each February, the NAHN convenes nearly 100 nursing 
        leaders from academia, research, education, and practice in the 
        District of Columbia for a day on Capitol Hill promoting 
        legislation that improves the health of Hispanic communities.
            (8) Hispanic nurses are strong allies to Congress as they 
        help inform, educate, and work closely with legislators to 
        improve the education, retention, recruitment, and practice of 
        all nurses and, more importantly, the health and safety of the 
        patients they care for.
            (9) Hispanic nurses add needed diversity to the nursing 
        profession, and these nurses have engaged in numerous ways to 
        support communities and the needs of an overlooked, under 
        resourced, and underserved population being severely impacted 
        by COVID-19.
    (b) Sense of Congress.--The Congress--
            (1) supports the goals and ideals, and the designation, of 
        National Hispanic Nurses Day, as proposed by the National 
        Association of Hispanic Nurses;
            (2) recognizes the significant contributions of Hispanic 
        nurses to the health care system of the United States; and
            (3) encourages the people of the United States to observe 
        National Hispanic Nurses Day with appropriate recognition, 
        ceremonies, activities, and programs to demonstrate the 
        importance of Hispanic nurses to the everyday lives of patients 
        and the communities they serve.

SEC. 3018. EXPANDING MEDICAL EDUCATION.

    Subpart II of part C of title VII of the Public Health Service Act 
(42 U.S.C. 293m et seq.) is amended by adding at the end the following:

``SEC. 749C. GRANTS FOR SCHOOLS OF MEDICINE AND SCHOOLS OF OSTEOPATHIC 
              MEDICINE IN UNDERSERVED AREAS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, may award grants 
to institutions of higher education (including consortiums of such 
institutions) for the establishment, improvement, or expansion of a 
school of medicine or osteopathic medicine, or a branch campus of a 
school of medicine or osteopathic medicine.
    ``(b) Priority.--In selecting grant recipients under this section, 
the Secretary shall give priority to any institution of higher 
education (or consortium of such institutions) that--
            ``(1) proposes to use the grant for the establishment of a 
        school of medicine or osteopathic medicine, or a branch campus 
        of a school of medicine or osteopathic medicine, in an area--
                    ``(A) in which no other such school is based; and
                    ``(B) that is a medically underserved community or 
                a health professional shortage area; or
            ``(2) is a minority-serving institution described in 
        section 371(a) of the Higher Education Act of 1965.
    ``(c) Considerations.--In awarding grants under this section, the 
Secretary, to the extent practicable, may ensure equitable distribution 
of awards among the geographical regions of the United States.
    ``(d) Use of Funds.--An institution of higher education (or a 
consortium of such institutions)--
            ``(1) shall use grant amounts received under this section 
        to--
                    ``(A) recruit, enroll, and retain students, 
                including individuals who are from disadvantaged 
                backgrounds (including racial and ethnic groups 
                underrepresented among medical students and health 
                professions), individuals from rural and underserved 
                areas, low-income individuals, and first generation 
                college students, at a school of medicine or 
                osteopathic medicine or branch campus of a school of 
                medicine or osteopathic medicine; and
                    ``(B) develop, implement, and expand curriculum 
                that emphasizes care for rural and underserved 
                populations, including accessible and culturally and 
                linguistically appropriate care and services, at such 
                school or branch campus; and
            ``(2) may use grant amounts received under this section 
        to--
                    ``(A) plan and construct--
                            ``(i) a school of medicine or osteopathic 
                        medicine in an area in which no other such 
                        school is based; or
                            ``(ii) a branch campus of a school of 
                        medicine or osteopathic medicine in an area in 
                        which no other such school is based;
                    ``(B) plan, develop, and meet criteria for 
                accreditation for a school of medicine or osteopathic 
                medicine or branch campus of a school of medicine or 
                osteopathic medicine;
                    ``(C) hire faculty, including faculty from racial 
                and ethnic groups who are underrepresented among the 
                medical and other health professions, and other staff 
                to serve at such a school or branch campus;
                    ``(D) support educational programs at such a school 
                or branch campus;
                    ``(E) modernize and expand infrastructure at such a 
                school or branch campus; and
                    ``(F) support other activities that the Secretary 
                determines further the establishment, improvement, or 
                expansion of a school of medicine or osteopathic 
                medicine or branch campus of a school of medicine or 
                osteopathic medicine.
    ``(e) Application.--To be eligible to receive a grant under 
subsection (a), an institution of higher education (or a consortium of 
such institutions), shall submit an application to the Secretary at 
such time, in such manner, and containing such information as the 
Secretary may require, including a description of the institution's or 
consortium's planned activities described in subsection (d).
    ``(f) Reporting.--
            ``(1) Reports from entities.--Each institution of higher 
        education, or consortium of such institutions, awarded a grant 
        under this section shall submit an annual report to the 
        Secretary on the activities conducted under such grant, and 
        other information as the Secretary may require.
            ``(2) Report to congress.--Not later than 5 years after the 
        date of enactment of this section and every 5 years thereafter, 
        the Secretary shall submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives a report 
        that provides a summary of the activities and outcomes 
        associated with grants made under this section. Such reports 
        shall include--
                    ``(A) a list of awardees, including their primary 
                geographic location, and location of any school of 
                medicine or osteopathic medicine, or a branch campus of 
                school of medicine or osteopathic medicine that was 
                established, improved, or expanded under this program;
                    ``(B) the total number of students (including the 
                number of students from racial and ethnic groups 
                underrepresented among medical students and health 
                professions, low-income students, and first generation 
                college students) who--
                            ``(i) are enrolled at or who have graduated 
                        from any school of medicine or osteopathic 
                        medicine, or a branch campus of school of 
                        medicine or osteopathic medicine, that was 
                        established, improved, or expanded under this 
                        program, deidentified and disaggregated by 
                        race, ethnicity, age, sex, geographic region, 
                        disability status, and other relevant factors, 
                        to the extent such information is available; 
                        and
                            ``(ii) who subsequently participate in an 
                        accredited internship or medical residency 
                        program upon graduation from any school of 
                        medicine or osteopathic medicine, or a branch 
                        campus of a school of medicine or osteopathic 
                        medicine, that was established, improved, or 
                        expanded under this program, deidentified and 
                        disaggregated by race, ethnicity, age, sex, 
                        geographic region, disability status, medical 
                        specialty pursued, and other relevant factors, 
                        to the extent such information is available;
                    ``(C) the effects of such program on the health 
                care provider workforce, including any impact on 
                demographic representation disaggregated by race, 
                ethnicity, and sex, and the fields or specialties 
                pursued by students who have graduated from any school 
                of medicine or osteopathic medicine, or a branch campus 
                of school of medicine or osteopathic medicine, that was 
                established, improved, or expanded under this program;
                    ``(D) the effects of such program on health care 
                access in underserved areas, including medically 
                underserved communities and health professional 
                shortage areas; and
                    ``(E) recommendations for improving the program 
                described in this section, and any other considerations 
                as the Secretary determines appropriate.
            ``(3) Public availability.--The Secretary shall make 
        reports submitted under paragraph (2) publicly available on the 
        internet website of the Department of Health and Human 
        Services.
    ``(g) Definitions.--In this section:
            ``(1) Branch campus.--
                    ``(A) In general.--The term `branch campus', with 
                respect to a school of medicine or osteopathic 
                medicine, means an additional location of such school 
                that is geographically apart and independent of the 
                main campus, at which the school offers at least 50 
                percent of the program leading to a degree of doctor of 
                medicine or doctor of osteopathy that is offered at the 
                main campus.
                    ``(B) Independence from main campus.--For purposes 
                of subparagraph (A), the location of a school described 
                in such subparagraph shall be considered to be 
                independent of the main campus described in such 
                subparagraph if the location--
                            ``(i) is permanent in nature;
                            ``(ii) offers courses in educational 
                        programs leading to a degree, certificate, or 
                        other recognized educational credential;
                            ``(iii) has its own faculty and 
                        administrative or supervisory organization; and
                            ``(iv) has its own budgetary and hiring 
                        authority.
            ``(2) First generation college student.--The term `first 
        generation college student' has the meaning given such term in 
        section 402A(h)(3) of the Higher Education Act of 1965.
            ``(3) Health professional shortage area.--The term `health 
        professional shortage area' has the meaning given such term in 
        section 332(a).
            ``(4) Institution of higher education.--The term 
        `institution of higher education' has the meaning given such 
        term in section 101 of the Higher Education Act of 1965.
            ``(5) Medically underserved community.--The term `medically 
        underserved community' has the meaning given such term in 
        section 799B(6).
    ``(h) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $1,000,000,000, to remain 
available until expended.''.

           TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY

SEC. 4000. DEFINITION.

    In this title and the amendments made by this title, the term 
``health care'' includes all health care needed throughout the life 
cycle and the end of life.

            Subtitle A--Reducing Barriers to Accessing Care

SEC. 4001. PROTECTING PROTECTED AREAS.

    Section 287 of the Immigration and Nationality Act (8 U.S.C. 1357) 
is amended--
            (1) by striking ``Service'' each place such term appears 
        and inserting ``Department of Homeland Security'';
            (2) by striking ``Attorney General'' each place such term 
        appears and inserting ``Secretary of Homeland Security'';
            (3) in subsection (f)(1), by striking ``Commissioner'' and 
        inserting ``Director of U.S. Citizenship and Immigration 
        Services'';
            (4) in subsection (h)--
                    (A) by striking ``of the Immigration and 
                Nationality Act''; and
                    (B) by striking ``of such Act''; and
            (5) by adding at the end the following:
    ``(i)(1) In this subsection:
            ``(A) The term `appropriate congressional committees' 
        means--
                    ``(i) the Committee on Homeland Security and 
                Governmental Affairs of the Senate;
                    ``(ii) the Committee on the Judiciary of the 
                Senate;
                    ``(iii) the Committee on Homeland Security of the 
                House of Representatives; and
                    ``(iv) the Committee on the Judiciary of the House 
                of Representatives.
            ``(B) The term `enforcement action'--
                    ``(i) means an apprehension, arrest, inspection 
                interview, request for identification, search, seizure, 
                service of charging documents or subpoenas, or 
                surveillance for the purposes of immigration 
                enforcement; and
                    ``(ii) includes an enforcement action at, or 
                focused on, a protected area that is part of a joint 
                case led by another law enforcement agency.
            ``(C) The term `exigent circumstances' means a situation 
        involving--
                    ``(i) the imminent risk of death, violence, or 
                physical harm to any person or property, including a 
                situation implicating terrorism or the national 
                security of the United States;
                    ``(ii) the immediate arrest or pursuit of a 
                dangerous felon, terrorist suspect, or other individual 
                presenting an imminent danger; or
                    ``(iii) the imminent risk of destruction of 
                evidence that is material to an ongoing criminal case.
            ``(D) The term `protected area' includes all of the 
        physical space located within 1,000 feet of--
                    ``(i) any medical treatment or mental health care 
                facility, including any hospital, doctor's office, 
                health clinic, alcohol or drug prevention, counseling, 
                or treatment facilities, syringe exchange services, 
                vaccination, treatment, or testing sites, emergent or 
                urgent care facility, sites that serve pregnant 
                individuals, or community health centers;
                    ``(ii) any public or private school, including any 
                known and licensed day care facility, preschool, sites 
                of early childhood programs, primary school, secondary 
                school, postsecondary school (including colleges and 
                universities), or other institution of learning 
                (including vocational or trade schools);
                    ``(iii) any scholastic or education-related 
                activity or event or before or after school program, 
                including field trips and interscholastic events;
                    ``(iv) any school bus or school bus stop;
                    ``(v) places where children gather such as a 
                playground, recreation center, library, foster care 
                facility, or group home for children;
                    ``(vi) any physical structure of an organization or 
                subdivision of government that--
                            ``(I) assists children, pregnant women, 
                        victims of crime or abuse, or individuals with 
                        significant mental or physical disabilities;
                            ``(II) provides social services and 
                        assistance, including homeless shelters, 
                        community-based organizations, facilities that 
                        serve disabled persons, drug or alcohol 
                        counseling and treatment facilities, food banks 
                        or food pantries, and other places providing 
                        emergency and disaster services or assistance 
                        with food and nutrition, housing affordability 
                        and income or other services funded by State or 
                        local government, charitable giving, the 
                        Special Supplemental Nutrition Program for 
                        Women, Infants, and Children (WIC), 
                        Supplemental Nutrition Assistance Program 
                        (SNAP), Temporary Assistance for Needy Families 
                        (TANF), Social Security, or the United States 
                        Housing Act; or
                            ``(III) provides hospice, palliative, or 
                        other available end-of-life care services to 
                        terminally ill persons;
                    ``(vii) any church, synagogue, mosque, or other 
                place of worship or religious study, including 
                buildings rented for the purpose of religious services, 
                retreats, counseling, workshops, instruction, and 
                education;
                    ``(viii) any Federal, State, or local courthouse, 
                including the office of an individual's legal counsel 
                or representative, and a probation, parole, or 
                supervised release office;
                    ``(ix) the site of a funeral, grave-side ceremony, 
                rosary, wedding, or other religious ceremony or 
                observance;
                    ``(x) any public demonstration, such as a march, 
                rally, or parade;
                    ``(xi) any domestic violence shelter, rape crisis 
                center, child advocacy center, supervised visitation 
                center, family justice center, or victim services 
                provider;
                    ``(xii) congressional district offices;
                    ``(xiii) indoor and outdoor premises of departments 
                of motor vehicles;
                    ``(xiv) a place where disaster or emergency 
                response and relief is provided, including evacuation 
                routes, places where shelter or emergency supplies, 
                food, or water are distributed, or places where 
                registration for disaster-relief assistance or family 
                reunification is underway; or
                    ``(xv) any other location specified by the 
                Secretary of Homeland Security for purposes of this 
                subsection.
            ``(E) The term `prior approval' means--
                    ``(i) in the case of officers and agents of U.S. 
                Immigration and Customs Enforcement, prior written 
                approval to carry out an enforcement action involving a 
                specific individual or individuals authorized by--
                            ``(I) the Assistant Director of Operations, 
                        Homeland Security Investigations;
                            ``(II) the Executive Associate Director, 
                        Homeland Security Investigations;
                            ``(III) the Assistant Director for Field 
                        Operations, Enforcement and Removal Operations; 
                        or
                            ``(IV) the Executive Associate Director for 
                        Field Operations, Enforcement and Removal 
                        Operations;
                    ``(ii) in the case of officers and agents of U.S. 
                Customs and Border Protection, prior written approval 
                to carry out an enforcement action involving a specific 
                individual or individuals authorized by--
                            ``(I) a Chief Patrol Agent;
                            ``(II) the Director of Field Operations;
                            ``(III) the Director of Air and Marine 
                        Operations; or
                            ``(IV) the Internal Affairs Special Agent 
                        in Charge; and
                    ``(iii) in the case of other Federal, State, or 
                local law enforcement officers, to carry out an 
                enforcement action involving a specific individual or 
                individuals authorized by--
                            ``(I) the head of the Federal agency 
                        carrying out the enforcement action; or
                            ``(II) the head of the State or local law 
                        enforcement agency carrying out the enforcement 
                        action.
    ``(2)(A) An enforcement action may not take place at, or be focused 
on, a protected area unless--
            ``(i) the action involves exigent circumstances; and
            ``(ii) prior approval for the enforcement action was 
        obtained.
    ``(B) If an enforcement action is initiated pursuant to 
subparagraph (A) and the exigent circumstances permitting the 
enforcement action cease, the enforcement action shall be discontinued 
until such exigent circumstances reemerge.
    ``(C) If an enforcement action is carried out in violation of this 
subsection--
            ``(i) no information resulting from the enforcement action 
        may be entered into the record or received into evidence in a 
        removal proceeding resulting from the enforcement action; and
            ``(ii) the noncitizen who is the subject of such removal 
        proceeding may file a motion for the immediate termination of 
        the removal proceeding.
    ``(3)(A) This subsection shall apply to any enforcement action by 
officers or agents of the Department of Homeland Security, including--
            ``(i) officers or agents of U.S. Immigration and Customs 
        Enforcement;
            ``(ii) officers or agents of U.S. Customs and Border 
        Protection; and
            ``(iii) any individual designated to perform immigration 
        enforcement functions pursuant to subsection (g).
    ``(B) While carrying out an enforcement action at a protected area, 
officers and agents referred to in subparagraph (A) shall make every 
effort--
            ``(i) to limit the time spent at the protected area;
            ``(ii) to limit the enforcement action at the protected 
        area to the person or persons for whom prior approval was 
        obtained; and
            ``(iii) to conduct themselves discreetly.
    ``(C) If, while carrying out an enforcement action that is not 
initiated at or focused on a protected area, officers or agents are led 
to a protected area, and no exigent circumstance and prior approval 
with respect to the protected area, such officers or agents shall--
            ``(i) cease before taking any further enforcement action;
            ``(ii) conduct themselves in a discreet manner;
            ``(iii) maintain surveillance on an individual; and
            ``(iv) immediately consult their supervisor in order to 
        determine whether such enforcement action should be 
        discontinued.
    ``(D) The limitations under this paragraph shall not apply to the 
transportation of an individual apprehended at or near a land or sea 
border to a hospital or health care provider for the purpose of 
providing medical care to such individual.
    ``(4)(A) Each official specified in subparagraph (B) shall ensure 
that the employees under his or her supervision receive annual training 
on compliance with--
            ``(i) the requirements under this subsection with respect 
        to enforcement actions at or focused on protected areas and 
        enforcement actions that lead officers or agents to a protected 
        area; and
            ``(ii) the requirements under section 239 of this Act and 
        section 384 of the Illegal Immigration Reform and Immigrant 
        Responsibility Act of 1996 (8 U.S.C. 1367).
    ``(B) The officials specified in this subparagraph are--
            ``(i) the Chief Counsel of each Field Office of U.S. 
        Immigration and Customs Enforcement;
            ``(ii) each Field Office Director of U.S. Immigration and 
        Customs Enforcement;
            ``(iii) each Special Agent in Charge of U.S. Immigration 
        and Customs Enforcement;
            ``(iv) each Chief Patrol Agent of U.S. Customs and Border 
        Protection;
            ``(v) the Director of Field Operations of U.S. Customs and 
        Border Protection;
            ``(vi) the Director of Air and Marine Operations of U.S. 
        Customs and Border Protection;
            ``(vii) the Internal Affairs Special Agent in Charge of 
        U.S. Customs and Border Protection; and
            ``(viii) the chief law enforcement officer of each State or 
        local law enforcement agency that enters into a written 
        agreement with the Department of Homeland Security pursuant to 
        subsection (g).
    ``(5) Not later than 180 days after the date of the Health Equity 
and Accountability Act, the Secretary of Homeland Security shall modify 
the Notice to Appear form (I-862)--
            ``(A) to provide the subject of an enforcement action with 
        information, written in plain language, summarizing the 
        restrictions against enforcement actions at protected areas set 
        forth in this subsection and the remedies available to the 
        individual if such action violates such restrictions;
            ``(B) to ensure that the information described in 
        subparagraph (A) is accessible to an individual with limited 
        English proficiency; and
            ``(C) to ensure that a subject of an enforcement action is 
        not permitted to verify that the officers or agents that 
        carried out such action complied with the restrictions set 
        forth in this subsection.
    ``(6)(A) The Director of U.S. Immigration and Customs Enforcement 
and the Commissioner of U.S. Customs and Border Protection shall each 
submit an annual report to the appropriate congressional committees 
that includes the information set forth in subparagraph (B) with 
respect to the respective agency.
    ``(B) Each report submitted under subparagraph (A) shall include, 
with respect to the submitting agency during the reporting period--
            ``(i) the number of enforcement actions that were carried 
        out at, or focused on, a protected area;
            ``(ii) the number of enforcement actions in which officers 
        or agents were subsequently led to a protected area; and
            ``(iii) for each enforcement action described in clause (i) 
        or (ii)--
                    ``(I) the date on which it occurred;
                    ``(II) the specific site, city, county, and State 
                in which it occurred;
                    ``(III) whether the site was a protected area and, 
                if so--
                            ``(aa) identification of the protected 
                        area;
                            ``(bb) each reason why the enforcement 
                        action was taken there;
                            ``(cc) where the enforcement action was 
                        taken without prior approval, certification 
                        that notification to headquarters of a 
                        submitting agency was provided after the 
                        enforcement action took place; and
                            ``(dd) a report of what occurred during and 
                        immediately after the enforcement action;
                    ``(IV) the components of the agency involved in the 
                enforcement action;
                    ``(V) a description of the enforcement action, 
                including the nature of the criminal activity of its 
                intended target;
                    ``(VI) the number of individuals, if any, arrested 
                or taken into custody;
                    ``(VII) the number of collateral arrests, if any, 
                and the reasons for each such arrest;
                    ``(VIII) a certification whether the location 
                administrator of a protected area was contacted before, 
                during, or after the enforcement action; and
                    ``(IX) the percentage of all of the staff members 
                and supervisors reporting to the officials listed in 
                paragraph (4)(B) who completed the training required 
                under paragraph (4)(A).
    ``(7) Nothing in the subsection may be construed--
            ``(A) to affect the authority of Federal, State, or local 
        law enforcement agencies--
                    ``(i) to enforce generally applicable Federal or 
                State criminal laws unrelated to immigration; or
                    ``(ii) to protect residents from imminent threats 
                to public safety; or
            ``(B) to limit or override the protections provided in--
                    ``(i) section 239; or
                    ``(ii) section 384 of the Illegal Immigration 
                Reform and Immigrant Responsibility Act of 1996 (8 
                U.S.C. 1367).''.

SEC. 4002. REPEAL OF REQUIREMENT FOR DOCUMENTATION EVIDENCING 
              CITIZENSHIP OR NATIONALITY UNDER THE MEDICAID PROGRAM.

    (a) Repeal.--Subsections (i)(22) and (x) of section 1903 of the 
Social Security Act (42 U.S.C. 1396b) are each repealed.
    (b) Conforming Amendments.--
            (1) State payments for medical assistance.--Section 1902 of 
        the Social Security Act (42 U.S.C. 1396a) is amended--
                    (A) by amending paragraph (46) of subsection (a) to 
                read as follows:
            ``(46) provide that information is requested and exchanged 
        for purposes of income and eligibility verification in 
        accordance with a State system which meets the requirements of 
        section 1137 of this Act;'';
                    (B) in subsection (e)(13)(A)(i)--
                            (i) in the matter preceding subclause (I), 
                        by striking ``sections 1902(a)(46)(B) and 
                        1137(d)'' and inserting ``section 1137(d)''; 
                        and
                            (ii) in subclause (IV), by striking 
                        ``1902(a)(46)(B) or''; and
                    (C) by striking subsection (ee).
            (2) Payment to states.--Section 1903 of the Social Security 
        Act (42 U.S.C. 1396b) is amended--
                    (A) in subsection (i), by redesignating paragraphs 
                (23) through (27) as paragraphs (22) through (26), 
                respectively; and
                    (B) by redesignating subsections (y), (z), and (aa) 
                as subsections (x), (y), and (z), respectively.
            (3) Repeal.--Subsection (c) of section 6036 of the Deficit 
        Reduction Act of 2005 (42 U.S.C. 1396b note) is repealed.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 4003. AVAILABILITY OF BASIC ASSISTANCE TO LAWFULLY PRESENT 
              NONCITIZENS.

    (a) Elimination of Arbitrary Eligibility Restrictions.--Sections 
402, 403, 411, 412, 421, and 422 of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612, 1613, 1621, 
1622, 1631, and 1632) are repealed.
    (b) Notification and Information Reporting.--Section 404 of the 
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 
(8 U.S.C. 1614) is amended by striking ``, 402, or 403''.
    (c) Qualified Noncitizens.--Title IV of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1601 et seq.) 
is amended--
            (1) in the header, by striking ``ALIENS'' and inserting 
        ``NONCITIZENS'';
            (2) by striking ``alien'' each place it appears and 
        inserting ``noncitizen'';
            (3) by striking ``aliens'' each place it appears and 
        inserting ``noncitizens'';
            (4) by striking ``alien's'' each place it appears and 
        inserting ``noncitizen's'';
            (5) by striking ``an alien'' each place that it appears and 
        inserting ``a noncitizen'';
            (6) by striking ``alien'' each place that it appears and 
        inserting ``noncitizen'';
            (7) by striking ``qualified alien'' each place that it 
        appears and inserting ``qualified noncitizen'';
            (8) by striking ``qualified aliens'' each place that it 
        appears and inserting ``qualified noncitizens'';
            (9) by striking ``qualified alien's'' each place that it 
        appears and inserting ``qualified noncitizen's''; and
            (10) in section 402--
                    (A) in the header, by striking ``qualified aliens'' 
                and inserting ``qualified noncitizens''; and
                    (B) in subsection (a)(2)(L), by striking 
                ``qualified aliens'' and inserting ``qualified 
                noncitizens''.
    (d) Access to Basic Services for Lawfully Residing Noncitizens.--
Section 431 of the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (8 U.S.C. 1641) is amended--
            (1) in subsection (b)--
                    (A) in the header, by striking ``Qualified Alien'' 
                and inserting ``Qualified Noncitizen'';
                    (B) by striking ``qualified alien'' and inserting 
                ``qualified noncitizen'';
                    (C) by striking ``alien'' and inserting 
                ``noncitizen'';
                    (D) by striking ``an alien'' and inserting ``a 
                noncitizen''; and
                    (E) by striking ``benefit'' and all that follows 
                through the period at the end of the subsection and 
                inserting ``benefit, is lawfully present in the United 
                States.'';
            (2) in subsection (c)--
                    (A) in the header, by striking ``Qualified Aliens'' 
                and inserting ``Qualified Noncitizens'';
                    (B) by striking ``; or'' at the end of paragraph 
                (3) and inserting ``;'';
                    (C) by striking the period at the end of paragraph 
                (4) and inserting ``; or''; and
                    (D) by inserting after paragraph (4) the following 
                new paragraph:
            ``(5) a noncitizen--
                    ``(A) in a category that was treated as lawfully 
                present for purposes of section 1101 of the Patient 
                Protection and Affordable Care Act of 2010 (42 U.S.C. 
                18001);
                    ``(B) who met the requirements of section 
                402(a)(2)(D) of the Personal Responsibility and Work 
                Opportunity Reconciliation Act of 1996 (8 U.S.C. 
                1612(a)(2)(D)) on or before January 1, 2023;
                    ``(C) who is granted special immigrant juvenile 
                status as described by section 101(a)(27)(J) of the 
                Immigration and Nationality Act (8 U.S.C. 
                1101(a)(27)(J));
                    ``(D) who has a pending, bona fide application for 
                nonimmigrant status under section 101(a)(15)(U) of the 
                Immigration and Nationality Act (8 U.S.C. 
                1101(1)(15)(U));
                    ``(E) who was granted relief under the Deferred 
                Action for Childhood Arrivals program; or
                    ``(F) any other person who is not a citizen of the 
                United States but who resides in a State or territory 
                of the United States and is Federally authorized to be 
                present in the United States.''; and
            (3) by adding at the end the following new subsection:
    ``(d) Noncitizen.--For the purposes of this title, the term 
`noncitizen' means any individual who is not a citizen of the United 
States.''.
    (e) Child Nutrition Programs.--Section 742 of the Personal 
Responsibility and Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1615) is amended--
            (1) in subsection (a)--
                    (A) in the header by striking ``School Lunch and 
                Breakfast Programs'' and inserting ``Child Nutrition 
                Programs'';
                    (B) by striking ``the school lunch program'' and 
                inserting ``any program''; and
                    (C) by striking ``the school breakfast program 
                under section 4 of the'' and inserting ``any program 
                under the''; and
            (2) in subsection (b)(1)--
                    (A) by striking ``Nothing in this Act shall 
                prohibit or require a State to provide to an individual 
                who is not a citizen or a qualified alien, as defined 
                in section 431(b),'' and inserting ``A State shall not 
                deny''; and
                    (B) by striking ``paragraph (2)'' and inserting 
                ``paragraph (2) on the basis of an individual's 
                citizenship or citizenship, alienage, or immigration 
                status''.
    (f) Exclusion of Medical Assistance Expenditures for Citizens of 
Freely Associated States.--Section 1108(h) of the Social Security Act 
(42 U.S.C. 1308(h)) is amended--
            (1) by striking ``Expenditures'' and inserting:
            ``(1) Expenditures''; and
            (2) by adding at the end the following new paragraph:
            ``(2) With respect to eligibility for benefits for the 
        designated Federal program defined in paragraph (3)(C) of 
        section 402(b)(3)(c) (relating to the Medicaid program), 
        paragraph (1) shall not apply to any individual who lawfully 
        resides in 1 of the 50 States or the District of Columbia in 
        accordance with the Compacts of Free Association between the 
        Government of the United States and the Governments of the 
        Federated States of Micronesia, the Republic of the Marshall 
        Islands, and the Republic of Palau and shall not apply, at the 
        option of the Governor of Puerto Rico, the Virgin Islands, 
        Guam, the Northern Mariana Islands, or American Samoa as 
        communicated to the Secretary of Health and Human Services in 
        writing, to any individual who lawfully resides in the 
        respective territory in accordance with such Compacts.''.
    (g) Child Health Insurance Program.--Section 2107(e)(1) of the 
Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
            (1) by striking subparagraph (O); and
            (2) by redesignating subparagraphs (P), (Q), (R), (S), (T), 
        and (U) as subparagraphs (O), (P), (Q), (R), (S), and (T).
    (h) Conforming Amendments.--
            (1) Supplemental food assistance program.--The Food and 
        Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) is amended--
                    (A) in section 5--
                            (i) by striking subsection (i); and
                            (ii) by redesignating subsections (j) 
                        through (n) as subsection (i) through (m), 
                        respectively;
                    (B) in section 6--
                            (i) in subsection (f), by striking ``an 
                        alien lawfully admitted for permanent'' and all 
                        that follows through the end of the subsection 
                        and inserting``a noncitizen lawfully present in 
                        the United States.''; and
                            (ii) in subsection (s)(2), by striking 
                        ``(m), and (n)'' and inserting ``and (m)''; and
                    (C) in section 11(e)(2)(B)(v)(II) by striking 
                ``aliens'' each place it appears and inserting 
                ``noncitizens''.
            (2) Medicaid.--Section 1903(v) of the Social Security Act 
        (42 U.S.C. 1396b(v)) is amended--
                    (A) in paragraph (1), by striking ``admitted for'' 
                and all that follows through the end of the paragraph 
                and inserting ``present in the United States.''; and
                    (B) by striking paragraph (4).
            (3) Housing assistance.--Section 214(a) of the Housing and 
        Community Development Act of 1980 (42 U.S.C. 1436a(a)) is 
        amended--
                    (A) by redesignating paragraphs (6) and (7) as 
                paragraphs (7) and (8), respectively; and
                    (B) by inserting after paragraph (5):
            ``(6) a qualified noncitizen as defined in section 431 of 
        the Personal Responsibility and Work Opportunity Reconciliation 
        Act of 1996 (8 U.S.C. 1641);''.
            (4) General rule on noncitizens' eligibility.--Section 401 
        of Personal Responsibility and Work Opportunity Reconciliation 
        Act of 1996 (8 U.S.C. 1611) is amended--
                    (A) in section 401, in the header--
                            (i) by striking ``qualified aliens'' and 
                        inserting ``qualified noncitizens''; and
                            (ii) by striking ``aliens'' and inserting 
                        ``noncitizens'';
                    (B) by striking ``qualified alien'' wherever it 
                occurs and inserting ``qualified noncitizen''; and
                    (C) by striking ``alien'' wherever it occurs and 
                inserting ``noncitizen''.
            (5) Assistance not treated as debt absent fraud.--Section 
        213A(b)(1)(A) of the Immigration and Nationality Act is amended 
        by striking ``benefit,'' and inserting ``benefit by fraud,''.
    (i) Preserving Access to Health Care.--Section 36B(c)(1)(B) of the 
Internal Revenue Code of 1986 is amended to read as follows:
                    ``(B) Special rule for certain individuals lawfully 
                present in the united states.--If--
                            ``(i) a taxpayer has a household income 
                        which is not greater than 100 percent of an 
                        amount equal to the poverty line for a family 
                        of the size involved,
                            ``(ii) the taxpayer is a non-citizen 
                        lawfully present in the United States,
                            ``(iii) the taxpayer is ineligible for 
                        minimum essential coverage under section 
                        5000A(f)(1)(A)(ii), and
                            ``(iv) under the Medicaid eligibility 
                        criteria for non-citizens in effect on December 
                        26, 2020, the taxpayer would be ineligible for 
                        such minimum essential coverage by reason of 
                        the taxpayer's immigration status,
                the taxpayer shall, for purposes of the credit under 
                this section, be treated as an applicable taxpayer with 
                a household income which is equal to 100 percent of the 
                poverty line for a family of the size involved.''.
    (j) Federal Agency Guidance.--Not later than 180 days after the 
date of the enactment of this Act, each Federal agency, as applicable, 
shall issue guidance with respect to implementing the amendments made 
by this section.
    (k) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act and shall apply to services 
furnished on or after the date that is 180 days after the date on which 
any guidance is issued pursuant to subsection (i).

SEC. 4004. IMPROVE AFFORDABILITY AND REDUCE PREMIUM COSTS OF HEALTH 
              INSURANCE FOR CONSUMERS.

    (a) In General.--Section 36B(b)(3)(A) of the Internal Revenue Code 
of 1986 is amended to read as follows:
                    ``(A) Applicable percentage.--The applicable 
                percentage for any taxable year shall be the percentage 
                such that the applicable percentage for any taxpayer 
                whose household income is within an income tier 
                specified in the following table shall increase, on a 
                sliding scale in a linear manner, from the initial 
                premium percentage to the final premium percentage 
                specified in such table for such income tier:


------------------------------------------------------------------------
                                                The initial   The final
 ``In the case of household income (expressed     premium      premium
   as a percent of poverty line) within the      percentage   percentage
            following income tier:                  is--         is--
------------------------------------------------------------------------
Up to 150 percent.............................          0.0          0.0
150 percent up to 200 percent.................          0.0          3.0
200 percent up to 250 percent.................          3.0          4.0
250 percent up to 300 percent.................          4.0          6.0
300 percent up to 400 percent.................          6.0          8.5
400 percent and higher........................          8.5      8.5.''.
------------------------------------------------------------------------

    (b) Conforming Amendment.--Section 36B(c)(1)(A) of the Internal 
Revenue Code of 1986 is amended by striking ``but does not exceed 400 
percent''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2021.

SEC. 4005. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO 
              AFFORDABLE HEALTH CARE UNDER THE ACA.

    (a) In General.--
            (1) Premium tax credits.--Section 36B of the Internal 
        Revenue Code of 1986 is amended--
                    (A) in subsection (c)(1)(B)--
                            (i) by amending the heading to read as 
                        follows: ``Special rule for certain individuals 
                        ineligible for medicaid due to status''; and
                            (ii) in clause (ii), to read as follows:
                            ``(ii) the taxpayer is a noncitizen who is 
                        not eligible for the Medicaid program under 
                        title XIX of the Social Security Act by reason 
                        of the individual's immigration status,''; and
                    (B) by striking subsection (e).
            (2) Cost-sharing reductions.--Section 1402 of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18071) is 
        amended--
                    (A) by striking subsection (e); and
                    (B) by redesignating subsection (f) as subsection 
                (e).
            (3) Basic health program eligibility.--Section 
        1331(e)(1)(B) of the Patient Protection and Affordable Care Act 
        (42 U.S.C. 18051(e)(1)(B)) is amended by striking ``lawfully 
        present in the United States,''.
            (4) Restrictions on federal payments.--Section 1412 of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18082) is 
        amended--
                    (A) by striking subsection (d); and
                    (B) by redesignating subsection (e) as subsection 
                (d).
            (5) Requirement to maintain minimum essential coverage.--
        Section 5000A(d) of the Internal Revenue Code of 1986 is 
        amended--
                    (A) by striking paragraph (3); and
                    (B) by redesignating paragraph (4) as paragraph 
                (3).
    (b) Conforming Amendments.--
            (1) Establishment of program.--Section 1411(a) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18081(a)) 
        is amended--
                    (A) by striking paragraph (1); and
                    (B) by redesignating paragraphs (2), (3), and (4) 
                as paragraphs (1), (2), and (3), respectively.
            (2) Qualified individuals.--Section 1312(f) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18032(f)) is 
        amended--
                    (A) in the heading, by striking ``; Access Limited 
                to Citizens and Lawful Residents''; and
                    (B) by striking paragraph (3).
    (c) Effective Date.--The amendments made by this section shall 
apply to years, plan years, and taxable years, as applicable, beginning 
after December 31, 2022.

SEC. 4006. REMOVING BARRIERS TO ACCESS TO AFFORDABLE HEALTH CARE FOR 
              LAWFULLY RESIDING IMMIGRANTS UNDER MEDICAID AND CHIP.

    (a) Medicaid.--Section 1903(v)(4) of the Social Security Act (42 
U.S.C. 1396b(v)(4)) is amended--
            (1) by amending subparagraph (A) to read as follows:
            ``(A) Notwithstanding sections 401(a), 402(b), 403, and 421 
        of the Personal Responsibility and Work Opportunity 
        Reconciliation Act of 1996, a State shall provide medical 
        assistance under this title to individuals who are lawfully 
        residing in the United States (including individuals described 
        in paragraph (1), battered individuals described in section 
        431(c) of such Act, and individuals with an approved or pending 
        application for deferred action or other federally authorized 
        presence), if they otherwise meet the eligibility requirements 
        for medical assistance under the State plan approved under this 
        title (other than the requirement of the receipt of aid or 
        assistance under title IV, supplemental security income 
        benefits under title XVI, or a State supplementary payment).'';
            (2) by amending subparagraph (B) to read as follows:
            ``(B) No debt shall accrue under an affidavit of support 
        against any sponsor of an individual provided medical 
        assistance under subparagraph (A) on the basis of provision of 
        assistance to such individual and the cost of such assistance 
        shall not be considered as an unreimbursed cost.''; and
            (3) in subparagraph (C)--
                    (A) by striking ``an election by the State under 
                subparagraph (A)'' and inserting ``the application of 
                subparagraph (A)'';
                    (B) by inserting ``or be lawfully present'' after 
                ``lawfully reside''; and
                    (C) by inserting ``or present'' after ``lawfully 
                residing'' each place it appears.
    (b) CHIP.--Subparagraph (O) of section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
                    ``(O) Paragraph (4) of section 1903(v) (relating to 
                lawfully residing individuals).''.
    (c) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall take effect on the date 
        of enactment of this Act and shall apply to services furnished 
        on or after the date that is 90 days after such date of 
        enactment.
            (2) Exception if state legislation required.--In the case 
        of a State plan for medical assistance under title XIX, or a 
        State child health plan under title XXI, of the Social Security 
        Act which the Secretary of Health and Human Services determines 
        requires State legislation (other than legislation 
        appropriating funds) in order for the plan to meet the 
        additional requirements imposed by the amendments made by this 
        section, the respective State plan shall not be regarded as 
        failing to comply with the requirements of such title solely on 
        the basis of its failure to meet these additional requirements 
        before the first day of the first calendar quarter beginning 
        after the close of the first regular session of the State 
        legislature that begins after the date of enactment of this 
        Act. For purposes of the previous sentence, in the case of a 
        State that has a 2-year legislative session, each year of such 
        session shall be deemed to be a separate regular session of the 
        State legislature.
    (d) Preserving Coverage.--
            (1) In general.--Nothing in this section, including the 
        amendments made by this section, shall prevent lawfully present 
        noncitizens who are ineligible for full benefits under the 
        Medicaid program under title XIX of the Social Security Act 
        from securing a credit for which such lawfully present 
        noncitizens would be eligible under section 36B(c)(1)(B) of the 
        Internal Revenue Code of 1986 and under the Medicaid provisions 
        for lawfully present noncitizens, as in effect on the date 
        prior to the date of enactment of this Act.
            (2) Definition.--For purposes of paragraph (1), the term 
        ``full benefits'' means, with respect to an individual and 
        State, medical assistance for all services covered under the 
        State plan under title XIX of the Social Security Act that is 
        not less in amount, duration, or scope, or is determined by the 
        Secretary of Health and Human Services to be substantially 
        equivalent to the medical assistance available for an 
        individual described in section 1902(a)(10)(A)(i) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).

SEC. 4007. CONSISTENCY IN HEALTH INSURANCE COVERAGE FOR INDIVIDUALS 
              WITH FEDERALLY AUTHORIZED PRESENCE, INCLUDING DEFERRED 
              ACTION.

    (a) In General.--For purposes of eligibility under any of the 
provisions described in subsection (b), all individuals granted lawful 
presence in the United States shall be considered to be lawfully 
present in the United States.
    (b) Provisions Described.--The provisions described in this 
subsection are the following:
            (1) Exchange eligibility.--Section 1411 of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18031).
            (2) Reduced cost-sharing eligibility.--Section 1402 of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18071).
            (3) Premium subsidy eligibility.--Section 36B of the 
        Internal Revenue Code of 1986 (26 U.S.C. 36B).
            (4) Medicaid and chip eligibility.--Titles XIX and XXI of 
        the Social Security Act, including under section 1903(v) of 
        such Act (42 U.S.C. 1396b(v)).
    (c) Effective Date.--
            (1) In general.--Subsection (a) shall take effect on the 
        date of enactment of this Act.
            (2) Transition through special enrollment period.--In the 
        case of an individual described in subsection (a) who, before 
        the first day of the first annual open enrollment period under 
        subparagraph (B) of section 1311(c)(6) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) 
        beginning after the date of enactment of this Act, is granted 
        lawful presence in the United States and who, as a result of 
        such subsection, qualifies for a subsidy under a provision 
        described in paragraph (2) or (3) of subsection (b), the 
        Secretary of Health and Human Services shall establish a 
        special enrollment period under subparagraph (C) of such 
        section 1311(c)(6) during which such individual may enroll in 
        qualified health plans through Exchanges under title I of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18001 
        note et seq.) and qualify for such a subsidy. For such an 
        individual who has been granted federally authorized presence 
        in the United States as of the date of enactment of this Act, 
        such special enrollment period shall begin not later than 90 
        days after such date of enactment. Nothing in this paragraph 
        shall be construed as affecting the authority of the Secretary 
        to establish additional special enrollment periods under such 
        subparagraph (C).

SEC. 4008. STUDY ON THE UNINSURED.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall--
            (1) conduct a study, in accordance with the standards under 
        section 3101 of the Public Health Service Act (42 U.S.C. 
        300kk), on the demographic characteristics of the population of 
        individuals who do not have health insurance coverage or oral 
        health coverage; and
            (2) predict, based on such study, the demographic 
        characteristics of the population of individuals who would 
        remain without health insurance coverage after the end of any 
        annual open enrollment or any special enrollment period or upon 
        enactment and implementation of any legislative changes to the 
        Patient Protection and Affordable Care Act (Public Law 111-148) 
        that affect the number of persons eligible for coverage.
    (b) Reporting Requirements.--
            (1) In general.--Not later than 12 months after the date of 
        the enactment of this Act, the Secretary shall submit to the 
        Congress the results of the study under subsection (a)(1) and 
        the prediction made under subsection (a)(2).
            (2) Reporting of demographic characteristics.--The 
        Secretary shall--
                    (A) report the demographic characteristics under 
                paragraphs (1) and (2) of subsection (a) on the basis 
                of racial and ethnic group (as defined in section 
                1707(g)(1) of the Public Health Service Act, as amended 
                by section 101 of this Act), and stratify the reporting 
                on each racial and ethnic group by other demographic 
                characteristics that can impact access to health 
                insurance coverage, such as sexual orientation, gender 
                identity, primary language, disability status, sex, 
                socioeconomic status, age group, citizenship, and 
                immigration status, in a manner consistent with title I 
                of this Act, including the amendments made by such 
                title; and
                    (B) not use such report, or any information 
                gathered in preparing such report--
                            (i) to engage in or anticipate any 
                        deportation or immigration related enforcement 
                        action by any entity, including the Department 
                        of Homeland Security; or
                    (C) for the exploitation of, or discrimination 
                against, communities of color or the LGBTQ+ population.

SEC. 4009. MEDICAID FALLBACK COVERAGE PROGRAM FOR LOW-INCOME ADULTS IN 
              NON-EXPANSION STATES.

    (a) In General.--As soon as possible after the date of enactment of 
this Act the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall--
            (1) directly or by contract, establish a program that 
        offers eligible individuals the opportunity to enroll in health 
        benefits coverage that meets the requirements described in 
        subsection (c) and any requirements applicable to such coverage 
        pursuant to subsection (d); and
            (2) ensure that such program is administered consistent 
        with the requirements of section 431.10(c)(2) of title 42, Code 
        of Federal Regulations.
    (b) Definition of Eligible Individual.--In this section, the term 
``eligible individual'' means an individual who--
            (1) is described in section 1902(a)(10)(A)(i)(VIII) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII));
            (2) resides in a State that--
                    (A) does not expend amounts for medical assistance 
                under title XIX of the Social Security Act (42 U.S.C. 
                1396 et seq.) for all individuals described in such 
                section; and
                    (B) did not expend amounts for medical assistance 
                under such title for all such individuals as of the 
                date of enactment of this Act; and
            (3) would not be eligible for medical assistance under such 
        State's plan for medical assistance under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of 
        such plan, as such plan or waiver was in effect on such date.
    (c) Health Benefits Coverage Requirements.--The requirements 
described in this subsection with respect to health benefits coverage 
are the following:
            (1) Essential health benefits.--At a minimum, the coverage 
        meets the minimum standards required under paragraph (5) of 
        section 1937(b) of the Social Security Act (42 U.S.C. 1396u-
        7(b)) for benchmark coverage described in paragraph (1) of such 
        section or benchmark equivalent coverage described in paragraph 
        (2) of such section.
            (2) Premiums and cost-sharing.--No premiums are imposed for 
        the coverage, and deductibles, cost sharing, or similar charges 
        may only be imposed in accordance with the requirements imposed 
        on State Medicaid plans under section 1916 of the Social 
        Security Act (42 U.S.C. 1396o).
    (d) Application of Requirements and Provisions of Title XIX of the 
Social Security Act.--The Secretary shall specify that--
            (1) any requirement applicable to the furnishing of medical 
        assistance under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) by States that have elected to make 
        medical assistance available to individuals described in 
        section 1902(a)(10)(A)(i)(VIII) of such title (42 U.S.C. 
        1396a(a)(10)(A)(i)(VIII)) that does not conflict with the 
        requirements specified in subsection (c) applies to the program 
        established under this section; and
            (2) other provisions of such title apply to such program.
    (e) No State Mandate.--Nothing in this section shall be construed 
as requiring a State to make expenditures related to the program 
established under this section and the Secretary shall not impose any 
such requirement.
    (f) Funding.--There are appropriated to the Secretary for each 
fiscal year beginning with fiscal year 2022 from any funds in the 
Treasury not otherwise appropriated, such sums as are necessary to 
carry out this section.

SEC. 4010. INCREASE AND EXTENSION OF TEMPORARY ENHANCED FMAP FOR STATES 
              WHICH BEGIN TO EXPEND AMOUNTS FOR CERTAIN MANDATORY 
              INDIVIDUALS.

    (a) In General.--Section 1905(ii)(1) of the Social Security Act (42 
U.S.C. 1396d(ii)(1)) is amended--
            (1) by striking ``8-quarter period'' and inserting ``40-
        quarter period''; and
            (2) by striking ``5 percentage points'' and inserting ``10 
        percentage points''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 9814 of the American 
Rescue Plan Act of 2021 (Public Law 117-2).

                  Subtitle B--Improvement of Coverage

SEC. 4101. MEDICAID IN THE TERRITORIES.

    (a) Elimination of General Medicaid Funding Limitations (``Cap'') 
for Territories.--
            (1) In general.--Section 1108 of the Social Security Act 
        (42 U.S.C. 1308) is amended--
                    (A) in subsection (f), in the matter preceding 
                paragraph (1), by striking ``subsections (g) and (h)'' 
                and inserting ``subsections (g), (h), and (i)'';
                    (B) in subsection (g)(2), in the matter preceding 
                subparagraph (A), by inserting ``subsection (i) and'' 
                after ``subject to''; and
                    (C) by adding at the end the following new 
                subsection:
    ``(i) Sunset of Medicaid Funding Limitations for Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana Islands, and American 
Samoa.--Subsections (f) and (g) shall not apply to Puerto Rico, the 
Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa 
beginning with fiscal year 2024.''.
            (2) Conforming amendments.--
                    (A) Section 1902(j) of the Social Security Act (42 
                U.S.C. 1396a(j)) is amended by striking ``, the 
                limitation in section 1108(f),,''.
                    (B) Section 1903(u) of the Social Security Act (42 
                U.S.C. 1396b(u)) is amended by striking paragraph (4).
            (3) Effective date.--The amendments made by this section 
        shall apply beginning with fiscal year 2024.
    (b) Elimination of Specific Federal Medical Assistance Percentage 
(FMAP) Limitation for Territories.--Section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by 
inserting ``for fiscal years before fiscal year 2024'' after ``American 
Samoa''.
    (c) Permitting Medicaid DSH Allotments for Territories.--Section 
1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) is amended--
            (1) in paragraph (6), by adding at the end the following 
        new subparagraph:
                    ``(C) Territories.--
                            ``(i) Fiscal year 2023.--For fiscal year 
                        2023, the DSH allotment for Puerto Rico, the 
                        Virgin Islands, Guam, the Northern Mariana 
                        Islands, and American Samoa shall bear the same 
                        ratio to $300,000,000 as the ratio of the 
                        number of individuals who are low-income or 
                        uninsured and residing in such respective 
                        territory (as estimated from time to time by 
                        the Secretary) bears to the sums of the number 
                        of such individuals residing in all of the 
                        territories.
                            ``(ii) Subsequent fiscal year.--For each 
                        subsequent fiscal year, the DSH allotment for 
                        each such territory is subject to an increase 
                        in accordance with paragraph (3).''; and
            (2) in paragraph (9), by inserting before the period at the 
        end the following: ``, and includes, beginning with fiscal year 
        2023, Puerto Rico, the Virgin Islands, Guam, the Northern 
        Mariana Islands, and American Samoa''.

SEC. 4102. EXTENSION OF THE SUPPLEMENTAL SECURITY INCOME PROGRAM TO 
              PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, AND 
              AMERICAN SAMOA.

    (a) In General.--Section 303 of the Social Security Amendments of 
1972 (86 Stat. 1484) is amended by striking subsection (b).
    (b) Conforming Amendments.--
            (1) Definition of state.--Section 1101(a)(1) of the Social 
        Security Act (42 U.S.C. 1301(a)(1)) is amended by striking the 
        5th sentence and inserting the following: ``Such term when used 
        in title XVI includes Puerto Rico, the United States Virgin 
        Islands, Guam, and American Samoa.''.
            (2) Elimination of limit on total payments to the 
        territories.--Section 1108 of such Act (42 U.S.C. 1308) is 
        amended--
                    (A) in the section heading, by striking ``; 
                limitation on total payments'';
                    (B) by striking subsection (a); and
                    (C) in subsection (c), by striking paragraphs (2) 
                and (4) and redesignating paragraphs (3) and (5) as 
                paragraphs (2) and (4), respectively.
            (3) United states nationals treated the same as citizens.--
        Section 1614(a)(1)(B) of such Act (42 U.S.C. 1382c(a)(1)(B)) is 
        amended--
                    (A) in clause (i)(I), by inserting ``or national,'' 
                after ``citizen'';
                    (B) in clause (i)(II), by adding ``; or'' at the 
                end; and
                    (C) in clause (ii), by inserting ``or national'' 
                after ``citizen''.
            (4) Territories included in geographic meaning of united 
        states.--Section 1614(e) of such Act (42 U.S.C. 1382c(e)) is 
        amended by striking ``and the District of Columbia'' and 
        inserting ``, the District of Columbia, Puerto Rico, the United 
        States Virgin Islands, Guam, and American Samoa''.
    (c) Waiver Authority.--The Commissioner of Social Security may 
waive or modify any statutory requirement relating to the provision of 
benefits under the Supplemental Security Income Program under title XVI 
of the Social Security Act in Puerto Rico, the United States Virgin 
Islands, Guam, or American Samoa, to the extent that the Commissioner 
deems it necessary in order to adapt the program to the needs of the 
territory involved.
    (d) Effective Date.--This section and the amendments made by this 
section shall take effect on the 1st day of the 1st Federal fiscal year 
that begins 1 year or more after the date of the enactment of this Act.

SEC. 4103. EXTENSION OF MEDICARE SECONDARY PAYER.

    (a) In General.--Section 1862(b)(1)(C) of the Social Security Act 
(42 U.S.C. 1395y(b)(1)(C)) is amended--
            (1) in the last sentence, by inserting ``, and before 
        January 1, 2023'' after ``prior to such date)''; and
            (2) by adding at the end the following new sentence: 
        ``Effective for items and services furnished on or after 
        January 1, 2023 (with respect to periods beginning on or after 
        the date that is 42 months prior to such date), clauses (i) and 
        (ii) shall be applied by substituting `42-month' for `12-month' 
        each place it appears.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act. For purposes of 
determining an individual's status under section 1862(b)(1)(C) of the 
Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by 
subsection (a), an individual who is within the coordinating period as 
of the date of enactment of this Act shall have that period extended to 
the full 42 months described in the last sentence of such section, as 
added by the amendment made by subsection (a)(2).

SEC. 4104. INDIAN DEFINED IN TITLE I OF THE PATIENT PROTECTION AND 
              AFFORDABLE CARE ACT.

    (a) Definition of Indian.--Section 1304 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the 
end the following:
    ``(f) Indian.--In this title:
            ``(1) In general.--The term `Indian' means--
                    ``(A) an Indian, California Indian, or Urban 
                Indian, as such terms are defined in section 4 of the 
                Indian Health Care Improvement Act (25 U.S.C. 1603); or
                    ``(B) an individual who is--
                            ``(i) of Indian descent and a member of an 
                        Indian community served by a local facility or 
                        program of the Indian Health Service; or
                            ``(ii) described in paragraph (2).
            ``(2) Inclusions.--The term `Indian' includes the following 
        individuals:
                    ``(A) A member of a federally recognized Indian 
                Tribe.
                    ``(B) A resident of an urban center who meets one 
                or more of the following criteria:
                            ``(i) A member of a Tribe, band, or other 
                        organized group of Indians, including those 
                        Tribes, bands, or groups terminated since 1940 
                        and those recognized as of the date of 
                        enactment of the Health Equity and 
                        Accountability Act of 2022 or later by the 
                        State in which they reside, or being a 
                        descendant, in the first or second degree, of 
                        any such member.
                            ``(ii) An Eskimo or Aleut or other Alaska 
                        Native.
                            ``(iii) An individual who is determined to 
                        be an Indian under regulations promulgated by 
                        the Secretary.
                    ``(C) An individual who is considered by the 
                Secretary of the Interior to be an Indian for any 
                purpose.
                    ``(D) An individual who is considered by the 
                Secretary to be an Indian for purposes of eligibility 
                for services provided by the Indian Health Service, 
                including as a California Indian, Eskimo, Aleut, or 
                other Alaska Native.''.
    (b) Conforming Amendments.--
            (1) Affordable choices health benefit plans.--Section 
        1311(c)(6)(D) of the Patient Protection and Affordable Care Act 
        (42 U.S.C. 18031(c)(6)(D)) is amended by striking ``(as defined 
        in section 4 of the Indian Health Care Improvement Act)''.
            (2) Reduced cost-sharing for individuals enrolling in 
        qualified health plans.--Section 1402(d) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18071(d)) is 
        amended--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by striking ``(as defined in section 
                4(d) of the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450b(d))''; and
                    (B) in paragraph (2), in the matter preceding 
                subparagraph (A), by striking ``(as so defined)''.
            (3) Exemption from penalty for not maintaining minimum 
        essential coverage.--Section 5000A(e) of the Internal Revenue 
        Code of 1986 is amended by striking paragraph (3) and inserting 
        the following:
            ``(3) Indians.--Any applicable individual who is an Indian 
        (as defined in section 1304(f) of the Patient Protection and 
        Affordable Care Act).''.
    (c) Effective Date of IRC Provision.--The amendment made by 
subsection (b)(3) shall apply to taxable years beginning after the date 
of the enactment of this section.

SEC. 4105. REMOVING MEDICARE BARRIER TO HEALTH CARE.

    (a) Part A.--Section 1818(a)(3) of the Social Security Act (42 
U.S.C. 1395i-2(a)(3)) is amended by striking ``an alien'' and all that 
follows through ``under this section'' and inserting ``an individual 
who is lawfully present in the United States''.
    (b) Part B.--Section 1836(2) of the Social Security Act (42 U.S.C. 
1395o(2)) is amended by striking ``an alien'' and all that follows 
through ``under this part'' and inserting ``an individual who is 
lawfully present in the United States''.

SEC. 4106. LOWERING MEDICARE PREMIUMS AND PRESCRIPTION DRUG COSTS.

    (a) Medicare Cost Assistance Program.--
            (1) In general.--Title XVIII of the Social Security Act (42 
        U.S.C. 1395 et seq.) is amended by adding at the end the 
        following new section:

``SEC. 1899C. MEDICARE COST ASSISTANCE PROGRAM.

    ``(a) In General.--Effective beginning January 1, 2023, in the case 
of a Medicare Cost Assistance Program eligible individual (as defined 
in subsection (b)(1)), the Secretary shall provide Medicare cost 
assistance for the following costs incurred with respect to the 
individual:
            ``(1)(A) premiums under section 1818; and
            ``(B) premiums under section 1839.
            ``(2) Coinsurance under this title (including coinsurance 
        described in section 1813).
            ``(3) Deductibles established under this title (including 
        those described in section 1813 and section 1833(b)).
            ``(4) The difference between the amount that is paid under 
        section 1833(a) and the amount that would be paid under such 
        section if any reference to a percent less than 100 percent 
        therein were deemed a reference to `100 percent'.
    ``(b) Determination of Eligibility.--
            ``(1) Medicare cost assistance program eligible individual 
        defined.--The term `Medicare Cost Assistance Program eligible 
        individual' means an individual who--
                    ``(A) is eligible for and is receiving medical 
                assistance for the payment of medicare cost-sharing 
                under a State Medicaid program pursuant to clause (i), 
                (iii), or (iv) of section 1902(a)(10)(E) as of December 
                31, 2022; or
                    ``(B)(i) is entitled to hospital insurance benefits 
                under part A (including an individual entitled to such 
                benefits pursuant to an enrollment under section 1818); 
                and
                    ``(ii) has income at or below 200 percent of the 
                poverty line applicable to a family of the size 
                involved.
            ``(2) Joint determination by commissioner of social 
        security for lis and medicare cost assistance.--
                    ``(A) In general.--The determination of whether an 
                individual is a Medicare Cost Assistance Program 
                eligible individual described in paragraph (1) shall be 
                determined by the Commissioner of Social Security 
                jointly with the determination of whether an individual 
                is a subsidy eligible individual described in section 
                1860D-14(a)(3). Such determination shall be made with 
                respect to eligibility for Medicare cost assistance 
                under this section and premium and cost-sharing 
                subsidies under section 1860D-14 upon application of an 
                individual for a determination with respect to 
                eligibility for either such assistance or such 
                subsidies. There are authorized to be appropriated to 
                the Social Security Administration such sums as may be 
                necessary for the determination of eligibility under 
                this paragraph.
                    ``(B) Effective period.--Determinations under this 
                paragraph with respect to eligibility for each of such 
                assistance or such subsidies shall be effective 
                beginning with the month in which the individual 
                applies for a determination described in subparagraph 
                (A) and shall remain in effect until such time as the 
                Secretary determines the individual is no longer 
                eligible as determined under subparagraph (C)(ii).
                    ``(C) Redeterminations.--With respect to 
                eligibility determinations under this paragraph--
                            ``(i) redeterminations shall be made at the 
                        same time with respect to eligibility for 
                        Medicare cost assistance under this section and 
                        cost-sharing subsidies under section 1860D-14, 
                        but not more frequently than once every 12 
                        months;
                            ``(ii) a redetermination shall 
                        automatically determine that an individual 
                        remains eligible for such assistance or 
                        subsidies unless--
                                    ``(I) the Commissioner has 
                                information indicating that the 
                                individual's circumstances have changed 
                                such that the individual is no longer 
                                eligible for such assistance or 
                                subsidies;
                                    ``(II) the Commissioner sends 
                                notice to the individual regarding such 
                                information that requests a response 
                                either confirming or correcting such 
                                information; and
                                    ``(III) the individual either 
                                confirms such information or fails to 
                                provide documentation indicating that 
                                such circumstances have not changed 
                                within 60 days of receiving the notice 
                                described in subclause (II);
                            ``(iii) the Commissioner shall establish 
                        procedures for appeals of such determinations 
                        that are similar to the procedures described in 
                        the third sentence of section 1631(c)(1)(A); 
                        and
                            ``(iv) judicial review of the final 
                        decision of the Commissioner made after a 
                        hearing shall be available to the same extent, 
                        and with the same limitations, as provided in 
                        subsections (g) and (h) of section 205.
                    ``(D) Treatment of medicaid beneficiaries.--The 
                Secretary shall provide that individuals who are full-
                benefit dual eligible individuals (as defined in 
                section 1935(c)(6)) or who are recipients of 
                supplemental security income benefits under title XVI 
                shall be treated as a Medicare Cost Assistance Program 
                eligible individual described in paragraph (1) and, in 
                the case of such individual who is a part D eligible 
                individual, a subsidy eligible individual described in 
                section 1860D-14(a)(3).
                    ``(E) Simplified application form.--
                            ``(i) In general.--The Secretary shall 
                        develop and distribute a simplified application 
                        form for use by individuals in applying for 
                        Medicare cost assistance under this section and 
                        premium and cost-sharing subsidies under 
                        section 1860D-14. Such form shall be easily 
                        readable based on culturally fluid language for 
                        all demographics beyond just the various 
                        languages offered. An audio version, digital 
                        version and photo-voice option should also be 
                        provided for all learners. The Secretary shall 
                        provide for the translation of such application 
                        form into at least the 10 languages (other than 
                        English) that are most often used by 
                        individuals applying for hospital insurance 
                        benefits under section 226 or 226A and shall 
                        make the translated forms available to the 
                        Commissioner of Social Security.
                            ``(ii) Consultation.--In developing such 
                        form, the Secretary shall consult with 
                        beneficiary groups.
            ``(3) Income determinations.--For purposes of applying this 
        section--
                    ``(A) in the case of an individual who is not 
                treated as a Medicare Cost Assistance Program eligible 
                individual or a subsidy eligible individual under 
                paragraph (2)(D), income shall be determined in the 
                manner described under section 1612 for purposes of the 
                supplemental security income program, except that 
                support and maintenance furnished in kind shall not be 
                counted as income; and
                    ``(B) the term `poverty line' has the meaning given 
                such term in section 673(2) of the Community Services 
                Block Grant Act (42 U.S.C. 9902(2)), including any 
                revision required by such section.
    ``(c) Beneficiary Protections.--
            ``(1) In general.--In the case in which the payment for 
        Medicare cost assistance for a Medicare Cost Assistance Program 
        eligible individual with respect to an item or service is 
        reduced or eliminated the individual shall not have any legal 
        liability to make payment to a provider of services or supplier 
        or to an organization described in section 1903(m)(1)(A) for 
        the service, and any lawful sanction that may be imposed upon a 
        provider of services or supplier or such an organization for 
        excess charges under this title or title XIX shall apply to the 
        imposition of any charge imposed upon the individual in such 
        case.
            ``(2) Clarification.--This paragraph shall not be construed 
        as preventing payment of any medicare cost assistance by a 
        medicare supplemental policy or an employer retiree health plan 
        on behalf of an individual.
    ``(d) Administration.--
            ``(1) In general.--The Secretary shall establish procedures 
        for the administration of the program under this section.
            ``(2) Funding.--For purposes of carrying out this section, 
        the Secretary shall make payments from the Federal Hospital 
        Insurance Trust Fund under section 1817 and the Federal 
        Supplementary Medical Insurance Trust Fund under section 1841, 
        in such proportion as the Secretary determines appropriate, of 
        such amounts as the Secretary determines necessary to provide 
        Medicare cost assistance under this section.
    ``(e) References to Medicare Cost-Sharing.--Effective beginning 
January 1, 2023, any reference to medicare cost-sharing described in 
section 1905(p) shall be deemed a reference to Medicare cost assistance 
under this section.
    ``(f) Outreach Efforts.--For provisions relating to outreach 
efforts to increase awareness of the availability of Medicare cost 
assistance, see section 1144.''.
            (2) Special enrollment period.--
                    (A) No premium penalty.--Section 1839(b) of the 
                Social Security Act (42 U.S.C. 1395r(b)) is amended, in 
                the last sentence, by inserting the following before 
                the period: ``or, effective beginning January 1, 2023, 
                for individuals who are Medicare Cost Assistance 
                Program eligible individuals (as defined in section 
                1899B(b)(1)).''.
                    (B) Special enrollment period.--Section 1837 of the 
                Social Security Act (42 U.S.C. 1395p) is amended by 
                adding at the end the following new subsection:
    ``(o) Special Enrollment Period for Medicare Cost Assistance 
Program Eligible Individual.--
            ``(1) In general.--Effective beginning January 1, 2023, the 
        Secretary shall establish special enrollment periods for 
        Medicare Cost Assistance Program eligible individuals (as 
        defined in section 1899B(b)(1)).
            ``(2) Coverage period.--In the case of an individual who 
        enrolls during the special enrollment period provided under 
        paragraph (1), the coverage period under this part shall--
                    ``(A) begin on the first day of the first month in 
                which the individual applies for a determination under 
                section 1899B(b)(2)(A); and
                    ``(B) remain in effect until such time as the 
                Secretary determines the individual no longer eligible 
                as determined under section 1899B(b)(2)(C)(ii).''.
                    (C) Conforming sunset of state agreements relating 
                to enrollment of qualified medicare beneficiaries.--
                            (i) Part a.--Section 1818(g) of the Social 
                        Security Act (42 U.S.C. 1395i-2(g)) is amended 
                        by adding at the end the following new 
                        paragraph:
    ``(3) Sunset.--This subsection shall not apply on or after January 
1, 2023.''.
                            (ii) Part b.--Section 1843(h) of the Social 
                        Security Act (42 U.S.C. 1395v(h)) is amended by 
                        adding at the end the following new paragraph:
    ``(3) Sunset With Respect to Qualified Medicare Beneficiaries.--
This subsection shall not apply with respect to qualified medicare 
beneficiaries on or after January 1, 2023.''.
            (3) Public awareness campaign.--Section 1144 of the Social 
        Security Act (42 U.S.C. 1320b-14) is amended by adding at the 
        end the following new subsection:
    ``(d) Public Awareness Campaign.--
            ``(1) In general.--The Commissioner shall conduct a public 
        awareness campaign to educate Medicare beneficiaries on the 
        availability of Medicare cost assistance for low-income 
        individuals under section 1899B.
            ``(2) Coordination.--In carrying out such public awareness 
        campaign, the Commissioner shall coordinate with State health 
        insurance assistance programs described in subsection (a)(1)(A) 
        of section 119 of the Medicare Improvements for Patients and 
        Providers Act of 2008 (42 U.S.C. 1395b-3 note)), the 
        Administrator of the Administration for Community Living, and 
        the Administrator of the Centers for Medicare & Medicaid 
        Services.
            ``(3) Funding.--There are hereby appropriated to the 
        Commissioner, out of any funds in the Treasury not otherwise 
        appropriated, $10,000,000 for each of fiscal years 2023 through 
        2025, to provide grants to State health insurance assistance 
        programs to carry out outreach and education activities under 
        the public awareness campaign pursuant to this subsection.''.
    (b) Moving Medicare Cost-Sharing Benefits From Medicaid to 
Medicare.--
            (1) Ending most medicare cost-sharing benefits under 
        medicaid.--Section 1902(a)(10) of the Social Security Act (42 
        U.S.C. 1396a(a)(10)) is amended--
                    (A) by inserting ``for calendar quarters beginning 
                before January 1, 2023,'' before ``for making'' each 
                place it appears in clauses (i), (iii), and (iv) of 
                subparagraph (E); and
                    (B) in the matter following subparagraph (G)--
                            (i) by inserting ``furnished during 
                        calendar quarters beginning before January 1, 
                        2023'' after ``(described in section 
                        1905(p)(3))'';
                            (ii) by striking ``(XV)'' and inserting ``, 
                        (XV)'';
                            (iii) by striking ``and (XVIII)'' and 
                        inserting ``, (XVIII)''; and
                            (iv) by inserting ``, and (XIX) no medical 
                        assistance for medicare cost-sharing, other 
                        than medical assistance for medicare cost-
                        sharing for qualified disabled and working 
                        individuals described in section 1905(s), shall 
                        be made available after January 1, 2023'' 
                        before the semicolon at the end.
            (2) Conforming amendments.--
                    (A) Title xix.--
                            (i) Section 1903(i) of such Act (42 U.S.C. 
                        1396b(i)) is amended--
                                    (I) in paragraph (26), by striking 
                                ``; and'' and inserting a semicolon;
                                    (II) in paragraph (27), by striking 
                                the period at the end and inserting ``; 
                                and''; and
                                    (III) by inserting after paragraph 
                                (27) the following new paragraph:
            ``(28) with respect to any amount expended for medical 
        assistance for medicare cost-sharing (other than medical 
        assistance for medicare cost-sharing for qualified disabled and 
        working individuals described in section 1905(s)) furnished 
        during calendar quarters beginning on or after January 1, 
        2023.''.
                            (ii) Section 1905(a) of such Act (42 U.S.C. 
                        1396d(a)) is amended, in the first sentence, by 
                        inserting ``furnished during calendar quarters 
                        beginning before January 1, 2023'' after 
                        ``medicare cost-sharing''.
                            (iii) Section 1933(g) of such Act (42 
                        U.S.C. 1396u-3(g)) is amended--
                                    (I) in paragraph (2)(Q), by 
                                striking ``paragraph (4), for each 
                                subsequent year'' and inserting 
                                ``paragraphs (4) and (5), for each 
                                subsequent year before 2023''; and
                                    (II) by adding at the end the 
                                following:
            ``(5) Sunset.--No individual shall be selected to be a 
        qualifying individual for any calendar year or period under 
        this section beginning on or after January 1, 2023, and no 
        State allocation shall be made for any fiscal year or period 
        under this section beginning on or after January 1, 2023.''.
                            (iv) Section 1935(a) of such Act (42 U.S.C. 
                        1396u-5(a)) is amended--
                                    (I) in paragraph (2), by striking 
                                ``make determinations'' and inserting 
                                ``prior to January 1, 2023, make 
                                determinations''; and
                                    (II) in paragraph (3), by inserting 
                                ``prior to January 1, 2023,'' before 
                                ``the State shall''.
                    (B) Title xi.--Section 1144 of the Social Security 
                Act (42 U.S.C. 1320b-14) is amended--
                            (i) in subsection (a)--
                                    (I) in paragraph (1)(A)--
                                            (aa) by striking ``sections 
                                        1902(a)(10)(E) and 1933'' and 
                                        inserting ``section 
                                        1902(a)(10)(E) and (prior to 
                                        January 1, 2023) section 
                                        1933'';
                                            (bb) by striking ``for the 
                                        transitional assistance under 
                                        section 1860D-31(f), or'' and 
                                        inserting a comma; and
                                            (cc) by inserting ``, or 
                                        for Medicare premium and cost-
                                        sharing assistance under 
                                        section 1899B (in the case of 
                                        months beginning on or after 
                                        January 1, 2023)'' before the 
                                        semicolon; and
                                    (II) by striking paragraph (2) and 
                                inserting the following:
            ``(2) Content of notice.--Any notice furnished under 
        paragraph (1) shall state that eligibility for such medical 
        assistance, subsidies, or program is conditioned upon meeting 
        the applicable eligibility criteria.'';
                            (ii) in subsection (b)(1)(A)--
                                    (I) by striking ``sections 
                                1902(a)(10)(E) and 1933'' and inserting 
                                ``section 1902(a)(10)(E) and (prior to 
                                January 1, 2023) section 1933'';
                                    (II) by striking ``for transitional 
                                assistance under section 1860D-31(f), 
                                or''; and
                                    (III) by inserting ``, or for 
                                Medicare premium and cost-sharing 
                                assistance under section 1899B'' before 
                                the semicolon; and
                            (iii) in subsection (c)--
                                    (I) in paragraph (1)(B), by 
                                inserting ``, and (beginning January 1, 
                                2023), provide an application for 
                                enrollment under the Medicare Savings 
                                Program'' before the period;
                                    (II) in paragraph (2), in the 
                                paragraph header, by inserting 
                                ``medicare savings program application 
                                and'' before ``lis application''; and
                                    (III) in paragraph (7), by striking 
                                ``means the program of medical 
                                assistance'' and all that follows 
                                through the period and inserting 
                                ``means--
                    ``(A) prior to January 1, 2023, the program of 
                medical assistance for payment of the cost of medicare 
                cost-sharing under the Medicaid program pursuant to 
                sections 1902(a)(10)(E) and 1933; and
                    ``(B) beginning January 1, 2023, the program for 
                medical assistance for payment of the cost of medicare 
                cost-sharing for qualified disabled and working 
                individuals described in section 1905(s) pursuant to 
                section 1902(a)(10)(E)(ii) and medicare premium and 
                cost-sharing assistance provided under section 
                1899B.''.
            (3) Ensuring that medicare cost-sharing beneficiaries under 
        medicaid receive medicare cost assistance.--Not later than June 
        1, 2022, the Secretary of Health and Human Services and the 
        Commissioner of Social Security shall jointly develop and 
        implement a transition plan to ensure that all individuals who 
        are eligible for and are receiving medical assistance for the 
        payment of medicare cost-sharing under a State Medicaid program 
        pursuant to clauses (i), (iii), and (iv) of section 
        1902(a)(10)(E) of the Social Security Act (42 U.S.C. 
        1396a(a)(10)(E)) as of December 31, 2022, receive Medicare cost 
        assistance under section 1899B of such Act, as added by 
        subsection (a), as of January 1, 2023.
    (c) Enhancing Prescription Drug Affordability by Expanding Access 
to Assistance With Out-of-Pocket Costs Under Medicare Part D for Low-
Income Seniors and Individuals With Disabilities.--
            (1) Expanding access.--Section 1860D-14 of the Social 
        Security Act (42 U.S.C. 1395w-114) is amended--
                    (A) in subsection (a)--
                            (i) in the heading, by striking ``150 
                        Percent'' and inserting ``200 Percent'';
                            (ii) in paragraph (1)--
                                    (I) in the heading, by striking 
                                ``135 percent'' and inserting ``200 
                                percent''; and
                                    (II) in the matter preceding 
                                subparagraph (A)--
                                            (aa) by striking ``135 
                                        percent'' and inserting ``200 
                                        percent''; and
                                            (bb) by striking ``and who 
                                        meets the resources requirement 
                                        described in paragraph (3)(D) 
                                        or who is covered under this 
                                        paragraph under paragraph 
                                        (3)(B)(i)'' and inserting ``or 
                                        who is covered under this 
                                        paragraph under paragraph 
                                        (3)(B)(v)'';
                            (iii) by striking paragraph (2);
                            (iv) in paragraph (3)--
                                    (I) in subparagraph (A)--
                                            (aa) in clause (i), by 
                                        adding ``and'' at the end;
                                            (bb) in clause (ii)--

                                                    (AA) by striking 
                                                ``150 percent'' and 
                                                inserting ``200 
                                                percent''; and

                                                    (BB) by striking 
                                                ``; and'' at the end 
                                                and inserting a period; 
                                                and

                                            (cc) by striking clause 
                                        (iii);
                                    (II) by striking subparagraphs (B) 
                                and (C) and inserting the following:
                    ``(B) Determinations.--For provisions relating to 
                joint determinations with respect to eligibility for 
                Medicare cost assistance under section 1899B and 
                premium and cost-sharing subsidies under this section, 
                see section 1899B(b)(2).
                    ``(C) Income determinations.--For purposes of 
                applying this section--
                            ``(i) in the case of an individual who is 
                        not treated as a Medicare cost-sharing 
                        assistance eligible individual and a subsidy 
                        eligible individual under section 
                        1899B(b)(2)(D), income shall be determined in 
                        the manner described under section 1612 for 
                        purposes of the supplemental security income 
                        program, except that support and maintenance 
                        furnished in kind shall not be counted as 
                        income; and
                            ``(ii) the term `poverty line' has the 
                        meaning given such term in section 673(2) of 
                        the Community Services Block Grant Act (42 
                        U.S.C. 9902(2)), including any revision 
                        required by such section.''; and
                                    (III) by striking subparagraphs 
                                (D), (E), and (G); and
                            (v) in paragraph (4), by striking 
                        subparagraph (B); and
                    (B) in subsection (c)(1), in the second sentence, 
                by striking ``subsections (a)(1)(D) and (a)(2)(E)'' and 
                inserting ``subsection (a)(1)(D)''.
            (2) Treatment of reduction of cost-sharing for individuals 
        receiving home and community based services.--Section 1860D-
        14(a)(1)(D) of the Social Security Act (42 U.S.C. 1395w-
        114(a)(1)(D)) is amended--
                    (A) by striking ``who would be such an 
                institutionalized individual or couple, if the full-
                benefit dual eligible individual were not''; and
                    (B) by striking ``or subsection (c) or (d) of 
                section 1915 or under a State plan amendment under 
                subsection (i) of such section'' and inserting ``, 
                section 1115A, section 1915, or under a State plan 
                amendment''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to plan year 2023 and subsequent plan years.

SEC. 4107. REDUCING COST-SHARING, ALIGNING INCOME AND RESOURCE 
              ELIGIBILITY TESTS, SIMPLIFYING ENROLLMENT, AND OTHER 
              PROGRAM IMPROVEMENTS FOR LOW-INCOME BENEFICIARIES.

    (a) Increase in Income Eligibility to 135 Percent of FPL for 
Qualified Medicare Beneficiaries.--
            (1) In general.--Section 1905(p)(2)(A) of the Social 
        Security Act (42 U.S.C. 1396d(p)(2)(A)) is amended by striking 
        ``shall be at least the percent provided under subparagraph (B) 
        (but not more than 100 percent) of the official poverty line'' 
        and all that follows through the period at the end and 
        inserting the following: ``shall be--
                            ``(i) before January 1, 2023, at least the 
                        percent provided under subparagraph (B) (but 
                        not more than 100 percent) of the official 
                        poverty line (as defined by the Office of 
                        Management and Budget, and revised annually in 
                        accordance with section 673(2) of the Omnibus 
                        Budget Reconciliation Act of 1981) applicable 
                        to a family of the size involved; and
                            ``(ii) on or after January 1, 2023, equal 
                        to 135 percent of the official poverty line (as 
                        so defined and revised) applicable to a family 
                        of the size involved.''.
            (2) Not counting in-kind support and maintenance as 
        income.--Section 1905(p)(2)(D) of the Social Security Act (42 
        U.S.C. 1396d(p)(2)(D)) is amended by adding at the end the 
        following new clause:
            ``(iii) In determining income under this subsection, 
        support and maintenance furnished in kind shall not be counted 
        as income.''.
    (b) Increase in Income Eligibility to 200 Percent of FPL for 
Specified Low-Income Medicare Beneficiaries.--
            (1) Eligibility of individuals with incomes below 150 
        percent of fpl.--Section 1902(a)(10)(E) of the Social Security 
        Act (42 U.S.C. 1396a(a)(10)(E)) is amended--
                    (A) by adding ``and'' at the end of clause (ii);
                    (B) in clause (iii)--
                            (i) by striking ``and 120 percent in 1995 
                        and years thereafter'' and inserting ``120 
                        percent in 1995 and years thereafter before 
                        2023, and 200 percent in 2023 and years 
                        thereafter''; and
                            (ii) by striking ``and'' at the end; and
                    (C) by striking clause (iv).
            (2) References.--Section 1905(p)(1) of the Social Security 
        Act (42 U.S.C. 1396d(p)(1)) is amended by adding at and below 
        subparagraph (C) the following flush sentence:
``The term `specified low-income medicare beneficiary' means an 
individual described in section 1902(a)(10)(E)(iii).''.
            (3) Conforming amendments.--
                    (A) The first sentence of section 1905(b) of such 
                Act (42 U.S.C. 1396d(b)) is amended by striking ``and 
                section 1933(d)''.
                    (B) Section 1933 of such Act (42 U.S.C. 1396u-3) is 
                repealed.
    (c) 100 Percent FMAP.--Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended by adding at the end the following new 
subsection:
    ``(jj) Increased FMAP for Expanded Medicare Cost-Sharing 
Populations.--
            ``(1) In general.--Notwithstanding subsection (b), with 
        respect to expenditures described in paragraph (2) the Federal 
        medical assistance percentage shall be equal to 100 percent.
            ``(2) Expenditures described.--The expenditures described 
        in this paragraph are expenditures made on or after January 1, 
        2023, for medical assistance for medicare cost-sharing provided 
        to any individual under clause (i), (ii), or (iii) of section 
        1902(a)(10)(E) who would not have been eligible for medicare 
        cost-sharing under any such clause under the income or resource 
        eligibility standards in effect on October 1, 2018.''.
    (d) Consolidation of Low-Income Subsidy Resource Eligibility 
Tests.--
            (1) In general.--Section 1860D-14(a)(3) of the Social 
        Security Act (42 U.S.C. 1395w-114(a)(3)) is amended--
                    (A) by striking subparagraph (D);
                    (B) by redesignating subparagraphs (E) through (G) 
                as subparagraphs (D) through (F), respectively; and
                    (C) in the heading of subparagraph (D), as so 
                redesignated, by striking ``Alternative''.
            (2) Clarification of certain rules relating to income and 
        resource determinations.--Section 1860D-14(a)(3) of the Social 
        Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by 
        paragraph (1), is amended by striking subparagraph (F) and 
        inserting the following new subparagraphs:
                    ``(F) Resource exclusions.--In determining the 
                resources of an individual (and the eligible spouse of 
                the individual, if any) under section 1613 for purposes 
                of subparagraph (D)--
                            ``(i) no part of the value of any life 
                        insurance policy shall be taken into account;
                            ``(ii) no part of the value of any vehicle 
                        shall be taken into account;
                            ``(iii) there shall be excluded an amount 
                        equal to $1,500 each with respect to any 
                        individual or eligible spouse of an individual 
                        who attests that some of the resources of such 
                        individual or spouse will be used to meet the 
                        burial and related expenses of such individual 
                        or spouse; and
                            ``(iv) no balance in, or benefits received 
                        under, an employee pension benefit plan (as 
                        defined in section 3 of the Employee Retirement 
                        Income Security Act of 1974) shall be taken 
                        into account.
                    ``(G) Family size.--In determining the size of the 
                family of an individual for purposes of determining the 
                income eligibility of such individual under this 
                section, an individual's family shall consist of--
                            ``(i) the individual;
                            ``(ii) the individual's spouse who lives in 
                        the same household as the individual (if any); 
                        and
                            ``(iii) any other individuals who--
                                    ``(I) are related to the individual 
                                whose income eligibility is in question 
                                or such individual's spouse who lives 
                                in the same household;
                                    ``(II) are living in the same 
                                household as such individual; and
                                    ``(III) are dependent on such 
                                individual or such individual's spouse 
                                who is living in the same household for 
                                at least one-half of their financial 
                                support.''.
            (3) Conforming amendments.--Section 1860D-14(a) of the 
        Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by inserting ``(as determined under 
                paragraph (3)(G))'' after ``family of the size 
                involved''; and
                    (B) in paragraph (3), as amended by paragraphs (1) 
                and (2)--
                            (i) in subparagraph (A), in the matter 
                        preceding clause (i), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (E)'';
                            (ii) in subparagraph (A)(ii), by inserting 
                        ``(as determined under subparagraph (G))'' 
                        after ``family of the size involved'';
                            (iii) in subparagraph (A)(iii), by striking 
                        ``or (E)'';
                            (iv) in subparagraph (B)(v), in the matter 
                        preceding subclause (I), by striking 
                        ``subparagraph (F)'' and inserting 
                        ``subparagraph (E)''; and
                            (v) in subparagraph (D)(i), in the matter 
                        preceding subclause (I), by striking ``subject 
                        to the life insurance policy exclusion provided 
                        under subparagraph (G)'' and inserting 
                        ``subject to the resource exclusions provided 
                        under subparagraph (F)''.
    (e) Alignment of Low-Income Subsidy and Medicare Savings Program 
Income and Resource Eligibility Tests.--
            (1) Application of medicaid spousal impoverishment resource 
        allowance to msp and lis resource eligibility.--Section 
        1905(p)(1)(C) of the Social Security Act (42 U.S.C. 
        1396d(p)(1)(C)) is amended to read as follows:
            ``(C) whose resources (as determined under section 1613 for 
        purposes of the supplemental security income program subject to 
        the resource exclusions under subparagraph (G) of section 
        1860D-14(a)(3)) do not exceed--
                    ``(i) in the case of an individual with a spouse, 
                an amount equal to the sum of the first amount 
                specified in subsection (f)(2)(A)(i) of section 1924 
                (as adjusted under subsection (g) of such section) and 
                the amount specified in subsection (f)(2)(A)(ii)(II) of 
                such section (as so adjusted); or
                    ``(ii) in the case of an individual who does not 
                have a spouse, an amount equal to \1/2\ of the amount 
                described in clause (i).''.
            (2) Application to qdwis.--Section 1905(s)(3) of the Social 
        Security Act (42 U.S.C. 1396d(s)(3)) is amended to read as 
        follows:
            ``(3) whose resources (as determined under section 1613 for 
        purposes of the supplemental security income program subject to 
        the resource exclusions under subparagraph (G) of section 
        1860D-14(a)(3)) do not exceed--
                    ``(A) in the case of an individual with a spouse, 
                the amount in effect for the year under clause (i) of 
                subsection (p)(1)(C); and
                    ``(B) in the case of an individual who does not 
                have a spouse, the amount in effect for the year under 
                clause (ii) of subsection (p)(1)(C); and''.
            (3) Application to lis.--Clause (i) of section 1860D-
        14(a)(3)(D) of the Social Security Act (42 U.S.C. 1395w-
        114(a)(3)(D)), as redesignated and amended by subsection 
        (d)(1), is amended to read as follows:
                            ``(i) In general.--The resources 
                        requirement of this subparagraph is that an 
                        individual's resources (as determined under 
                        section 1613 for purposes of the supplemental 
                        security income program subject to the resource 
                        exclusions provided under subparagraph (G)) do 
                        not exceed the amount in effect for the year 
                        under section 1905(p)(1)(C)(ii).''.
    (f) Enrollment Simplifications.--
            (1) Application of 3-month retroactive eligibility to 
        qmbs.--
                    (A) In general.--Section 1902(e)(8) of the Social 
                Security Act (42 U.S.C. 1396a(e)(8)) is amended by 
                striking ``after the end of the month in which the 
                determination first occurs'' and inserting ``in or 
                after the third month before the month in which the 
                individual makes application for assistance''.
                    (B) Process for submitting claims during 
                retroactive eligibility period.--Section 1902(e)(8) of 
                the Social Security Act (42 U.S.C. 1396a(e)(8)) is 
                further amended by adding at the end the following: 
                ``The Secretary shall provide for a process under which 
                claims for medical assistance under the State plan may 
                be submitted for services furnished to such an 
                individual during such 3-month period before the month 
                in which the individual made application for 
                assistance.''.
                    (C) Conforming amendment.--Section 1905(a) of the 
                Social Security Act (42 U.S.C. 1396d(a)) is amended, in 
                the matter preceding paragraph (1), by striking ``or, 
                in the case of medicare cost-sharing with respect to a 
                qualified medicare beneficiary described in subsection 
                (p)(1), if provided after the month in which the 
                individual becomes such a beneficiary''.
            (2) State option for 12-month continuous eligibility for 
        slmbs and qwdis.--Section 1902(e)(12) of the Social Security 
        Act (42 U.S.C. 1396a(e)(12)) is amended--
                    (A) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively;
                    (B) by inserting ``(A)'' after ``(12)''; and
                    (C) by adding at the end the following:
    ``(B) At the option of the State, the plan may provide that an 
individual who is determined to be eligible for benefits under a State 
plan approved under this title under any of the following eligibility 
categories, or who is redetermined to be eligible for such benefits 
under any of such categories, shall be considered to meet the 
eligibility requirements met on the date of application and shall 
remain eligible for those benefits until the end of the 12-month period 
following the date of the determination or redetermination of 
eligibility, except that a State may provide for such determinations 
more frequently, but not more frequently than once every 6 months for 
an individual:
            ``(i) A specified low-income medicare beneficiary described 
        in subsection (a)(10)(E)(iii) of this section who is determined 
        eligible for medicare cost sharing described in section 
        1905(p)(3)(A)(ii).
            ``(ii) A qualified disabled and working individual 
        described in section 1905(s) who is determined eligible for 
        medicare cost-sharing described in section 1905(p)(3)(A)(i).''.
            (3) State option to use express lane eligibility for the 
        medicare savings program.--Section 1902(e)(13)(A) of the Social 
        Security Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding 
        at the end the following new clause:
                    ``(iii) State option to extend express lane 
                eligibility to other populations.--
                            ``(I) In general.--At the option of the 
                        State, the State may apply the provisions of 
                        this paragraph with respect to determining 
                        eligibility under this title for an eligible 
                        individual (as defined in subclause (II)). In 
                        applying this paragraph in the case of a State 
                        making such an option, any reference in this 
                        paragraph to a child with respect to this title 
                        (other than a reference to child health 
                        assistance) shall be deemed to be a reference 
                        to an eligible individual.
                            ``(II) Eligible individual defined.--In 
                        this clause, the term `eligible individual' 
                        means any of the following:
                                    ``(aa) A qualified medicare 
                                beneficiary described in section 
                                1905(p)(1) for purposes of determining 
                                eligibility for medicare cost-sharing 
                                (as defined in section 1905(p)(3)).
                                    ``(bb) A specified low-income 
                                medicare beneficiary described in 
                                subsection (a)(10)(E)(iii) of this 
                                section for purposes of determining 
                                eligibility for medicare cost-sharing 
                                described in section 1905(p)(3)(A)(ii).
                                    ``(cc) A qualified disabled and 
                                working individual described in section 
                                1905(s) for purposes of determining 
                                eligibility for medicare cost-sharing 
                                described in section 
                                1905(p)(3)(A)(i).''.
    (g) Medicaid Treatment of Certain Medicare Providers.--Section 
1902(n) of the Social Security Act (42 U.S.C. 1396a(n)) is amended by 
adding at the end the following new paragraph:
    ``(4) A State plan shall not deny a claim from a provider or 
supplier with respect to medicare cost-sharing described in 
subparagraph (B), (C), or (D) of section 1905(p)(3) for an item or 
service which is eligible for payment under title XVIII on the basis 
that the provider or supplier does not have a provider agreement in 
effect under this title or does not otherwise serve all individuals 
entitled to medical assistance under this title. The State shall create 
a mechanism through which provider or suppliers that do not otherwise 
have provider agreements with the State can bill the State for medicare 
cost-sharing for qualified medicare beneficiaries.''.
    (h) Eligibility for Other Programs.--Section 1905(p) of the Social 
Security Act (42 U.S.C. 1396d(p)) is amended by adding at the end the 
following new paragraph:
    ``(7) Notwithstanding any other provision of law, any medical 
assistance for some or all medicare cost-sharing under this title shall 
not be considered income or resources in determining eligibility for, 
or the amount of assistance or benefits provided under, any other 
public benefit provided under Federal law or the law of any State or 
political subdivision thereof.''.
    (i) Treatment of Qualified Medicare Beneficiaries, Specified Low-
Income Medicare Beneficiaries, and Other Dual Eligibles as Medicare 
Beneficiaries.--Section 1862 of the Social Security Act (42 U.S.C. 
1395y) is amended by adding at the end the following new subsection:
    ``(p) Treatment of Qualified Medicare Beneficiaries (QMBs), 
Specified Low-Income Medicare Beneficiaries (SLMBs), and Other Dual 
Eligibles.--Nothing in this title shall be construed as authorizing a 
provider of services or supplier to discriminate (through a private 
contractual arrangement or otherwise) against an individual who is 
otherwise entitled to services under this title on the basis that the 
individual is a qualified medicare beneficiary (as defined in section 
1905(p)(1)), a specified low-income medicare beneficiary, or is 
otherwise eligible for medical assistance for medicare cost-sharing or 
other benefits under title XIX.''.
    (j) Additional Funding for State Health Insurance Assistance 
Programs.--
            (1) Grants.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall use amounts made available under 
                subparagraph (B) to make grants to States for State 
                health insurance assistance programs receiving 
                assistance under section 4360 of the Omnibus Budget 
                Reconciliation Act of 1990.
                    (B) Funding.--For purposes of making grants under 
                this subsection, the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 of the Social Security Act (42 
                U.S.C. 1395i) and the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841 of such Act (42 
                U.S.C. 1395t), in the same proportion as the Secretary 
                determines under section 1853(f) of such Act (42 U.S.C. 
                1395w-23(f)), of $50,000,000 to the Centers for 
                Medicare & Medicaid Services Program Management Account 
                for each of the fiscal years 2024 through 2028, to 
                remain available until expended.
            (2) Amount of grants.--The amount of a grant to a State 
        under this subsection from the total amount made available 
        under paragraph (1) shall be equal to the sum of the amount 
        allocated to the State under paragraph (3)(A) and the amount 
        allocated to the State under subparagraph (3)(B).
            (3) Allocation to states.--
                    (A) Allocation based on percentage of low-income 
                beneficiaries.--The amount allocated to a State under 
                this subparagraph from \2/3\ of the total amount made 
                available under paragraph (1) shall be based on the 
                number of individuals who meet the requirement under 
                subsection (a)(3)(A)(ii) of section 1860D-14 of the 
                Social Security Act (42 U.S.C. 1395w-114) but who have 
                not enrolled to receive a subsidy under such section 
                1860D-14 relative to the total number of individuals 
                who meet the requirement under such subsection 
                (a)(3)(A)(ii) in each State, as estimated by the 
                Secretary.
                    (B) Allocation based on percentage of rural 
                beneficiaries.--The amount allocated to a State under 
                this subparagraph from \1/3\ of the total amount made 
                available under paragraph (1) shall be based on the 
                number of part D eligible individuals (as defined in 
                section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-
                101(a)(3)(A))) residing in a rural area relative to the 
                total number of such individuals in each State, as 
                estimated by the Secretary.
            (4) Portion of grant based on percentage of low-income 
        beneficiaries to be used to provide outreach to individuals who 
        may be subsidy eligible individuals or eligible for the 
        medicare savings program.--Each grant awarded under this 
        subsection with respect to amounts allocated under paragraph 
        (3)(A) shall be used to provide outreach to individuals who may 
        be subsidy eligible individuals (as defined in section 1860D-
        14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
        114(a)(3)(A))) or eligible for the program of medical 
        assistance for payment of the cost of medicare cost-sharing 
        under the Medicaid program pursuant to sections 1902(a)(10)(E) 
        and 1933 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).
    (k) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments and repeal made by this section take effect on 
        January 1, 2023, and, with respect to title XIX of the Social 
        Security Act, apply to calendar quarters beginning on or after 
        January 1, 2023.
            (2) Exception for state legislation.--In the case of a 
        State plan for medical assistance under title XIX of the Social 
        Security Act which the Secretary of Health and Human Services 
        determines requires State legislation (other than legislation 
        appropriating funds) in order for the plan to meet the 
        additional requirements imposed by the amendments and repeal 
        made by this section, the State plan shall not be regarded as 
        failing to comply with the requirements of such title solely on 
        the basis of its failure to meet these additional requirements 
        before the first day of the first calendar quarter beginning 
        after the close of the first regular session of the State 
        legislature that begins after the date of the enactment of this 
        Act. For purposes of the previous sentence, in the case of a 
        State that has a 2-year legislative session, each year of such 
        session shall be deemed to be a separate regular session of the 
        State legislature.

SEC. 4108. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED BY URBAN 
              INDIAN ORGANIZATIONS.

    (a) In General.--The third sentence of section 1905(b) of the 
Social Security Act (42 U.S.C. 1396(b)) is amended by inserting ``or 
are received through a program operated by an urban Indian organization 
through a grant or contract under title V of the Indian Health Care 
Improvement Act'' after ``(as defined in section 4 of the Indian Health 
Care Improvement Act)''.
    (b) Effective Date.--The amendment made by this section shall apply 
to medical assistance provided on or after the date of enactment of 
this Act.

SEC. 4109. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED TO A NATIVE 
              HAWAIIAN THROUGH A FEDERALLY QUALIFIED HEALTH CENTER OR A 
              NATIVE HAWAIIAN HEALTH CARE SYSTEM UNDER THE MEDICAID 
              PROGRAM.

    (a) In General.--The third sentence of section 1905(b) of the 
Social Security Act (42 U.S.C. 1396d(b)) is amended by striking ``, for 
such 8 fiscal year quarters''.
    (b) Effective Date.--The amendment made by this section shall apply 
to medical assistance provided on or after the date of enactment of 
this Act.

SEC. 4110. REPEAL OF REQUIREMENT FOR ESTATE RECOVERY UNDER THE MEDICAID 
              PROGRAM.

     Section 1917 of the Social Security Act (42 U.S.C. 1396p) is 
amended--
            (1) in subsection (a)--
                    (A) by amending paragraph (1) to read as follows:
            ``(1) No lien may be imposed against the property of any 
        individual prior to his death on account of medical assistance 
        paid or to be paid on his behalf under the State plan, except 
        pursuant to the judgment of a court on account of benefits 
        incorrectly paid on behalf of such individual.'';
                    (B) by striking paragraph (2);
                    (C) in paragraph (3), by striking ``(1)(B)'' and 
                inserting ``(1)''; and
                    (D) by redesignating paragraph (3) as paragraph 
                (2); and
            (2) by amending subsection (b) to read as follows:
    ``(b) Adjustment or Recovery of Medical Assistance Correctly Paid 
Under a State Plan.--No adjustment or recovery of any medical 
assistance correctly paid on behalf of an individual under the State 
plan may be made.''.

SEC. 4111. ALLOW FOR SUSPENSION OF MEDICARE BENEFITS AND PREMIUM 
              LIABILITY FOR INDIVIDUALS WHO ARE INCARCERATED AND 
              PROVIDE A SPECIAL ENROLLMENT PERIOD AROUND THE DATE OF 
              RELEASE.

    (a) Special Enrollment Period for Individuals Incarcerated at Time 
of Medicare Eligibility.--Section 1837(i) of the Social Security Act 
(42 U.S.C. 1395p(i)) is amended by adding at the end the following new 
paragraph:
            ``(5)(A) In the case of an individual who--
                    ``(i) at the time the individual first satisfies 
                paragraph (1) or (2) of section 1836(a), is 
                incarcerated; or
                    ``(ii) has elected not to enroll (or to be deemed 
                enrolled) under this section during the individual's 
                initial enrollment period;
                there shall be a special enrollment period described in 
                subparagraph (B).
                    ``(B) The special enrollment period referred to in 
                subparagraph (A) is the 6-month period on the first day 
                after which the individual is no longer 
                incarcerated.''.
    (b) Premium Amount.--Section 1839(b) of the Social Security Act (42 
U.S.C. 1395r(b)) is amended--
            (1) by inserting ``(1)'' after ``(b)'';
            (2) in paragraph (1), as so redesignated by paragraph (1), 
        by striking ``or (l)'' and inserting ``(l), or (m)''; and
            (3) by adding at the end the following new paragraph:
    ``(2) In the case of an individual whose coverage period includes 
months in which by reason of custody under penal authority coverage is 
excluded pursuant to section 1862(a)(3), the premium amount for such 
months such individual is in custody under penal authority shall be 
zero.''.
    (c) Conforming Amendment.--Section 1818(d)(5) of the Social 
Security Act (42 U.S.C. 1395i-2(d)(5)) is amended by adding at the end 
the following:
                    ``(D) In the case of an individual who is a person 
                who is excluded from coverage pursuant to section 
                1862(a)(3) by reason of custody under penal authority, 
                the amount of the monthly premium for such individual 
                shall be zero for any month in which such individual is 
                in custody under penal authority.''.

SEC. 4112. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.

    (a) Coverage of Pregnancy.--The Director of the Office of Personnel 
Management shall issue such regulations as are necessary to ensure that 
pregnancy is considered a change in family status and a qualifying life 
event for an individual who is eligible to enroll, but is not enrolled, 
in a health benefit plan under chapter 89 of title 5, United States 
Code.
    (b) Effective Date.--The requirement in paragraph (1) shall apply 
with respect to any contract entered into under section 8902 of such 
title beginning 12 months after the date of enactment of this Act.

SEC. 4113. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR 
              PREGNANT INDIVIDUALS AND INFANTS.

    Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C. 
1396a(l)(2)(A)) is amended--
            (1) in clause (i), by striking ``and not more than 185 
        percent'';
            (2) in clause (ii)--
                    (A) in subclause (I), by striking ``and'' after the 
                comma;
                    (B) in subclause (II), by striking the period at 
                the end and inserting ``, and''; and
                    (C) by adding at the end the following:
                                    ``(III) January 1, 2023, is the 
                                percentage provided under clause 
                                (v).''; and
            (3) by adding at the end the following new clause:
                            ``(v) The percentage provided under clause 
                        (ii) for medical assistance provided on or 
                        after January 1, 2023, with respect to 
                        individuals described in subparagraph (A) or 
                        (B) of paragraph (1) shall not be less than--
                                    ``(I) the percentage specified for 
                                such individuals by the State in an 
                                amendment to its State plan (whether 
                                approved or not) as of January 1, 2014; 
                                or
                                    ``(II) if no such percentage is 
                                specified as of January 1, 2014, the 
                                percentage established for such 
                                individuals under the State's 
                                authorizing legislation or provided for 
                                under the State's appropriations as of 
                                that date.''.

                    Subtitle C--Expansion of Access

                       PART 1--GENERAL PROVISIONS

SEC. 4201. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title XXXIV of the Public Health Service Act, as amended by titles 
I, II, and III of this Act, is further amended by inserting after 
subtitle D the following:

 ``Subtitle D--Reconstruction and Improvement Grants for Public Health 
    Care Facilities Serving Pacific Islanders and the Insular Areas

``SEC. 3441. GRANT SUPPORT FOR QUALITY IMPROVEMENT INITIATIVES.

    ``(a) In General.--The Secretary, in collaboration with the 
Administrator of the Health Resources and Services Administration, the 
Director of the Agency for Healthcare Research and Quality, and the 
Administrator of the Centers for Medicare & Medicaid Services, shall 
award grants to eligible entities for the conduct of demonstration 
projects to improve the quality of and access to health care.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a health center, hospital, health plan, health 
        system, community clinic, hospice or palliative care provider, 
        or other health entity determined appropriate by the 
        Secretary--
                    ``(A) that, by legal mandate or explicitly adopted 
                mission, provides patients with access to services 
                regardless of their ability to pay;
                    ``(B) that provides care or treatment for a 
                substantial number of patients who are uninsured, are 
                receiving assistance under a State plan under title XIX 
                of the Social Security Act (or under a waiver of such 
                plan), or are members of vulnerable populations, as 
                determined by the Secretary; and
                    ``(C)(i) with respect to which, not less than 50 
                percent of the entity's patient population is made up 
                of racial and ethnic minority groups (as defined in 
                section 1707(g)(1)); or
                    ``(ii) that--
                            ``(I) serves a disproportionate percentage 
                        of local patients who are from a racial and 
                        ethnic minority group, or has a patient 
                        population at least 50 percent of which is 
                        composed of individuals with limited English 
                        proficiency; and
                            ``(II) provides an assurance that amounts 
                        received under the grant will be used only to 
                        support quality improvement activities in the 
                        racial and ethnic minority population served; 
                        and
            ``(2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to eligible entities that--
            ``(1) demonstrate an intent to operate as part of a health 
        care partnership, network, collaborative, coalition, or 
        alliance where each member entity contributes to the design, 
        implementation, and evaluation of the proposed intervention; or
            ``(2) intend to use funds to carry out systemwide changes 
        with respect to health care quality improvement, including--
                    ``(A) improved systems for data collection and 
                reporting;
                    ``(B) innovative collaborative or similar 
                processes;
                    ``(C) group programs with behavioral or self-
                management interventions;
                    ``(D) case management services;
                    ``(E) physician or patient reminder systems;
                    ``(F) educational interventions;
                    ``(G) comprehensive and patient-centric health 
                care;
                    ``(H) creation and distribution of education 
                materials on available health care options; or
                    ``(I) other activities determined appropriate by 
                the Secretary.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under subsection (a) to support the implementation and evaluation 
of health care quality improvement activities or minority health and 
health care disparity reduction activities that include--
            ``(1) with respect to health care systems, activities 
        relating to improving--
                    ``(A) patient safety;
                    ``(B) timeliness of care;
                    ``(C) effectiveness of care;
                    ``(D) efficiency of care;
                    ``(E) patient centeredness;
                    ``(F) health information technology;
                    ``(G) accessibility and availability of information 
                on health care;
                    ``(H) comprehensiveness of health care; and
                    ``(I) patient involvement and choice in health 
                care; and
            ``(2) with respect to patients, activities relating to--
                    ``(A) staying healthy;
                    ``(B) getting well, mentally and physically;
                    ``(C) living effectively with illness or 
                disability;
                    ``(D) preparing for end of life and ensuring that 
                end-of-life care is accessible and available, as well 
                as coping with end-of-life issues; and
                    ``(E) shared decision making.
    ``(e) Common Data Systems.--The Secretary shall provide financial 
and other technical assistance to grantees under this section for the 
development of common data systems.
    ``(f) 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 2023 through 2030.

``SEC. 3442. CENTERS OF EXCELLENCE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall designate 
centers of excellence at public hospitals, and other health systems 
serving large numbers of minority patients, that--
            ``(1) meet the requirements of section 3441(b)(1);
            ``(2) demonstrate excellence in providing care to minority 
        populations; and
            ``(3) demonstrate excellence in reducing disparities in 
        health and health care.
    ``(b) Requirements.--A hospital or health system that serves as a 
center of excellence under subsection (a) shall--
            ``(1) design, implement, and evaluate programs and policies 
        relating to the delivery of care in racially, ethnically, and 
        linguistically diverse populations;
            ``(2) provide training and technical assistance to other 
        hospitals and health systems relating to the provision of high-
        quality health care to minority populations; and
            ``(3) develop activities for graduate or continuing medical 
        education that institutionalize a focus on cultural competence 
        training for health care providers.
    ``(c) 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 2023 through 2030.

``SEC. 3443. RECONSTRUCTION AND IMPROVEMENT GRANTS FOR PUBLIC HEALTH 
              CARE FACILITIES SERVING PACIFIC ISLANDERS AND THE INSULAR 
              AREAS.

    ``(a) In General.--The Secretary shall provide direct financial 
assistance to designated health care providers and community health 
centers in American Samoa, Guam, the Commonwealth of the Northern 
Mariana Islands, the United States Virgin Islands, Puerto Rico, and 
Hawaii for the purposes of reconstructing and improving health care 
facilities and services in a culturally competent and sustainable 
manner.
    ``(b) Eligibility.--To be eligible to receive direct financial 
assistance under subsection (a), an entity shall be a public health 
facility or community health center located in American Samoa, Guam, 
the Commonwealth of the Northern Mariana Islands, the United States 
Virgin Islands, Puerto Rico, or Hawaii that--
            ``(1) is owned or operated by--
                    ``(A) the Government of American Samoa, Guam, the 
                Commonwealth of the Northern Mariana Islands, the 
                United States Virgin Islands, Puerto Rico, or Hawaii or 
                a unit of local government; or
                    ``(B) a nonprofit organization; and
            ``(2)(A) provides care or treatment for a substantial 
        number of patients who are uninsured, are receiving assistance 
        under title XVIII of the Social Security Act or under a State 
        plan under title XIX of such Act (or under a waiver of such 
        plan), or are members of a vulnerable population, as determined 
        by the Secretary; or
            ``(B) serves a disproportionate percentage of local 
        patients that are from a racial and ethnic minority group.
    ``(c) Report.--Not later than 180 days after the date of enactment 
of this title and annually thereafter, the Secretary shall submit to 
the Congress and the President a report that includes an assessment of 
health resources and facilities serving populations in American Samoa, 
Guam, the Commonwealth of the Northern Mariana Islands, the United 
States Virgin Islands, Puerto Rico, and Hawaii. In preparing such 
report, the Secretary shall--
            ``(1) consult with and obtain information on all health 
        care facilities needs from the entities receiving direct 
        financial assistance under subsection (a);
            ``(2) include all amounts of Federal assistance received by 
        each such entity in the preceding fiscal year;
            ``(3) review the total unmet needs of health care 
        facilities serving American Samoa, Guam, the Commonwealth of 
        the Northern Mariana Islands, the United States Virgin Islands, 
        Puerto Rico, and Hawaii, including needs for renovation and 
        expansion of existing facilities;
            ``(4) include a strategic plan for addressing the needs of 
        each such population identified in the report; and
            ``(5) evaluate the effectiveness of the care provided by 
        measuring patient outcomes and cost measures.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as necessary to carry out this section.''.

SEC. 4202. BORDER HEALTH GRANTS.

    (a) Definitions.--In this section:
            (1) Border area.--The term ``border area'' means the United 
        States-Mexico Border Area, as defined in section 8 of the 
        United States-Mexico Border Health Commission Act (22 U.S.C. 
        290n-6).
            (2) Eligible entity.--The term ``eligible entity'' means an 
        entity that is located in the border area and is any of the 
        following:
                    (A) A State, local government, or Tribal 
                government.
                    (B) A public institution of higher education.
                    (C) A nonprofit health organization.
                    (D) A community health center.
                    (E) A community clinic that is a health center 
                receiving assistance under section 330 of the Public 
                Health Service Act (42 U.S.C. 254b).
                    (F) A nonprofit organization serving immigrants.
    (b) Authorization.--From funds appropriated pursuant to subsection 
(f), the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary''), acting through the United States 
members of the United States-Mexico Border Health Commission, shall 
award grants to eligible entities to address priorities and 
recommendations to improve the health of border area residents that are 
established by--
            (1) the United States members of the United States-Mexico 
        Border Health Commission;
            (2) the State border health offices; and
            (3) the Secretary.
    (c) Application.--An eligible entity that desires a grant under 
subsection (b) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require and demonstrating the entity's capacity to provide 
culturally and linguistically appropriate services to border area 
residents.
    (d) Use of Funds.--An eligible entity that receives a grant under 
subsection (b) shall use the grant funds for--
            (1) programs relating to--
                    (A) maternal and child health;
                    (B) primary care and preventative health;
                    (C) public health and public health infrastructure;
                    (D) musculoskeletal health and obesity;
                    (E) health education and promotion;
                    (F) oral health;
                    (G) mental and behavioral health;
                    (H) substance use disorders;
                    (I) health conditions that have a high prevalence 
                in the border area;
                    (J) medical and health services research;
                    (K) workforce training and development;
                    (L) community health workers, patient navigators, 
                and promotores;
                    (M) health care infrastructure problems in the 
                border area (including planning and construction 
                grants);
                    (N) health disparities in the border area;
                    (O) environmental health;
                    (P) outreach and enrollment services with respect 
                to Federal programs (including programs authorized 
                under titles XIX and XXI of the Social Security Act (42 
                U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.));
                    (Q) end-of-life care; and
                    (R) addressing social determinants of health; and
            (2) other programs determined appropriate by the Secretary.
    (e) Supplement, Not Supplant.--Amounts provided to an eligible 
entity awarded a grant under subsection (b) shall be used to supplement 
and not supplant other funds available to the eligible entity to carry 
out the activities described in subsection (d).
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $200,000,000 for fiscal year 
2024, and such sums as may be necessary for each succeeding fiscal 
year.

SEC. 4203. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.

    (a) Elimination of Isolation Test for Cost-Based Ambulance 
Reimbursement.--
            (1) In general.--Section 1834(l)(8) of the Social Security 
        Act (42 U.S.C. 1395m(l)(8)) is amended--
                    (A) in subparagraph (B)--
                            (i) by striking ``owned and''; and
                            (ii) by inserting ``(including when such 
                        services are provided by the entity under an 
                        arrangement with the hospital)'' after 
                        ``hospital''; and
                    (B) by striking the comma at the end of 
                subparagraph (B) and all that follows and inserting a 
                period.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after January 1, 2021.
    (b) Provision of a More Flexible Alternative to the CAH Designation 
25 Inpatient Bed Limit Requirement.--
            (1) In general.--Section 1820(c)(2) of the Social Security 
        Act (42 U.S.C. 1395i-4(c)(2)) is amended--
                    (A) in subparagraph (B)(iii), by striking 
                ``provides not more than'' and inserting ``subject to 
                subparagraph (F), provides not more than''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(F) Alternative to 25 inpatient bed limit 
                requirement.--
                            ``(i) In general.--A State may elect to 
                        treat a facility, with respect to the 
                        designation of the facility for a cost-
                        reporting period, as satisfying the requirement 
                        of subparagraph (B)(iii) relating to a maximum 
                        number of acute care inpatient beds if the 
                        facility elects, in accordance with a method 
                        specified by the Secretary and before the 
                        beginning of the cost reporting period, to meet 
                        the requirement under clause (ii).
                            ``(ii) Alternate requirement.--The 
                        requirement under this clause, with respect to 
                        a facility and a cost-reporting period, is that 
                        the total number of inpatient bed days 
                        described in subparagraph (B)(iii) during such 
                        period will not exceed 7,300. For purposes of 
                        this subparagraph, an individual who is an 
                        inpatient in a bed in the facility for a single 
                        day shall be counted as one inpatient bed day.
                            ``(iii) Withdrawal of election.--The option 
                        described in clause (i) shall not apply to a 
                        facility for a cost-reporting period if the 
                        facility (for any two consecutive cost-
                        reporting periods during the previous 5 cost-
                        reporting periods) was treated under such 
                        option and had a total number of inpatient bed 
                        days for each of such two cost-reporting 
                        periods that exceeded the number specified in 
                        such clause.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to cost-reporting periods beginning on or after the 
        date of the enactment of this Act.
    (c) Expanding the Funding Authority for Renovating, Constructing, 
and Expanding Certain Facilities.--Section 509 of the Indian Health 
Care Improvement Act (25 U.S.C. 1659) is amended--
            (1) by striking ``minor'' before ``renovations''; and
            (2) by striking ``, to assist'' and all that follows 
        through ``standards''.

SEC. 4204. MEDICARE REMOTE MONITORING PILOT PROJECTS.

    (a) Pilot Projects.--
            (1) In general.--Not later than 9 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall conduct pilot projects under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.) for the purpose of 
        providing incentives to home health agencies to utilize home 
        monitoring and communications technologies that--
                    (A) enhance health and health care outcomes for 
                Medicare beneficiaries; and
                    (B) reduce expenditures under such title.
            (2) Site requirements.--
                    (A) Urban and rural.--The Secretary shall conduct 
                the pilot projects under this section in both urban and 
                rural areas.
                    (B) Site in a small state.--The Secretary shall 
                conduct at least 3 of the pilot projects in a State 
                with a population of less than 1,000,000.
            (3) Definition of home health agency.--In this section, the 
        term ``home health agency'' has the meaning given that term in 
        section 1861(o) of the Social Security Act (42 U.S.C. 
        1395x(o)).
    (b) Medicare Beneficiaries Within the Scope of Projects.--The 
Secretary shall specify the criteria for identifying those Medicare 
beneficiaries who shall be considered within the scope of the pilot 
projects under this section for purposes of the application of 
subsection (c) and for the assessment of the effectiveness of the home 
health agency in achieving the objectives of this section. Such 
criteria may provide for the inclusion in the projects of Medicare 
beneficiaries who begin receiving home health services under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) after the 
date of the implementation of the projects.
    (c) Incentives.--
            (1) Performance targets.--The Secretary shall establish for 
        each home health agency participating in a pilot project under 
        this section a performance target using one of the following 
        methodologies, as determined appropriate by the Secretary:
                    (A) Adjusted historical performance target.--The 
                Secretary shall establish for the agency--
                            (i) a base expenditure amount equal to the 
                        average total payments made to the agency under 
                        parts A and B of title XVIII of the Social 
                        Security Act (42 U.S.C. 1395 et seq.) for 
                        Medicare beneficiaries determined to be within 
                        the scope of the pilot project in a base period 
                        determined by the Secretary; and
                            (ii) an annual per capita expenditure 
                        target for such beneficiaries, reflecting the 
                        base expenditure amount adjusted for risk and 
                        adjusted growth rates.
                    (B) Comparative performance target.--The Secretary 
                shall establish for the agency a comparative 
                performance target equal to the average total payments 
                under such parts A and B during the pilot project for 
                comparable individuals in the same geographic area that 
                are not determined to be within the scope of the pilot 
                project.
            (2) Incentive.--Subject to paragraph (3), the Secretary 
        shall pay to each participating home care agency an incentive 
        payment for each year under the pilot project equal to a 
        portion of the Medicare savings realized for such year relative 
        to the performance target under paragraph (1).
            (3) Limitation on expenditures.--The Secretary shall limit 
        incentive payments under this section in order to ensure that 
        the aggregate expenditures under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.) (including incentive 
        payments under this subsection) do not exceed the amount that 
        the Secretary estimates would have been expended if the pilot 
        projects under this section had not been implemented.
    (d) Waiver Authority.--The Secretary may waive such provisions of 
titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 
42 U.S.C. 1395 et seq.) as the Secretary determines to be appropriate 
for the conduct of the pilot projects under this section.
    (e) Report to Congress.--Not later than 5 years after the date that 
the first pilot project under this section is implemented, the 
Secretary shall submit to Congress a report on the pilot projects. Such 
report shall contain a detailed description of issues related to the 
expansion of the projects under subsection (f) and recommendations for 
such legislation and administrative actions as the Secretary considers 
appropriate.
    (f) Expansion.--If the Secretary determines that any of the pilot 
projects under this section enhance health outcomes for Medicare 
beneficiaries and reduce expenditures under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.), the Secretary may initiate 
comparable projects in additional areas.
    (g) Incentive Payments Have No Effect on Other Medicare Payments to 
Agencies.--An incentive payment under this section--
            (1) shall be in addition to the payments that a home health 
        agency would otherwise receive under title XVIII of the Social 
        Security Act for the provision of home health services; and
            (2) shall have no effect on the amount of such payments.

SEC. 4205. COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.

    Section 330(r)(4) of the Public Health Service Act (42 U.S.C. 
254b(r)(4)) is amended--
            (1) in subparagraph (A), by striking ``primary health care 
        services'' each place it appears and inserting ``primary health 
        care and other mental, dental, and physical health services''; 
        and
            (2) in subparagraph (B)--
                    (A) in clause (i), by striking ``and'' at the end;
                    (B) in clause (ii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(iii) in the case of a rural health 
                        clinic described in such subparagraph--
                                    ``(I) that such clinic provides, to 
                                the extent possible, enabling services, 
                                such as transportation and language 
                                assistance (including translation and 
                                interpretation); and
                                    ``(II) that the primary health care 
                                and other services described in such 
                                subparagraph are subject to full 
                                reimbursement according to the 
                                prospective payment system for 
                                Federally qualified health center 
                                services under section 1834(o) of the 
                                Social Security Act.''.

SEC. 4206. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS 
              STATE LINES.

    (a) In General.--For purposes of expediting the provision of 
telehealth services, for which payment is made under the Medicare 
Program, across State lines, the Secretary of Health and Human Services 
shall, in consultation with representatives of States, physicians, 
health care practitioners, and patient advocates, encourage and 
facilitate the adoption of provisions allowing for multistate 
practitioner practice across State lines.
    (b) Definitions.--In subsection (a):
            (1) Telehealth service.--The term ``telehealth service'' 
        has the meaning given that term in subparagraph (F) of section 
        1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
            (2) Physician, practitioner.--The terms ``physician'' and 
        ``practitioner'' have the meaning given those terms in 
        subparagraphs (D) and (E), respectively, of such section.
            (3) Medicare program.--The term ``Medicare Program'' means 
        the program of health insurance administered by the Secretary 
        of Health and Human Services under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).

SEC. 4207. SCORING OF PREVENTIVE HEALTH SAVINGS.

    Section 202 of the Congressional Budget and Impoundment Control Act 
of 1974 (2 U.S.C. 602) is amended by adding at the end the following:
    ``(h) Scoring of Preventive Health Savings.--
            ``(1) Determination by the director.--Upon a request by the 
        chairman or ranking minority member of the Committee on the 
        Budget of the Senate, or by the chairman or ranking minority 
        member of the Committee on the Budget of the House of 
        Representatives, the Director shall determine if a proposed 
        measure would result in reductions in budget outlays in 
        budgetary outyears through the use of preventive health and 
        preventive health services.
            ``(2) Projections.--If the Director determines that a 
        measure would result in substantial reductions in budget 
        outlays as described in paragraph (1), the Director--
                    ``(A) shall include, in any projection prepared by 
                the Director, a description and estimate of the 
                reductions in budget outlays in the budgetary outyears 
                and a description of the basis for such conclusions; 
                and
                    ``(B) may prepare a budget projection that includes 
                some or all of the budgetary outyears, notwithstanding 
                the time periods for projections described in 
                subsection (e) and sections 308, 402, and 424.
            ``(3) Definitions.--As used in this subsection--
                    ``(A) the term `budgetary outyears' means the 2 
                consecutive 10-year periods beginning with the first 
                fiscal year that is 10 years after the budget year 
                provided for in the most recently agreed to concurrent 
                resolution on the budget; and
                    ``(B) the term `preventive health' means an action 
                that focuses on the health of the public, individuals, 
                and defined populations in order to protect, promote, 
                and maintain health, wellness, and functional ability, 
                and prevent disease, disability, and premature death 
                that is demonstrated by credible and publicly available 
                epidemiological projection models, incorporating 
                clinical trials or observational studies in humans, to 
                avoid future health care costs.''.

SEC. 4208. SENSE OF CONGRESS ON MAINTENANCE OF EFFORT PROVISIONS 
              REGARDING CHILDREN'S HEALTH.

    It is the sense of the Congress that--
            (1) the maintenance of effort provisions added to sections 
        1902 and 2105(d) of the Social Security Act (42 U.S.C. 1396a; 
        42 U.S.C. 1397ee(d)) by sections 2001(b) and 2101(b) of the 
        Patient Protection and Affordable Care Act were intended to 
        maintain the eligibility standards for the Medicaid program 
        under title XIX of the Social Security Act (42 U.S.C. 1396 et 
        seq.) and Children's Health Insurance Program under title XXI 
        of such Act (42 U.S.C. 1397aa et seq.) to protect vulnerable 
        and disabled adults, children, and senior citizens, many of 
        whom are also members of communities of color;
            (2) the maintenance of effort provisions for children's 
        coverage have been extended by the Congress through September 
        30, 2027;
            (3) the maintenance of effort provisions ensure the 
        continued success of the Medicaid program and Children's Health 
        Insurance Program and were intended to specifically protect 
        vulnerable and disabled children, many of whom are also members 
        of communities of color; and
            (4) the maintenance of effort provisions must be strictly 
        enforced and proposals to weaken or waive the maintenance of 
        effort provisions must not be considered.

SEC. 4209. PROTECTION OF THE HHS OFFICES OF MINORITY HEALTH.

    (a) In General.--Pursuant to section 1707A of the Public Health 
Service Act (42 U.S.C. 300u-6a), the Offices of Minority Health 
established within the Centers for Disease Control and Prevention, the 
Health Resources and Services Administration, the Substance Abuse and 
Mental Health Services Administration, the Agency for Healthcare 
Research and Quality, the Food and Drug Administration, and the Centers 
for Medicare & Medicaid Services, are offices that, regardless of 
change in the structure of the Department of Health and Human Services, 
shall report to the Secretary of Health and Human Services.
    (b) Sense of Congress.--It is the sense of the Congress that the 
Offices of Minority Health referred to in subsection (a) play a 
critical role in addressing health disparities and should be adequately 
funded and given a prominent role in evaluating and establishing health 
policies and programs.

SEC. 4210. OFFICE OF MINORITY HEALTH IN VETERANS HEALTH ADMINISTRATION 
              OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Establishment and Functions.--Subchapter I of chapter 73 of 
title 38, United States Code, is amended by inserting after section 
7308 the following new section:
``Sec. 7308A. Office of Minority Health
    ``(a) Establishment.--There is established in the Department within 
the Office of the Under Secretary for Health an office to be known as 
the `Office of Minority Health' (in this section referred to as the 
`Office').
    ``(b) Head.--The Director of the Office of Minority Health shall be 
the head of the Office. The Director of the Office of Minority Health 
shall be appointed by the Under Secretary for Health from among 
individuals qualified to perform the duties of the position.
    ``(c) Functions.--The functions of the Office are as follows:
            ``(1) To establish short-range and long-range goals and 
        objectives and coordinate all other activities within the 
        Veterans Health Administration that relate to disease 
        prevention, health promotion, health care services delivery, 
        health and health care education, health care quality, and 
        health care research concerning veterans who are members of a 
        racial or ethnic minority group.
            ``(2) To support research, demonstrations, and evaluations 
        to test new and innovative models for the discharge of 
        activities described in paragraph (1).
            ``(3) To increase knowledge and understanding of health 
        risk factors for veterans who are members of a racial or ethnic 
        minority group.
            ``(4) To develop mechanisms that support better health care 
        information dissemination, education, prevention, and services 
        delivery to veterans from disadvantaged backgrounds, including 
        veterans who are members of a racial or ethnic minority group.
            ``(5) To enter into contracts or agreements with 
        appropriate public and nonprofit private entities to develop 
        and carry out programs to provide bilingual or interpretive 
        services to assist veterans who are members of a racial or 
        ethnic minority group and who lack proficiency in speaking the 
        English language in accessing and receiving health care 
        services through the Veterans Health Administration.
            ``(6) To carry out programs to improve access to health 
        care services through the Veterans Health Administration for 
        veterans with limited proficiency in speaking the English 
        language, including the development and evaluation of 
        demonstration and pilot projects for that purpose.
            ``(7) To advise the Under Secretary for Health on matters 
        relating to the development, implementation, and evaluation of 
        health professions education in decreasing disparities in 
        health care outcomes between veterans who are members of a 
        racial or ethnic minority group and other veterans, including 
        cultural competency as a method of eliminating such health 
        disparities.
            ``(8) To perform such other functions and duties as the 
        Secretary or the Under Secretary for Health considers 
        appropriate.
    ``(d) Definitions.--In this section:
            ``(1) The term `racial or ethnic minority group' means any 
        of the following:
                    ``(A) American Indians (including Alaska Natives, 
                Eskimos, and Aleuts).
                    ``(B) Asian Americans.
                    ``(C) Native Hawaiians and Pacific Islanders.
                    ``(D) Blacks.
                    ``(E) Hispanics.
            ``(2) The term `Hispanic' means individuals whose origin is 
        Mexican, Puerto Rican, Cuban, Central or South American, or any 
        other Spanish-speaking country.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
such subchapter is amended by inserting after the item relating to 
section 7308 the following new item:

``7308A. Office of Minority Health.''.

SEC. 4211. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL ACCESS FOR LOW-
              INCOME PATIENTS.

    (a) In General.--Not later than January 1, 2021, the Comptroller 
General of the United States shall conduct a study on how amendments 
made by the Patient Protection and Affordable Care Act (Public Law 111-
148) and the Health Care and Education Reconciliation Act of 2010 
(Public Law 111-152) to titles XVIII and XIX of the Social Security Act 
(42 U.S.C. 1395 et seq.; 42 U.S.C. 1396 et seq.) relating to 
disproportionate share hospital adjustment payments under Medicare and 
Medicaid (and subsequent amendments made with respect to such payments) 
affect the timely access to health care services for low-income 
patients. Such study shall--
            (1) evaluate and examine whether States electing to make 
        medical assistance available under section 
        1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C. 
        1396a(a)(10)(A)(i)(VIII)) (including States making such an 
        election through a waiver of the State plan) to individuals 
        described in such section mitigate the need for payments to 
        disproportionate share hospitals under section 1886(d)(5)(F) of 
        the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section 
        1923 of such Act (42 U.S.C. 1396r-4), including the impact of 
        such States electing to make medical assistance available to 
        such individuals on--
                    (A) the number of individuals in the United States 
                who are without health insurance and the distribution 
                of such individuals in relation to areas primarily 
                served by disproportionate share hospitals; and
                    (B) the low-income utilization rate of such 
                hospitals and the resulting fiscal sustainability of 
                such hospitals;
            (2) evaluate the appropriate level and distribution of such 
        payments among such disproportionate share hospitals for 
        purposes of--
                    (A) sufficiently accounting for the level of 
                uncompensated care provided by such hospitals to low-
                income patients; and
                    (B) providing timely access to health care services 
                for individuals in medically underserved areas; and
            (3) assess, with respect to such disproportionate share 
        hospitals--
                    (A) the role played by such hospitals in providing 
                critical access to emergency, inpatient, and outpatient 
                health services, including end-of-life services, as 
                well as the location of such hospitals in relation to 
                medically underserved areas; and
                    (B) the extent to which such hospitals satisfy the 
                requirements established for charitable hospital 
                organizations under section 501(r) of the Internal 
                Revenue Code of 1986 with respect to community health 
                needs assessments, financial assistance policy 
                requirements, limitations on charges, and billing and 
                collection requirements.
    (b) Reports.--
            (1) Report to congress.--Not later than 180 days after the 
        date on which the study under subsection (a) is completed, the 
        Comptroller General of the United States shall submit to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Finance of the Senate a 
        report that contains--
                    (A) the results of the study;
                    (B) recommendations to Congress for any legislative 
                changes to the payments to disproportionate share 
                hospitals under section 1886(d)(5)(F) of the Social 
                Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section 
                1923 of such Act (42 U.S.C. 1396r-4) that are needed to 
                ensure access to health services for low-income 
                patients that--
                            (i) are based on the number of individuals 
                        without health insurance, the amount of 
                        uncompensated care provided by such hospitals, 
                        and the impact of reduced payment levels on 
                        low-income communities; and
                            (ii) takes into account any reports 
                        submitted by the Secretary of the Treasury, in 
                        consultation with the Secretary of Health and 
                        Human Services, to congressional committees 
                        regarding the costs incurred by charitable 
                        hospital organizations for charity care, bad 
                        debt, nonreimbursed expenses for services 
                        provided to individuals under the Medicare 
                        program under title XVIII of the Social 
                        Security Act and the Medicaid program under 
                        title XIX of such Act, and any community 
                        benefit activities provided by such 
                        organizations.
            (2) Report to the secretary of health and human services.--
        Not later than 180 days after the date on which the study under 
        subsection (a) is completed, the Comptroller General of the 
        United States shall submit to the Secretary of Health and Human 
        Services a report that contains--
                    (A) the results of the study; and
                    (B) any recommendations for purposes of assisting 
                in the development of the methodology for the 
                adjustment of payments to disproportionate share 
                hospitals, as required under section 1886(r) of the 
                Social Security Act (42 U.S.C. 1395ww(r)) and the 
                reduction of such payments under section 1923(f)(7) of 
                such Act (42 U.S.C. 1396r-4(f)(7)), taking into account 
                the reports referred to in paragraph (1)(B)(ii).

SEC. 4212. REAUTHORIZATION OF THE NATIVE HAWAIIAN HEALTH CARE 
              IMPROVEMENT ACT.

    (a) Native Hawaiian Health Care Systems.--Section 6(h)(1) of the 
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is 
amended by striking ``may be necessary for fiscal years 1993 through 
2019'' and inserting ``are necessary''.
    (b) Administrative Grant for Papa Ola Lokahi.--Section 7(b) of the 
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is 
amended by striking ``may be necessary for fiscal years 1993 through 
2019'' and inserting ``are necessary''.
    (c) Native Hawaiian Health Scholarships.--Section 10(c) of the 
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is 
amended by striking ``may be necessary for fiscal years 1993 through 
2019'' and inserting ``are necessary''.

                             PART 2--RURAL

SEC. 4221. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) PROGRAM.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x), as amended by the previous sections, is amended by adding at 
the end of the following new subsection:

     ``Rural Community Hospital; Rural Community Hospital Services

    ``(lll)(1) The term `rural community hospital' means a hospital (as 
defined in subsection (e)) that--
            ``(A) is located in a rural area (as defined in section 
        1886(d)(2)(D)) or treated as being so located pursuant to 
        section 1886(d)(8)(E);
            ``(B) subject to paragraph (2), has less than 51 acute care 
        inpatient beds, as reported in its most recent cost report;
            ``(C) makes available 24-hour emergency care services;
            ``(D) subject to paragraph (3), has a provider agreement in 
        effect with the Secretary and is open to the public as of 
        January 1, 2010; and
            ``(E) applies to the Secretary for such designation.
    ``(2) For purposes of paragraph (1)(B), beds in a psychiatric or 
rehabilitation unit of the hospital which is a distinct part of the 
hospital shall not be counted.
    ``(3) Paragraph (1)(D) shall not be construed to prohibit any of 
the following from qualifying as a rural community hospital:
            ``(A) A replacement facility (as defined by the Secretary 
        in regulations in effect on January 1, 2012) with the same 
        service area (as defined by the Secretary in regulations in 
        effect on such date).
            ``(B) A facility obtaining a new provider number pursuant 
        to a change of ownership.
            ``(C) A facility which has a binding written agreement with 
        an outside, unrelated party for the construction, 
        reconstruction, lease, rental, or financing of a building as of 
        January 1, 2012.
    ``(4) Nothing in this subsection shall be construed as prohibiting 
a critical access hospital from qualifying as a rural community 
hospital if the critical access hospital meets the conditions otherwise 
applicable to hospitals under subsection (e) and section 1866.
    ``(5) Nothing in this subsection shall be construed as prohibiting 
a rural community hospital participating in the demonstration program 
under section 410A of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2313) from 
qualifying as a rural community hospital if the rural community 
hospital meets the conditions otherwise applicable to hospitals under 
subsection (e) and section 1866.''.
    (b) Payment.--
            (1) Inpatient hospital services.--Section 1814 of the 
        Social Security Act (42 U.S.C. 1395f) is amended by adding at 
        the end the following new subsection:

``Payment for Inpatient Services Furnished in Rural Community Hospitals

    ``(m) The amount of payment under this part for inpatient hospital 
services furnished in a rural community hospital, other than such 
services furnished in a psychiatric or rehabilitation unit of the 
hospital which is a distinct part, is, at the election of the hospital 
in the application referred to in section 1861(lll)(1)(E)--
            ``(1) 101 percent of the reasonable costs of providing such 
        services, without regard to the amount of the customary or 
        other charge, or
            ``(2) the amount of payment provided for under the 
        prospective payment system for inpatient hospital services 
        under section 1886(d).''.
            (2) Outpatient services.--Section 1834 of such Act (42 
        U.S.C. 1395m) is amended by adding at the end the following new 
        subsection:
    ``(z) Payment for Outpatient Services Furnished in Rural Community 
Hospitals.--The amount of payment under this part for outpatient 
services furnished in a rural community hospital is, at the election of 
the hospital in the application referred to in section 
1861(lll)(1)(E)--
            ``(1) 101 percent of the reasonable costs of providing such 
        services, without regard to the amount of the customary or 
        other charge and any limitation under section 1861(v)(1)(U), or
            ``(2) the amount of payment provided for under the 
        prospective payment system for covered OPD services under 
        section 1833(t).''.
            (3) Exemption from 30-percent reduction in reimbursement 
        for bad debt.--Section 1861(v)(1)(T) of such Act (42 U.S.C. 
        1395x(v)(1)(T)) is amended by inserting ``(other than for a 
        rural community hospital)'' after ``In determining such 
        reasonable costs for hospitals''.
    (c) Beneficiary Cost-Sharing for Outpatient Services.--Section 
1834(z) of such Act (as added by subsection (b)(2)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively;
            (2) by inserting ``(1)'' after ``(z)''; and
            (3) by adding at the end the following:
    ``(2) The amounts of beneficiary cost-sharing for outpatient 
services furnished in a rural community hospital under this part shall 
be as follows:
            ``(A) For items and services that would have been paid 
        under section 1833(t) if furnished by a hospital, the amount of 
        cost-sharing determined under paragraph (8) of such section.
            ``(B) For items and services that would have been paid 
        under section 1833(h) if furnished by a provider of services or 
        supplier, no cost-sharing shall apply.
            ``(C) For all other items and services, the amount of cost-
        sharing that would apply to the item or service under the 
        methodology that would be used to determine payment for such 
        item or service if provided by a physician, provider of 
        services, or supplier, as the case may be.''.
    (d) Conforming Amendments.--
            (1) Part a payment.--Section 1814(b) of such Act (42 U.S.C. 
        1395f(b)) is amended in the matter preceding paragraph (1) by 
        inserting ``other than inpatient hospital services furnished by 
        a rural community hospital,'' after ``critical access hospital 
        services,''.
            (2) Part b payment.--Section 1833(a) of such Act (42 U.S.C. 
        1395l(a)), as amended by section 207(b)(3), is amended--
                    (A) by striking ``and'' at the end of paragraph 
                (9);
                    (B) by striking the period at the end of paragraph 
                (10) and inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(11) in the case of outpatient services furnished by a 
        rural community hospital, the amounts described in section 
        1834(z).''.
            (3) Technical amendments.--
                    (A) Consultation with state agencies.--Section 1863 
                of such Act (42 U.S.C. 1395z) is amended by striking 
                ``and (dd)(2)'' and inserting ``(dd)(2), and 
                (lll)(1)''.
                    (B) Provider agreements.--Section 1866(a)(2)(A) of 
                such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
                inserting ``section 1834(z)(2),'' after ``section 
                1833(b),''.
    (e) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after October 1, 2022.

SEC. 4222. RURAL HEALTH QUALITY ADVISORY COMMISSION AND DEMONSTRATION 
              PROJECTS.

    (a) Rural Health Quality Advisory Commission.--
            (1) Establishment.--Not later than 6 months after the date 
        of the enactment of this section, the Secretary of Health and 
        Human Services (in this section referred to as the 
        ``Secretary'') shall establish a commission to be known as the 
        Rural Health Quality Advisory Commission (in this section 
        referred to as the ``Commission'').
            (2) Duties of commission.--
                    (A) National plan.--The Commission shall develop, 
                coordinate, and facilitate implementation of a national 
                plan for rural health quality improvement. The national 
                plan shall--
                            (i) identify objectives for rural health 
                        quality improvement;
                            (ii) identify strategies to eliminate known 
                        gaps in rural health system capacity and 
                        improve rural health quality; and
                            (iii) provide recommendations for Federal 
                        programs to identify opportunities for 
                        strengthening and aligning policies and 
                        programs to improve rural health quality.
                    (B) Demonstration projects.--The Commission shall 
                design demonstration projects to recommend to the 
                Secretary to test alternative models for rural health 
                quality improvement, including with respect to both 
                personal and population health.
                    (C) Monitoring.--The Commission shall monitor 
                progress toward the objectives identified pursuant to 
                subparagraph (A)(i).
            (3) Membership.--
                    (A) Number.--The Commission shall be composed of 11 
                members appointed by the Secretary.
                    (B) Selection.--The Secretary shall select the 
                members of the Commission from among individuals with 
                significant rural health care and health care quality 
                expertise, including expertise in clinical health care, 
                health care quality research, end-of-life care, 
                population or public health, or purchaser 
                organizations.
            (4) Contracting authority.--Subject to the availability of 
        funds, the Commission may enter into contracts and make other 
        arrangements, as may be necessary to carry out the duties 
        described in paragraph (2).
            (5) Staff.--Upon the request of the Commission, the 
        Secretary may detail, on a reimbursable basis, any of the 
        personnel of the Office of Rural Health Policy of the Health 
        Resources and Services Administration, the Agency for 
        Healthcare Research and Quality, or the Centers for Medicare & 
        Medicaid Services to the Commission to assist in carrying out 
        this subsection.
            (6) Reports to congress.--Not later than 1 year after the 
        establishment of the Commission, and annually thereafter, the 
        Commission shall submit a report to the Congress on rural 
        health quality. Each such report shall include the following:
                    (A) An inventory of relevant programs and 
                recommendations for improved coordination and 
                integration of policy and programs.
                    (B) An assessment of achievement of the objectives 
                identified in the national plan developed under 
                paragraph (2) and recommendations for realizing such 
                objectives.
                    (C) Recommendations on Federal legislation, 
                regulations, or administrative policies to enhance 
                rural health quality and outcomes.
    (b) Rural Health Quality Demonstration Projects.--
            (1) In general.--Not later than 270 days after the date of 
        the enactment of this section, the Secretary, in consultation 
        with the Rural Health Quality Advisory Commission, the Office 
        of Rural Health Policy of the Health Resources and Services 
        Administration, the Agency for Healthcare Research and Quality, 
        and the Centers for Medicare & Medicaid Services, shall make 
        grants to eligible entities for a total of 5 demonstration 
        projects to implement and evaluate methods for improving the 
        quality of health care in rural communities. Each such 
        demonstration project shall include--
                    (A) alternative community models that--
                            (i) will achieve greater integration of 
                        personal and population health services; and
                            (ii) address safety, effectiveness, 
                        patient- or community-centeredness, timeliness, 
                        efficiency, and equity (the 6 aims identified 
                        by the National Academy of Medicine (formerly 
                        known as the ``Institute of Medicine'') in its 
                        report entitled ``Crossing the Quality Chasm: A 
                        New Health System for the 21st Century'' 
                        released on March 1, 2001);
                    (B) innovative approaches to the financing and 
                delivery of health care services to achieve rural 
                health quality and accessibility goals for patients; 
                and
                    (C) development of quality improvement support 
                structures to assist rural health systems and 
                professionals in the provision of health care (such as 
                workforce support structures, quality monitoring and 
                reporting, clinical care protocols, and information 
                technology applications).
            (2) Eligible entities.--In this subsection, the term 
        ``eligible entity'' means a consortium that--
                    (A) shall include--
                            (i) at least one health care provider or 
                        health care delivery system located in a rural 
                        area; and
                            (ii) at least one organization representing 
                        multiple community stakeholders; and
                    (B) may include other partners such as rural 
                research centers.
            (3) Consultation.--In developing the program for awarding 
        grants under this subsection, the Secretary shall consult with 
        the Administrator of the Agency for Healthcare Research and 
        Quality, rural health care providers, rural health care 
        researchers, and private and nonprofit groups (including 
        national associations) which are undertaking similar efforts.
            (4) Expedited waivers.--The Secretary shall expedite the 
        processing of any waiver that--
                    (A) is authorized under title XVIII or XIX of the 
                Social Security Act (42 U.S.C. 1395 et seq.; 42 U.S.C. 
                1396 et seq.); and
                    (B) is necessary to carry out a demonstration 
                project under this subsection.
            (5) Demonstration project sites.--The Secretary shall 
        ensure that the 5 demonstration projects funded under this 
        subsection are conducted at a variety of sites representing the 
        diversity of rural communities in the United States.
            (6) Duration.--Each demonstration project under this 
        subsection shall be for a period of 4 years.
            (7) Independent evaluation.--The Secretary shall enter into 
        an arrangement with an entity that has experience working 
        directly with rural health systems for the conduct of an 
        independent evaluation of the program carried out under this 
        subsection.
            (8) Report.--Not later than 1 year after the conclusion of 
        all of the demonstration projects funded under this subsection, 
        the Secretary shall submit a report to the Congress on the 
        results of such projects. The report shall include--
                    (A) an evaluation of patient access to care, 
                patient outcomes, and an analysis of the cost 
                effectiveness of each such project; and
                    (B) recommendations on Federal legislation, 
                regulations, or administrative policies to enhance 
                rural health quality and outcomes.
    (c) Appropriation.--
            (1) In general.--Out of funds in the Treasury not otherwise 
        appropriated, there are appropriated to the Secretary to carry 
        out this section $30,000,000 for the period of fiscal years 
        2023 through 2027.
            (2) Availability.--
                    (A) In general.--Funds appropriated under paragraph 
                (1) shall remain available for expenditure through 
                fiscal year 2027.
                    (B) Report.--For purposes of carrying out 
                subsection (b)(8), funds appropriated under paragraph 
                (1) shall remain available for expenditure through 
                fiscal year 2028.
            (3) Reservation.--Of the amount appropriated under 
        paragraph (1), the Secretary shall reserve--
                    (A) $5,000,000 to carry out subsection (a); and
                    (B) $25,000,000 to carry out subsection (b), of 
                which--
                            (i) 2 percent shall be for the provision of 
                        technical assistance to grant recipients; and
                            (ii) 5 percent shall be for independent 
                        evaluation under subsection (b)(7).

SEC. 4223. RURAL HEALTH CARE SERVICES.

    Section 330A of the Public Health Service Act (42 U.S.C. 254c) is 
amended to read as follows:

``SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK 
              DEVELOPMENT, DELTA RURAL DISPARITIES AND HEALTH SYSTEMS 
              DEVELOPMENT, AND SMALL RURAL HEALTH CARE PROVIDER QUALITY 
              IMPROVEMENT GRANT PROGRAMS.

    ``(a) Purpose.--The purpose of this section is to provide for 
grants--
            ``(1) under subsection (b), to promote rural health care 
        services outreach;
            ``(2) under subsection (c), to provide for the planning and 
        implementation of integrated health care networks in rural 
        areas;
            ``(3) under subsection (d), to assist rural communities in 
        the Delta Region to reduce health disparities and to promote 
        and enhance health system development; and
            ``(4) under subsection (e), to provide for the planning and 
        implementation of small rural health care provider quality 
        improvement activities.
    ``(b) Rural Health Care Services Outreach Grants.--
            ``(1) Grants.--The Director of the Office of Rural Health 
        Policy of the Health Resources and Services Administration 
        (referred to in this section as the `Director') may award 
        grants to eligible entities to promote rural health care 
        services outreach by expanding the delivery of health care 
        services to include new and enhanced services in rural areas. 
        The Director may award the grants for periods of not more than 
        3 years.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection for a project, an entity--
                    ``(A) shall be a rural public or rural nonprofit 
                private entity, a facility that qualifies as a rural 
                health clinic under title XVIII of the Social Security 
                Act, a public or nonprofit entity existing exclusively 
                to provide services to migrant and seasonal farm 
                workers in rural areas, or a Tribal government whose 
                grant-funded activities will be conducted within 
                federally recognized Tribal areas;
                    ``(B) shall represent a consortium composed of 
                members--
                            ``(i) that include 3 or more independently 
                        owned health care entities; and
                            ``(ii) that may be nonprofit or for-profit 
                        entities; and
                    ``(C) shall not previously have received a grant 
                under this subsection for the same or a similar 
                project, unless the entity is proposing to expand the 
                scope of the project or the area that will be served 
                through the project.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Director an application at such time, in such 
        manner, and containing such information as the Director may 
        require, including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) a description of the manner in which the 
                project funded under the grant will meet the health 
                care needs of rural populations in the local community 
                or region to be served;
                    ``(C) a plan for quantifying how health care needs 
                will be met through identification of the target 
                population and benchmarks of service delivery or health 
                status, such as--
                            ``(i) quantifiable measurements of health 
                        and health care status improvement for projects 
                        focusing on health promotion; or
                            ``(ii) benchmarks of increased access to 
                        primary and end-of-life care, including 
                        tracking factors such as the number and type of 
                        primary and end-of-life care visits, 
                        identification of a medical home, or other 
                        general measures of such access;
                    ``(D) a description of how the local community or 
                region to be served will be involved in the development 
                and ongoing operations of the project;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated;
                    ``(G) the administrative capacity to submit annual 
                performance data electronically as specified by the 
                Director; and
                    ``(H) other such information as the Director 
                determines to be appropriate.
    ``(c) Rural Health Network Development Grants.--
            ``(1) Grants.--
                    ``(A) In general.--The Director may award rural 
                health network development grants to eligible entities 
                to promote, through planning and implementation, the 
                development of integrated health care networks that 
                have combined the functions of the entities 
                participating in the networks in order to--
                            ``(i) achieve efficiencies and economies of 
                        scale;
                            ``(ii) expand access to, coordinate, and 
                        improve the quality of the health care delivery 
                        system through development of organizational 
                        efficiencies;
                            ``(iii) implement health information 
                        technology to achieve efficiencies, reduce 
                        medical errors, and improve quality;
                            ``(iv) coordinate care and manage chronic 
                        and terminal illness; and
                            ``(v) strengthen the rural health care 
                        system as a whole and across all facets of the 
                        health care delivery system, including end-of-
                        life care, in such a manner as to show a 
                        quantifiable return on investment to the 
                        participants in the network.
                    ``(B) Grant periods.--The Director may award such a 
                rural health network development grant--
                            ``(i) for a period of 3 years for 
                        implementation activities; or
                            ``(ii) for a period of 1 year for planning 
                        activities to assist in the initial development 
                        of an integrated health care network, if the 
                        proposed participants in the network do not 
                        have a history of collaborative efforts and a 
                        3-year grant would be inappropriate.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection, an entity--
                    ``(A) shall be a rural public or rural nonprofit 
                private entity, a facility that qualifies as a rural 
                health clinic under title XVIII of the Social Security 
                Act, a public or nonprofit entity existing exclusively 
                to provide services to migrant and seasonal farm 
                workers in rural areas, or a Tribal government whose 
                grant-funded activities will be conducted within 
                federally recognized Tribal areas;
                    ``(B) shall represent a network composed of 
                participants--
                            ``(i) that include 3 or more independently 
                        owned health care entities; and
                            ``(ii) that may be nonprofit or for-profit 
                        entities; and
                    ``(C) shall not previously have received a grant 
                under this subsection (other than a 1-year grant for 
                planning activities) for the same or a similar project.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity, in consultation with 
        the appropriate State office of rural health or another 
        appropriate State entity, shall prepare and submit to the 
        Director an application at such time, in such manner, and 
        containing such information as the Director may require, 
        including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of--
                            ``(i) the history of collaborative 
                        activities carried out by the participants in 
                        the network;
                            ``(ii) the degree to which the participants 
                        are ready to integrate their functions; and
                            ``(iii) how the local community or region 
                        to be served will benefit from and be involved 
                        in the activities carried out by the network;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services across the continuum of 
                care as a result of the integration activities carried 
                out by the network, including a description of--
                            ``(i) return on investment for the 
                        community and the network members; and
                            ``(ii) other quantifiable performance 
                        measures that show the benefit of the network 
                        activities;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated;
                    ``(G) the administrative capacity to submit annual 
                performance data electronically as specified by the 
                Director; and
                    ``(H) other such information as the Director 
                determines to be appropriate.
    ``(d) Delta Rural Disparities and Health Systems Development 
Grants.--
            ``(1) Grants.--The Director may award grants to eligible 
        entities to support reduction of health disparities, improve 
        access to health care, and enhance rural health system 
        development in the Delta Region.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection, an entity shall be a rural public or rural 
        nonprofit private entity, a facility that qualifies as a rural 
        health clinic under title XVIII of the Social Security Act, a 
        public or nonprofit entity existing exclusively to provide 
        services to migrant and seasonal farm workers in rural areas, 
        or a Tribal government whose grant-funded activities will be 
        conducted within federally recognized Tribal areas.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Director an application at such time, in such 
        manner, and containing such information as the Director may 
        require, including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of the manner in which the 
                project funded under the grant will meet the health 
                care needs of the Delta Region;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services as a result of the 
                activities carried out by the entity;
                    ``(E) a description of how health disparities will 
                be reduced or the health system will be improved;
                    ``(F) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(G) a description of how the project will be 
                evaluated including process and outcome measures 
                related to the quality of care provided or how the 
                health care system improves its performance;
                    ``(H) a description of how the grantee will develop 
                an advisory group made up of representatives of the 
                communities to be served to provide guidance to the 
                grantee to best meet community need; and
                    ``(I) other such information as the Director 
                determines to be appropriate.
    ``(e) Small Rural Health Care Provider Quality Improvement 
Grants.--
            ``(1) Grants.--The Director may award grants to provide for 
        the planning and implementation of small rural health care 
        provider quality improvement activities. The Director may award 
        the grants for periods of 1 to 3 years.
            ``(2) Eligibility.--To be eligible for a grant under this 
        subsection, an entity--
                    ``(A) shall be--
                            ``(i) a rural public or rural nonprofit 
                        private health care provider or provider of 
                        health care services, such as a rural health 
                        clinic; or
                            ``(ii) another rural provider or network of 
                        small rural providers identified by the 
                        Director as a key source of local care; and
                    ``(B) shall not previously have received a grant 
                under this subsection for the same or a similar 
                project.
            ``(3) Preference.--In awarding grants under this 
        subsection, the Director shall give preference to facilities 
        that qualify as rural health clinics under title XVIII of the 
        Social Security Act.
            ``(4) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Director an application at such time, in such 
        manner, and containing such information as the Director may 
        require, including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of the manner in which the 
                project funded under the grant will assure continuous 
                quality improvement in the provision of services by the 
                entity;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services as a result of the 
                activities carried out by the entity;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated including process and outcome measures 
                related to the quality of care provided; and
                    ``(G) other such information as the Director 
                determines to be appropriate.
    ``(f) General Requirements.--
            ``(1) Prohibited uses of funds.--An entity that receives a 
        grant under this section may not use funds provided through the 
        grant--
                    ``(A) to build or acquire real property; or
                    ``(B) for construction.
            ``(2) Coordination with other agencies.--The Director shall 
        coordinate activities carried out under grant programs 
        described in this section, to the extent practicable, with 
        Federal and State agencies and nonprofit organizations that are 
        operating similar grant programs, to maximize the effect of 
        public dollars in funding meritorious proposals.
    ``(g) Report.--Not later than September 30, 2024, the Secretary 
shall prepare and submit to the appropriate committees of Congress a 
report on the progress and accomplishments of the grant programs 
described in subsections (b), (c), (d), and (e).
    ``(h) Definition of Delta Region.--In this section, the term `Delta 
Region' has the meaning given to the term `region' in section 382A of 
the Consolidated Farm and Rural Development Act (7 U.S.C. 2009aa).
    ``(i) 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 2024 through 2027.''.

                       PART 3--INDIAN COMMUNITIES

SEC. 4231. ASSISTANT SECRETARY OF THE INDIAN HEALTH SERVICE.

    (a) References.--Any reference in a law, regulation, document, 
paper, or other record of the United States to the Director of the 
Indian Health Service shall be deemed to be a reference to the 
Assistant Secretary of the Indian Health Service.
    (b) Executive Schedule.--Section 5315 of title 5, United States 
Code, is amended in the matter relating to the Assistant Secretaries of 
Health and Human Services by striking ``(6)'' and inserting ``(7), one 
of whom shall be the Assistant Secretary of the Indian Health 
Service''.
    (c) Conforming Amendment.--Section 5316 of title 5, United States 
Code, is amended by striking ``Director, Indian Health Service, 
Department of Health and Human Services.''.

SEC. 4232. EXTENSION OF FULL FEDERAL MEDICAL ASSISTANCE PERCENTAGE TO 
              INDIAN HEALTH CARE PROVIDERS.

    Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
            (1) in subsection (a), by amending paragraph (9) to read as 
        follows:
            ``(9) clinic services furnished by or under the direction 
        of a physician, without regard to whether the clinic itself is 
        administered by a physician, including--
                    ``(A) such services furnished outside the clinic by 
                clinic personnel to an eligible individual who does not 
                reside in a permanent dwelling or does not have a fixed 
                home or mailing address; and
                    ``(B) such services furnished outside the clinic by 
                any Indian Health Service facility, a health program or 
                facility operated by a tribe or tribal organization 
                under the Indian Self-Determination Act (Public Law 93-
                638), or an urban Indian organization receiving funds 
                under title V of the Indian Health Care Improvement 
                Act;''; and
            (2) in subsection (b), by inserting after ``Papa Ola Lokahi 
        under section 8 of such Act'' the following: ``; the Federal 
        medical assistance percentage shall also be 100 per centum with 
        respect to amounts expended as medical assistance for services 
        which are received by an Indian Health Service facility, a 
        health program or facility operated by a tribe or tribal 
        organization under the Indian Self-Determination Act (Public 
        Law 93-638), or an urban Indian organization receiving funds 
        under title V of the Indian Health Care Improvement Act''.

SEC. 4233. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.

    Section 514(b) of the Indian Health Care Improvement Act (25 U.S.C. 
1660d) is amended to read as follows:
    ``(b) Requirement.--The Secretary shall ensure that the Service and 
the other agencies and offices of the Department of Health and Human 
Services and the Department of Veterans Affairs confer, to the maximum 
extent practicable, with urban Indian organizations in carrying out--
            ``(1) this Act; and
            ``(2) other provisions of law relating to Indian health 
        care.''.

                           PART 4--PROVIDERS

SEC. 4241. AVAILABILITY OF NON-ENGLISH LANGUAGE SPEAKING PROVIDERS.

    (a) In General.--Section 1311(c)(1)(B) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)) is amended by 
inserting before the semicolon the following: ``and the ability of such 
provider to provide care in a language other than English either 
through the provider speaking such language or by the provider having a 
qualified interpreter for an individual with limited English 
proficiency (as defined in section 3400 of such Act) who speaks such 
language available during office hours''.
    (b) Effective Date.--The amendment made by subsection (a) shall not 
apply to any plan beginning on or prior to the date that is 1 year 
after the date of the enactment of this Act.

SEC. 4242. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS.

    (a) Essential Community Providers.--Section 1311(c)(1)(C) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(C)) 
is amended--
            (1) by inserting ``(i)'' after ``(C)''; and
            (2) by adding at the end the following new clauses:
                    ``(ii) not later than January 1, 2023, increase the 
                percentage of essential community providers as 
                described in clause (i) included in its network by 10 
                percent annually (based on the level in the plan for 
                2016) until 90 percent of all federally qualified 
                health centers and 75 percent of all other such 
                essential community providers in the contract service 
                area are in-network; and
                    ``(iii) include at least one essential community 
                provider in each of the essential community provider 
                categories described in section 156.235(a)(2)(ii)(B) of 
                title 45, Code of Federal Regulations (as in effect on 
                the date of enactment of the Health Equity and 
                Accountability Act of 2022), in each county in the 
                service area, where available;''.
    (b) Reporting Requirements.--Section 1311(e)(3) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended 
by adding at the end the following new subparagraph:
                    ``(E) Data on essential community providers.--The 
                Secretary shall require qualified health plans to 
                submit annually to the Secretary data on the percentage 
                of essential community providers as described in clause 
                (ii) of subsection (c)(1)(C), by county, that contract 
                with each qualified health plan offered in that county 
                and the percentage of such essential community 
                providers, by category as described in clause (iii) of 
                such subsection, that contract with each qualified 
                health plan offered in that county. Such data shall be 
                made available to the general public.''.
    (c) Essential Community Provider Provisions Applied Under Medicare 
and Medicaid.--
            (1) Medicare.--Section 1852(d)(1) of the Social Security 
        Act (42 U.S.C. 1395w-22(d)(1)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (D);
                    (B) by striking the period at the end of 
                subparagraph (E) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) the plan meets the requirements of clauses 
                (ii) and (iii) of section 1311(c)(1)(C) of the Patient 
                Protection and Affordable Care Act (relating to 
                inclusion in networks of essential community 
                providers).''.
            (2) Medicaid.--Section 1932(b)(5) of the Social Security 
        Act (42 U.S.C. 1396u-2(b)(5)) is amended--
                    (A) by striking ``and'' at the end of subparagraph 
                (A);
                    (B) by striking the period at the end of 
                subparagraph (B) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) meets the requirements of clauses (ii) and 
                (iii) of section 1311(c)(1)(C) of the Patient 
                Protection and Affordable Care Act (relating to 
                inclusion in networks of essential community providers) 
                with respect to services offered in the service area 
                involved.''.

SEC. 4243. PROVIDER NETWORK ADEQUACY IN COMMUNITIES OF COLOR.

    (a) In General.--Section 1311(c)(1)(B) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)), as amended by 
section 4241(a), is further amended--
            (1) by inserting ``(i)'' after ``(B)''; and
            (2) by adding at the end the following new clauses:
                            ``(ii) meet such network adequacy standards 
                        as the Secretary may establish with regard to--
                                    ``(I) appointment wait time;
                                    ``(II) travel time and distance to 
                                health care provider facilities and 
                                providers by public and private 
                                transit;
                                    ``(III) hours of operation to 
                                accommodate individuals who cannot come 
                                to provider appointments during 
                                standard business hours;
                                    ``(IV) availability of health care 
                                options for patients; and
                                    ``(V) other network adequacy 
                                standards to ensure that care through 
                                these plans is accessible to diverse 
                                communities, including individuals with 
                                limited English proficiency as defined 
                                in section 3400 of such Act; and
                            ``(iii) provide coverage for services for 
                        enrollees through out-of-network providers at 
                        no additional cost to the enrollees in cases 
                        where in-network providers are unable to comply 
                        with the standards established under subclause 
                        (III) or (IV) of clause (ii) for such services 
                        and the out-of-network providers can deliver 
                        such services in compliance with such 
                        standards.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
not apply to plans beginning on or prior to the date that is 1 year 
after the date of the enactment of the Health Equity and Accountability 
Act of 2022.

                             PART 5--DENTAL

SEC. 4251. IMPROVING ACCESS TO DENTAL CARE.

    (a) Reports to Congress.--
            (1) GAO reports.--Not later than 1 year after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to Congress--
                    (A) a report on the Alaska Dental Health Aide 
                Therapists program and the Dental Therapist and 
                Advanced Dental Therapist programs in Minnesota, to 
                assess the effectiveness of dental therapists in--
                            (i) improving access to timely dental care 
                        among communities of color;
                            (ii) providing high-quality care;
                            (iii) providing culturally competent care; 
                        and
                            (iv) providing accessible care to people 
                        with disabilities;
                    (B) a report on State variations in the use of 
                dental hygienists and the effectiveness of expanding 
                the scope of practice for dental hygienists in--
                            (i) improving access to timely dental care 
                        among communities of color;
                            (ii) providing high-quality care;
                            (iii) providing culturally competent care; 
                        and
                            (iv) providing accessible care to people 
                        with disabilities; and
                    (C) a report on the use of telehealth services to 
                enhance services provided by dental hygienists and 
                therapists, including recommendations for any 
                modifications to the Medicare program under title XVIII 
                of the Social Security Act and the Medicaid program 
                under title XIX of such Act to better provide for 
                telehealth consultations in conjunction with 
                therapists' and hygienists' care.
            (2) HRSA report on dental shortage areas.--Not later than 1 
        year after the date of the enactment of this Act, the Secretary 
        of Health and Human Services, acting through the Administrator 
        of the Health Resources and Services Administration, shall 
        submit to Congress a report which details geographic dental 
        access shortages and the preparedness of dental providers to 
        offer culturally and linguistically appropriate, affordable, 
        accessible, and timely services.
    (b) Expansion of Dental Health Aid Therapists in Tribal and Urban 
Indian Communities.--Section 119 of the Indian Health Care Improvement 
Act (25 U.S.C. 1616l) is amended--
            (1) in subsection (d)--
                    (A) in paragraph (2), to read as follows:
            ``(2) Requirement; exclusion.--Subject to paragraphs (3) 
        and (4), in establishing a national program under paragraph 
        (1), the Secretary--
                    ``(A) shall not reduce the amounts provided for the 
                Community Health Aide Program described in subsections 
                (a) and (b);
                    ``(B) shall exclude dental health aide therapist 
                services from services covered under such Program; and
                    ``(C) shall include urban Indian organizations.''; 
                and
                    (B) in paragraph (3), by striking ``or tribal 
                organization'' each place it appears and inserting ``, 
                tribal organization, or urban Indian organization''; 
                and
            (2) in subsection (e), by striking ``or a tribal 
        organization'' and inserting ``a tribal organization, or an 
        urban Indian organization''.
    (c) Coverage of Dental Services Under the Medicare Program.--
            (1) Coverage.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (GG), by striking ``and'' at 
                the end;
                    (B) in subparagraph (HH), by striking the period 
                and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(II) dental and oral health services (as defined in 
        subsection (mmm));''.
            (2) Dental and oral health services defined.--Section 1861 
        of the Social Security Act (42 U.S.C. 1395x), as amended by 
        previous provisions of this Act, is amended by adding at the 
        end the following new subsection:

                   ``Dental and Oral Health Services

    ``(mmm)(1) The term `dental and oral health services' means 
services (as defined by the Secretary) that are necessary to prevent 
disease and promote oral health, restore oral structures to health and 
function, and treat emergency conditions, including--
            ``(A) routine diagnostic and preventive care such as dental 
        cleanings, exams, and x-rays;
            ``(B) basic dental services such as fillings and 
        extractions;
            ``(C) major dental services such as root canals, crowns, 
        and dentures;
            ``(D) emergency dental care; and
            ``(E) other necessary services related to dental and oral 
        health (as defined by the Secretary).
    ``(2) For purposes of paragraph (1), such term shall include mobile 
and portable oral health services (as defined by the Secretary) that--
            ``(A) are provided for the purpose of overcoming mobility, 
        transportation, and access barriers for individuals; and
            ``(B) satisfy the standards and certification requirements 
        established under section 1902(a)(82)(B) for the State in which 
        the services are provided.''.
            (3) Payment and coinsurance.--Section 1833(a)(1) of the 
        Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``and (EE) with respect to dental and 
                oral health services (as defined in section 1861(mmm)), 
                the amount paid shall be (i) in the case of such 
                services that are preventive, 100 percent of the lesser 
                of the actual charge for the services or the amount 
                determined under the payment basis determined under 
                section 1848, and (ii) in the case of all other such 
                services, 80 percent of the lesser of the actual charge 
                for the services or the amount determined under the 
                payment basis determined under section 1848''.
            (4) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``, (2)(II),'' after ``(including 
        administration of the health risk assessment)''.
            (5) Dentures.--Section 1861(s)(8) of the Social Security 
        Act (42 U.S.C. 1395x(s)(8)) is amended--
                    (A) by striking ``(other than dental)'' and 
                inserting ``(including dentures)''; and
                    (B) by striking ``internal body''.
            (6) Repeal of ground for exclusion.--Section 1862(a) of the 
        Social Security Act (42 U.S.C. 1395y) is amended by striking 
        paragraph (12).
            (7) Effective date.--The amendments made by this section 
        shall apply to services furnished on or after January 1, 2023.
    (d) Requiring Coverage of Dental Services Under the Medicaid 
Program.--
            (1) Mandatory coverage.--
                    (A) In general.--
                            (i) Requirement.--Section 1902(a)(10)(A) of 
                        the Social Security Act (42 U.S.C. 
                        1396a(a)(10)(A)) is amended by inserting ``, 
                        (10)'' after ``(5)''.
                            (ii) Effective date.--The amendment made by 
                        clause (i) shall apply with respect to medical 
                        assistance furnished in calendar quarters 
                        beginning on or after the date that is 1 year 
                        after the date of the enactment of this Act.
                    (B) Benchmark coverage.--Section 1937(b)(5) of the 
                Social Security Act (42 U.S.C. 1396u-7(b)(5)) is 
                amended by striking the period and inserting ``, and, 
                beginning with the first quarter beginning on or after 
                the date of the enactment of the Health Equity and 
                Accountability Act of 2022, coverage of dental and oral 
                health services (as defined in section 1905(jj)).''.
            (2) Definition of services.--Section 1905 of the Social 
        Security Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)(10), by striking ``dental 
                services'' and inserting ``dental and oral health 
                services (as defined in subsection (jj)(1))''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jj) Dental and Oral Health Services.--(1) For purposes of this 
title, the term `dental and oral health services' means services 
necessary to prevent disease and promote oral health, restore oral 
structures to health and function, reduce oral pain, and treat 
emergency oral conditions. Such term includes the services specified in 
paragraph (2).
    ``(2) For purposes of paragraph (1), the services specified in this 
paragraph are the following:
            ``(A) Routine diagnostic and preventive care (such as 
        dental cleanings, exams, and x-rays).
            ``(B) Basic dental services (such as fillings and 
        extractions) and major dental services (such as root canals, 
        crowns, and dentures).
            ``(C) Emergency dental care.
            ``(D) Temporomandibular (TMD) and orofacial pain disorder 
        treatment.
            ``(E) Other necessary services related to dental and oral 
        health (as specified by the Secretary).
    ``(3) For purposes of paragraph (1), such term shall not include 
dental care or services provided to individuals under the age of 21 
under subsection (r)(3).''.
            (3) Conforming amendments.--
                    (A) State plan requirements.--Section 1902(a) of 
                the Social Security Act (42 U.S.C. 1396a(a)) is 
                amended--
                            (i) in paragraph (10)(A), in the matter 
                        preceding clause (i), by inserting ``(10),'' 
                        after ``(5),'';
                            (ii) in paragraph (85), by striking ``and'' 
                        at the end;
                            (iii) in paragraph (86), by striking the 
                        period at the end and inserting ``; and''; and
                            (iv) by inserting after paragraph (86) the 
                        following:
            ``(87) provide for--
                    ``(A) informing, in writing, all individuals who 
                have been determined to be eligible for medical 
                assistance of the availability of oral health services 
                (as defined in section 1905(gg));
                    ``(B) conducting targeted outreach to pregnant 
                women who have been determined to be eligible for 
                medical assistance about the availability of medical 
                assistance for such dental services and the importance 
                of receiving dental care while pregnant; and
                    ``(C) establishing and maintaining standards for 
                and certification of mobile and portable oral health 
                services (as described in subsections (r)(3)(C) and 
                (jj)(2)(B) of section 1905).''.
                    (B) Definition of medical assistance.--Section 
                1905(a)(12) of the Social Security Act (42 U.S.C. 
                1396d(a)(12)) is amended by striking ``, dentures,''.
            (4) Mobile and portable oral health services under epsdt.--
        Section 1905(r)(3) of the Social Security Act (42 U.S.C. 
        1396d(r)(3)) is amended--
                    (A) in subparagraph (A)(ii), by striking ``; and'' 
                and inserting a semicolon;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) which shall include mobile and portable oral 
                health services (as defined by the Secretary) that--
                            ``(i) are provided for the purpose of 
                        overcoming mobility, transportation, or access 
                        barriers for children; and
                            ``(ii) satisfy the standards and 
                        certification requirements established under 
                        section 1902(a)(87)(C) for the State in which 
                        the services are provided.''.
            (5) Enhanced fmap; maintenance of effort.--
                    (A) Medicaid.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d), as amended by paragraph (2), is 
                further amended--
                            (i) in subsection (b), by striking ``and 
                        (ii)'' and inserting ``(ii), and (kk)''; and
                            (ii) by adding at the end of the following 
                        new subsection:
    ``(kk) Increased FMAP for Expenditures for Dental and Oral Health 
Services.--
            ``(1) In general.--The Federal medical assistance 
        percentage with respect to amounts expended by such State for 
        medical assistance consisting of dental and oral health 
        services (as defined in subsection (jj)) furnished during the 
        first calendar quarter beginning on or after the date that is 1 
        year after the date of the enactment of this subsection or 
        during any subsequent quarter) to individuals 21 years of age 
        or older shall be equal to, in the case of such services 
        furnished--
                    ``(A) during the 3-year period beginning on the 
                first day of such first calendar year, 100 percent;
                    ``(B) during the 1-year period immediately 
                following the period described in subparagraph (A), 95 
                percent;
                    ``(C) during each subsequent 1-year period (through 
                the third such subsequent period), the percentage 
                specified under this paragraph for the preceding 1-year 
                period, reduced by 5 percentage points; and
                    ``(D) during any quarter beginning after the 7-year 
                period beginning on the first day described in 
                subparagraph (A), 80 percent.
            ``(2) No reduction in fmap.--Paragraph (1) shall not apply 
        with respect to amounts expended by a State if the Federal 
        medical assistance percentage otherwise applicable to such 
        amounts without application of such paragraph would be higher 
        than such percentage available to such amounts with application 
        of such paragraph.''.
            (6) Exclusion of amounts attributable to increased fmap 
        from territorial caps.--Section 1108 of the Social Security Act 
        (42 U.S.C. 1308) is amended--
                    (A) in subsection (f), in the matter preceding 
                paragraph (1), by striking ``subsections (g), (h), and 
                (i)''; and
                    (B) by adding at the end the following:
    ``(i) Exclusion From Caps of Amounts Attributable to Increased FMAP 
for Coverage of Dental and Oral Services.--Any payment made to a 
territory for expenditures for medical assistance that are subject to 
an increase in the Federal medical assistance percentage applicable to 
such expenditures under section 1905(kk) shall not be taken into 
account for purposes of applying payment limits under subsections (f) 
and (g) to the extent that such payment exceeds the amount of the 
payment that would have been made to the territory for such 
expenditures without regard to such section.''.
    (e) Oral Health Services as an Essential Health Benefit.--Section 
1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 
18022(b)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (J), by striking ``oral and''; 
                and
                    (B) by adding at the end the following:
                    ``(K) Oral health services for children and 
                adults.''; and
            (2) by adding at the end the following:
            ``(6) Oral health services.--For purposes of paragraph 
        (1)(K), the term `oral health services' means services (as 
        defined by the Secretary) that are necessary to prevent any 
        oral disease and promote oral health, restore oral structures 
        to health and function, and treat emergency oral conditions.''.
    (f) Demonstration Program on Training and Employment of Alternative 
Dental Health Care Providers for Dental Health Care Services for 
Veterans in Rural and Other Underserved Communities.--
            (1) Demonstration program authorized.--The Secretary of 
        Veterans Affairs may carry out a demonstration program to 
        establish programs to train and employ alternative dental 
        health care providers in order to increase access to dental 
        health care services for veterans who are entitled to such 
        services from the Department of Veterans Affairs and reside in 
        rural and other underserved communities.
            (2) Telehealth.--For purposes of alternative dental health 
        care providers and other dental care providers who are licensed 
        to provide clinical care, dental services provided under the 
        demonstration program under this subsection may be administered 
        by such providers through telehealth-enabled collaboration and 
        supervision when appropriate and feasible.
            (3) Alternative dental health care providers defined.--In 
        this subsection, the term ``alternative dental health care 
        providers'' has the meaning given that term in section 340G-
        1(a)(2) of the Public Health Service Act (42 U.S.C. 256g-
        1(a)(2)).
            (4) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as are necessary to carry out the 
        demonstration program under this subsection.
    (g) Demonstration Program on Training and Employment of Alternative 
Dental Health Care Providers for Dental Health Care Services for 
Members of the Armed Forces and Dependents Lacking Ready Access to Such 
Services.--
            (1) Demonstration program authorized.--The Secretary of 
        Defense may carry out a demonstration program to establish 
        programs to train and employ alternative dental health care 
        providers in order to increase access to dental health care 
        services for members of the Armed Forces and their dependents 
        who lack ready access to such services, including the 
        following:
                    (A) Members and dependents who reside in rural 
                areas or areas otherwise underserved by dental health 
                care providers.
                    (B) Members of a reserve component of the Armed 
                Forces in active status who are potentially deployable.
            (2) Telehealth.--For purposes of alternative dental health 
        care providers and other dental care providers who are licensed 
        to provide clinical care, dental services provided under the 
        demonstration program under this subsection may be administered 
        by such providers through telehealth-enabled collaboration and 
        supervision when appropriate and feasible.
            (3) Definitions.--In this subsection:
                    (A) Active status.--The term ``active status'' has 
                the meaning given that term in section 101(d) of title 
                10, United States Code.
                    (B) Alternative dental health care providers.--The 
                term ``alternative dental health care providers'' has 
                the meaning given that term in section 340G-1(a)(2) of 
                the Public Health Service Act (42 U.S.C. 256g-1(a)(2)).
            (4) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as are necessary to carry out the 
        demonstration program under this subsection.
    (h) Demonstration Program on Training and Employment of Alternative 
Dental Health Care Providers for Dental Health Care Services for 
Prisoners Within the Custody of the Bureau of Prisons.--
            (1) Demonstration program authorized.--The Attorney 
        General, acting through the Director of the Bureau of Prisons, 
        may carry out a demonstration program to establish programs to 
        train and employ alternative dental health care providers in 
        order to increase access to dental health services for 
        prisoners within the custody of the Bureau of Prisons.
            (2) Telehealth.--For purposes of alternative dental health 
        care providers and other dental care providers who are licensed 
        to provide clinical care, dental services provided under the 
        demonstration program under this subsection may be administered 
        by such providers through telehealth-enabled collaboration and 
        supervision when appropriate and feasible.
            (3) Alternative dental health care providers defined.--In 
        this subsection and subsection (i), the term ``alternative 
        dental health care providers'' has the meaning given that term 
        in section 340G-1(a)(2) of the Public Health Service Act (42 
        U.S.C. 256g-1(a)(2)).
            (4) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as are necessary to carry out the 
        demonstration program under this subsection.
    (i) Demonstration Program on Training and Employment of Alternative 
Dental Health Care Providers for Dental Health Care Services Under the 
Indian Health Service.--
            (1) Demonstration program authorized.--The Secretary of 
        Health and Human Services, acting through the Indian Health 
        Service, may carry out a demonstration program to establish 
        programs to train and employ alternative dental health care 
        providers in order to help eliminate oral health disparities 
        and increase access to dental services through health programs 
        operated by the Indian Health Service, Indian tribes, tribal 
        organizations, and urban Indian organizations (as the preceding 
        3 terms are defined in section 4 of the Indian Health Care 
        Improvement Act (25 U.S.C. 1603)).
            (2) Telehealth.--For purposes of alternative dental health 
        care providers and other dental care providers who are licensed 
        to provide clinical care, dental services provided under the 
        demonstration program under this subsection may be administered 
        by such providers through telehealth-enabled collaboration and 
        supervision when appropriate and feasible.
            (3) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as are necessary to carry out the 
        demonstration program under this subsection.

SEC. 4252. ORAL HEALTH LITERACY AND AWARENESS CAMPAIGN.

    The Public Health Service Act is amended by inserting after section 
340G-1 of such Act (42 U.S.C. 256g-1) the following:

``SEC. 340G-2. ORAL HEALTH LITERACY AND AWARENESS.

    ``(a) Campaign.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, shall establish a 
public education campaign (referred to in this subsection as the 
`campaign') across all relevant programs of the Health Resources and 
Services Administration (including the health center program, oral 
health workforce programs, maternal and child health programs, the Ryan 
White HIV/AIDS Program, and rural health programs) to increase oral 
health literacy and awareness.
    ``(b) Strategies.--In carrying out the campaign, the Secretary 
shall identify oral health literacy and awareness strategies that are 
evidence-based and focused on oral health care education, including 
education on prevention of oral disease such as early childhood and 
other caries, periodontal disease, and oral cancer.
    ``(c) Focus.--The Secretary shall design the campaign to 
communicate directly with specific populations, including children, 
pregnant women, parents, the elderly, individuals with disabilities, 
and ethnic and racial minority populations, including Indians, Alaska 
Natives, and Native Hawaiians, in a culturally and linguistically 
appropriate manner.
    ``(d) Outcomes.--In carrying out the campaign, the Secretary shall 
include a process for measuring outcomes and effectiveness.
    ``(e) Report to Congress.--Not later than 3 years after the date of 
enactment of this section, the Secretary shall submit to the Committee 
on Energy and Commerce of the House of Representatives and the 
Committee on Health, Education, Labor, and Pensions of the Senate a 
report on the outcomes and effectiveness of the campaign.
    ``(f) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $750,000 for each of fiscal 
years 2023 through 2027.''.

Subtitle D--Advancing Health Equity Through Payment and Delivery Reform

SEC. 4301. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) the sustainability of the health care system in the 
        United States hinges on restructuring how health care is paid 
        for, shifting away from paying for the volume of services 
        provided to the value the services provide;
            (2) high value care is care that provides higher quality 
        care more efficiently, achieving greater health improvement and 
        better health outcomes at lower cost (per patient and overall);
            (3) a high value health care system must deliver timely, 
        accessible, well-coordinated, high-quality, culturally 
        centered, and language-appropriate care to everyone;
            (4) eliminating health and health care disparities and 
        achieving health equity must be central to and required in 
        efforts to achieve a high value health care system;
            (5) eliminating such disparities and achieving such equity 
        will require tailored interventions and targeted investments to 
        address inequities in health and health care to make sure that 
        health care delivery and payment efforts are responsive to and 
        inclusive of the needs of communities of color and other 
        communities experiencing disparities; and
            (6) new models of value-based payment and care delivery 
        should prioritize primary care and consider the holistic needs 
        of and other factors with respect to the patient population, 
        including with respect to behavioral health, oral health, end-
        of-life care, history of adverse childhood experiences and 
        adverse community environments, social determinants of health, 
        social risk factors, unmet social needs, and the burden of 
        intergenerational racial and other inequities.

SEC. 4302. CENTERS FOR MEDICARE & MEDICAID SERVICES REPORTING AND 
              VALUE-BASED PROGRAMS.

    (a) Advancing Health Equity in Reporting and Value-Based Payment 
Programs.--
            (1) In general.--The Administrator of the Centers for 
        Medicare & Medicaid Services (in this section referred to as 
        the ``Administrator'') shall require that a clinician or other 
        professional participating in any pay-for-reporting or value-
        based payment program stratify clinical quality measures by 
        disparity variables, including race, ethnicity, sex, primary 
        language, disability status, sexual orientation, gender 
        identity, and socioeconomic status. A clinician or other 
        professional may use existing demographic data collection 
        fields in certified electronic health record technology (as 
        defined in section 1848(o)(4) of the Social Security Act (42 
        U.S.C. 1395w-4(o)(4))) to carry out such data stratification 
        under the preceding sentence. Such stratified data will assist 
        clinicians and other professionals in the identification of 
        disparities obscured in aggregated data and assist with the 
        provision of interventions that target reducing those 
        disparities.
            (2) Clinician.--In assessing performance in any value-based 
        payment program, the Administrator shall incorporate a 
        clinician or other professional's performance in reducing 
        disparities across race, ethnicity, sex, primary language, 
        disability status, sexual orientation, gender identity, and 
        socioeconomic status. Linking performance payments to the 
        reduction of health care disparities across such variables will 
        assist in holding clinicians and other professionals 
        accountable for providing quality care that can lead to 
        decreased health inequities.
            (3) Requirement of adoption of cert.--All entities, 
        clinicians, or other professionals participating in the Quality 
        Payment Program of the Centers for Medicare & Medicaid Services 
        shall be required to adopt 2015 certified electronic health 
        record technology (as so defined) as a condition of 
        participating in such program.
    (b) Quality Improvement Activities.--The Administrator, upon yearly 
review of the Quality Payment Program, shall add quality improvement 
activities that implement the Culturally and Linguistically Accessible 
Standards (CLAS) as Improvement Activities under the Quality Payment 
Program.

SEC. 4303. DEVELOPMENT AND TESTING OF DISPARITY REDUCING DELIVERY AND 
              PAYMENT MODELS.

    (a) In General.--The Center for Medicare and Medicaid Innovation 
established under section 1115A of the Social Security Act (42 U.S.C. 
1315a) (in this section referred to as the ``CMI'') shall establish a 
dedicated fund to identify, test, evaluate, and scale delivery and 
payment models under the applicable titles (as defined in subsection 
(a)(4)(B) of such section) that target health disparities among racial 
and ethnic minorities, including models that support high-value 
nonmedical services that address socially determined barriers to health 
in all stages of the life cycle through end-of-life, including English 
proficiency status, low health and health care literacy, lack of access 
to health care planning, including end-of-life care planning, case 
management, transportation, enrollment assistance needs, stable and 
affordable housing, utility assistance, employment and career 
development, and nutrition and food security which will help to reduce 
disparities and impact the overall cost of care.
    (b) Amendment to Social Security Act.--The second sentence of 
section 1115A(a)(1) of the Social Security Act (42 U.S.C. 1315a(a)(1)) 
is amended by inserting ``and improve health equity'' after 
``expenditures''.
    (c) Pilot Programs.--The CMI shall prioritize the testing of models 
under such section 1115A that include partnerships with entities, 
including community based organizations or other nonprofit entities, to 
help address socially determined barriers to health and health care.
    (d) Alternatives.--Any model tested by the CMI under such 1115A 
shall include measures to assess and track the impact of the model on 
health disparities, using existing measures such as the Healthcare 
Disparities and Cultural Competency Measures endorsed by the entity 
with a contract under section 1890(a) of the Social Security Act (42 
U.S.C. 1395aaa(a)), and stratified by race, ethnicity, English 
proficiency, gender identity, sexual orientation, and disability 
status.

SEC. 4304. DIVERSITY IN CENTERS FOR MEDICARE AND MEDICAID CONSULTATION.

    (a) In General.--In carrying out the duties under this section, the 
CMI shall consult representatives of relevant Federal agencies, and 
clinical and analytical experts with expertise in medicine and health 
care management, specifically such experts with expertise in--
            (1) the health care needs of minority, rural, and 
        underserved populations; and
            (2) the financial needs of safety net, community based, 
        rural, and critical access providers, including federally 
        qualified health centers.
    (b) Open Door Forums.--The CMI shall use open door forums or other 
mechanisms to seek external feedback from interested parties and 
incorporate that feedback into the development of models.

SEC. 4305. SUPPORTING SAFETY NET AND COMMUNITY-BASED PROVIDERS TO 
              COMPETE IN VALUE-BASED PAYMENT SYSTEMS.

    (a) In General.--Any pay-for-performance or alternative payment 
model that is developed and tested by the Center for Medicare and 
Medicaid Innovation established under section 1115A of the Social 
Security Act (42 U.S.C. 1315a), or any other agency of the Department 
of Health and Human Services with respect to the programs under titles 
XVIII, XIX, or XXI of such Act, shall be assessed for potential impact 
on safety net, community based, and critical access providers, 
including Federally qualified health centers.
    (b) New Models.--The rollout of any such models shall include 
training and additional up front resources for community based and 
safety net providers to enable those providers to participate in the 
model.

                  Subtitle E--Health Empowerment Zones

SEC. 4401. DESIGNATION OF HEALTH EMPOWERMENT ZONES.

    (a) In General.--The Secretary may, at the request of an eligible 
community partnership described in subsection (b)(1), designate an 
eligible area described in subsection (b)(2) as a health empowerment 
zone for the purpose of eligibility for a grant under section 4402.
    (b) Eligibility Criteria.--
            (1) Eligible community partnership.--A community 
        partnership is eligible to submit a request under this section 
        if the partnership--
                    (A) demonstrates widespread public support from key 
                individuals and entities in the eligible area, 
                including members of the target community, State and 
                local governments, nonprofit organizations including 
                national and regional intermediaries with demonstrated 
                capacity to serve low-income urban communities, and 
                community and industry leaders, for designation of the 
                eligible area as a health empowerment zone; and
                    (B) includes representatives of--
                            (i) a broad cross section of stakeholders 
                        and residents from communities in the eligible 
                        area experiencing disproportionate disparities 
                        in health status and health care; and
                            (ii) organizations, facilities, and 
                        institutions that have a history of working 
                        within and serving such communities.
            (2) Eligible area.--An area is eligible to be designated as 
        a health empowerment zone under this section if one or more 
        communities in the area experience disproportionate disparities 
        in health status and health care. In determining whether a 
        community experiences such disparities, the Secretary shall 
        consider data collected by the Department of Health and Human 
        Services focusing on the following areas:
                    (A) Access to affordable, high-quality health care 
                services.
                    (B) The prevalence of disproportionate rates of 
                certain illnesses or diseases including the following:
                            (i) Arthritis, osteoporosis, chronic back 
                        conditions, and other musculoskeletal diseases.
                            (ii) Cancer.
                            (iii) Chronic kidney disease.
                            (iv) Diabetes.
                            (v) Injury (intentional and unintentional).
                            (vi) Violence (intimate and nonintimate).
                            (vii) Maternal and paternal illnesses and 
                        diseases.
                            (viii) Infant mortality.
                            (ix) Mental illness and other disabilities.
                            (x) Substance use disorder treatment and 
                        prevention, including underage drinking.
                            (xi) Nutrition, obesity, and overweight 
                        conditions.
                            (xii) Heart disease.
                            (xiii) Hypertension.
                            (xiv) Cerebrovascular disease or stroke.
                            (xv) Tuberculosis.
                            (xvi) HIV/AIDS and other sexually 
                        transmitted infections.
                            (xvii) Viral hepatitis.
                            (xviii) Asthma.
                            (xix) Tooth decay and other oral health 
                        issues.
                    (C) Within the community, the historical and 
                persistent presence of conditions that have been found 
                to contribute to health disparities including any such 
                conditions respecting any of the following:
                            (i) Poverty.
                            (ii) Educational status and the quality of 
                        community schools.
                            (iii) Income.
                            (iv) Access to high-quality affordable 
                        health care.
                            (v) Work and work environment.
                            (vi) Environmental conditions in the 
                        community, including with respect to clean 
                        water, clean air, and the presence or absence 
                        of pollutants.
                            (vii) Language and English proficiency.
                            (viii) Access to affordable healthy food.
                            (ix) Access to ethnically and culturally 
                        diverse health and human service providers and 
                        practitioners.
                            (x) Access to culturally and linguistically 
                        competent health and human services and health 
                        and human service providers.
                            (xi) Health-supporting infrastructure.
                            (xii) Health insurance that is adequate and 
                        affordable.
                            (xiii) Race, racism, and bigotry (conscious 
                        and unconscious).
                            (xiv) Sexual orientation.
                            (xv) Health and health care literacy.
                            (xvi) Place of residence (such as urban 
                        areas, rural areas, and reservations of Indian 
                        Tribes).
                            (xvii) Stress.
    (c) Procedure.--
            (1) Request.--A request under subsection (a) shall--
                    (A) describe the bounds of the area to be 
                designated as a health empowerment zone and the process 
                used to select those bounds;
                    (B) demonstrate that the partnership submitting the 
                request is an eligible community partnership described 
                in subsection (b)(1);
                    (C) demonstrate that the area is an eligible area 
                described in subsection (b)(2);
                    (D) include a comprehensive assessment of 
                disparities in health status and health care experience 
                by one or more communities in the area;
                    (E) set forth--
                            (i) a vision and a set of values for the 
                        area; and
                            (ii) a comprehensive and holistic set of 
                        goals to be achieved in the area through 
                        designation as a health empowerment zone; and
                    (F) include a strategic plan and an action plan for 
                achieving the goals described in subparagraph (E)(ii).
            (2) Approval.--Not later than 60 days after the receipt of 
        a request for designation of an area as a health empowerment 
        zone under this section, the Secretary shall approve or 
        disapprove the request.
    (d) Minimum Number.--The Secretary--
            (1) shall designate not more than 110 health empowerment 
        zones under this section; and
            (2) of such zones designated under paragraph (1), shall 
        designate at least one health empowerment zone in each of the 
        several States, the District of Columbia, and each territory or 
        possession of the United States.

SEC. 4402. ASSISTANCE TO THOSE SEEKING DESIGNATION.

    At the request of any organization or entity seeking to submit a 
request under section 4401(a), the Secretary shall provide technical 
assistance, and may award a grant, to assist such organization or 
entity--
            (1) to form an eligible community partnership described in 
        section 4401(b)(1);
            (2) to complete a health assessment, including an 
        assessment of health disparities under section 4401(c)(1)(D); 
        or
            (3) to prepare and submit a request, including a strategic 
        plan, in accordance with section 4401.

SEC. 4403. BENEFITS OF DESIGNATION.

    (a) Priority.--In awarding a grant under subsection (b), a Federal 
official shall give priority to any applicant that--
            (1) meets the eligibility criteria for the grant;
            (2) proposes to use the grant for activities in a health 
        empowerment zone; and
            (3) demonstrates that such activities will directly and 
        significantly further the goals of the strategic plan approved 
        for such zone under section 4401.
    (b) Grants for Initial Implementation of Strategic Plan.--
            (1) In general.--Upon designating an eligible area as a 
        health empowerment zone at the request of an eligible community 
        partnership, the Secretary shall, subject to the availability 
        of appropriations, make a grant to the community partnership 
        for implementation of the strategic plan for such zone.
            (2) Grant period.--A grant under paragraph (1) for a health 
        empowerment zone shall be for a period of 2 years and may be 
        renewed, except that the total period of grants under paragraph 
        (1) for such zone may not exceed 10 years.
            (3) Limitation.--In awarding grants under this subsection, 
        the Secretary shall not give less priority to an applicant or 
        reduce the amount of a grant because the Secretary rendered 
        technical assistance or made a grant to the same applicant 
        under section 4401.
            (4) Reporting.--The Secretary shall establish metrics for 
        measuring the progress of grantees under this subsection and, 
        based on such metrics, require each such grantee to report to 
        the Secretary not less than every 6 months on the progress in 
        implementing the strategic plan for the health empowerment 
        zone.

SEC. 4404. DEFINITION OF SECRETARY.

    In this subtitle, the term ``Secretary'' means the Secretary of 
Health and Human Services, acting through the Administrator of the 
Health Resources and Services Administration and the Deputy Assistant 
Secretary for Minority Health, and in cooperation with the Director of 
the Office of Community Services and the Director of the National 
Institute on Minority Health and Health Disparities.

SEC. 4405. AUTHORIZATION OF APPROPRIATIONS.

    To carry out this subtitle, there is authorized to be appropriated 
$100,000,000 for fiscal year 2023.

               Subtitle F--Equitable Health Care For All

SEC. 4501. FINDINGS.

    Congress finds the following:
            (1) In 1966, Dr. Martin Luther King, Jr., said ``Of all the 
        forms of inequality, injustice in health care is the most 
        shocking and inhuman because it often results in physical 
        death.''.
            (2) Inequity in health care remains a persistent and 
        devastating reality for many communities, and, in particular, 
        communities of color.
            (3) The provision of inequitable health care has complex 
        causes, many stemming from systemic inequality in access to 
        health care, housing, nutrition, economic opportunity, 
        education, and other factors.
            (4) Health care outcomes for Black communities in 
        particular lag far behind those of the population as a whole.
            (5) Dr. Anthony Fauci, Director of the National Institute 
        of Allergy and Infectious Diseases, said on April 7, 2020, the 
        coronavirus outbreak is ``shining a bright light'' on 
        ``unacceptable'' health disparities in the Black community.
            (6) A contributing factor in health disparities is explicit 
        and implicit bias in the delivery of health care, resulting in 
        inferior care and poorer outcomes for some patients on the 
        basis of factors that include race, national origin, sex 
        (including sexual orientation or gender identity), disability, 
        age, and religion.
            (7) The National Academy of Medicine (formerly known as the 
        ``Institute of Medicine'') issued a report in 2002 titled 
        ``Unequal Treatment'', finding that racial and ethnic 
        minorities receive lower-quality health care than Whites do, 
        even when insurance status, income, age, and severity of 
        condition is comparable.
            (8) Just as Congress has sought to eliminate bias, both 
        explicit and implicit, in employment, housing, and other parts 
        of our society, the elimination of bias and the legacy of 
        structural racism in health care is of paramount importance.

SEC. 4502. DATA COLLECTION AND REPORTING.

    (a) Required Reporting.--
            (1) In general.--The Secretary of Health and Human 
        Services, in consultation with the Director for Civil Rights 
        and Health Equity, the Director of the National Institutes of 
        Health, the Administrator of the Centers for Medicare & 
        Medicaid Services, the Director of the Agency for Healthcare 
        Research and Quality, the Deputy Assistant Secretary for 
        Minority Health, and the Director of the Centers for Disease 
        Control and Prevention, shall by regulation require all health 
        care providers and facilities that are required under other 
        provisions of law to report data on specific health outcomes to 
        the Department of Health and Human Services in aggregate form, 
        to disaggregate such data by demographic characteristics, 
        including by race, national origin, sex (including sexual 
        orientation and gender identity), disability, and age, as well 
        as any other factor that the Secretary of Health and Human 
        Services determines would be useful for determining a pattern 
        of provision of inequitable health care.
            (2) Proposed regulations.--Not later than 90 days after the 
        date of enactment of this Act, the Secretary of Health and 
        Human Services shall issue proposed regulations to carry out 
        paragraph (1).
    (b) Repository.--The Secretary of Health and Human Services shall--
            (1) not later than 1 year after the date of enactment of 
        this Act, establish a repository of the disaggregated data 
        reported pursuant to subsection (a);
            (2) subject to paragraph (3), make the data in such 
        repository publicly available; and
            (3) ensure that such repository does not contain any data 
        that is individually identifiable.

SEC. 4503. REQUIRING EQUITABLE HEALTH CARE IN THE HOSPITAL VALUE-BASED 
              PURCHASING PROGRAM.

    (a) Equitable Health Care as Value Measurement.--Section 
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)(viii)) is amended by adding at the end the following 
new subclause:
    ``(XIII)(aa) Effective for payments beginning with fiscal year 
2024, in expanding the number of measures under subclause (III), the 
Secretary shall adopt measures that relate to equitable health care 
furnished by hospitals in inpatient settings.
    ``(bb) In carrying out this subclause, the Secretary shall solicit 
input and recommendations from individuals and groups representing 
communities of color and other protected classes and ensure measures 
adopted pursuant to this subclause account for social determinants of 
health, as defined in section 7(e)(10) of the Equal Health Care for All 
Act.
    ``(cc) For purposes of this subclause, the term `equitable health 
care' refers to the principle that high-quality care should be provided 
to all individuals and health care treatment and services should not 
vary on account of the real or perceived race, national origin, sex 
(including sexual orientation and gender identity), disability, or age 
of an individual, as well as any other factor that the Secretary 
determines would be useful for determining a pattern of provision of 
inequitable health care.''.
    (b) Inclusion of Equitable Health Care Measures.--Section 
1886(o)(2)(B) of the Social Security Act (42 U.S.C. 1395ww(o)(2)(B)) is 
amended by adding at the end the following new clause:
                            ``(iv) Inclusion of equitable health care 
                        measures.--Beginning in fiscal year 2024, 
                        measures selected under subparagraph (A) shall 
                        include the equitable health care measures 
                        described in subsection 
                        (b)(3)(B)(viii)(XIII).''.

SEC. 4504. PROVISION OF INEQUITABLE HEALTH CARE AS A BASIS FOR 
              PERMISSIVE EXCLUSION FROM MEDICARE AND STATE HEALTH CARE 
              PROGRAMS.

    Section 1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) 
is amended by adding at the end the following new paragraph:
            ``(18) Provision of inequitable health care.--
                    ``(A) In general.--Subject to subparagraph (B), any 
                health care provider that the Secretary determines has 
                engaged in a pattern of providing inequitable health 
                care (as defined in section 7(e)(7) of the Equal Health 
                Care for All Act) on the basis of race, national 
                origin, sex (including sexual orientation and gender 
                identity), disability, or age of an individual.
                    ``(B) Exception.--For purposes of carrying out 
                subparagraph (A), the Secretary shall not exclude any 
                health care provider from participation in the Medicare 
                program under title XVIII of the Social Security Act or 
                the Medicaid program under title XIX of such Act if the 
                exclusion of such health care provider would result in 
                increased difficulty in access to health care services 
                for underserved or low-income communities.''.

SEC. 4505. OFFICE FOR CIVIL RIGHTS AND HEALTH EQUITY OF THE DEPARTMENT 
              OF HEALTH AND HUMAN SERVICES.

    (a) Name of Office.--Beginning on the date of enactment of this 
Act, the Office for Civil Rights of the Department of Health and Human 
Services shall be known as the ``Office for Civil Rights and Health 
Equity'' of the Department of Health and Human Services. Any reference 
to the Office for Civil Rights of the Department of Health and Human 
Services in any law, regulation, map, document, record, or other paper 
of the United States shall be deemed to be a reference to the Office 
for Civil Rights and Health Equity.
    (b) Head of Office.--The head of the Office for Civil Rights and 
Health Equity shall be the Director for Civil Rights and Health Equity, 
to be appointed by the President. Any reference to the Director of the 
Office for Civil Rights of the Department of Health and Human Services 
in any law, regulation, map, document, record, or other paper of the 
United States shall be deemed to be a reference to the Director for 
Civil Rights and Health Equity.

SEC. 4506. PROHIBITING DISCRIMINATION IN HEALTH CARE.

    (a) Prohibiting Discrimination.--
            (1) In general.--No health care provider may, on the basis, 
        in whole or in part, of race, sex (including sexual orientation 
        and gender identity), disability, age, or religion, subject an 
        individual to the provision of inequitable health care.
            (2) Notice of patient rights.--The Secretary shall provide 
        to each patient a notice of a patient's rights under this 
        section.
    (b) Administrative Complaint and Conciliation Process.--
            (1) Complaints and answers.--
                    (A) In general.--An aggrieved person may, not later 
                than 1 year after an alleged violation of subsection 
                (a) has occurred or concluded, file a complaint with 
                the Director alleging inequitable provision of health 
                care by a provider described in subsection (a).
                    (B) Complaint.--A complaint submitted pursuant to 
                subparagraph (A) shall be in writing and shall contain 
                such information and be in such form as the Director 
                requires.
                    (C) Oath or affirmation.--The complaint and any 
                answer made under this subsection shall be made under 
                oath or affirmation, and may be reasonably and fairly 
                modified at any time.
            (2) Response to complaints.--
                    (A) In general.--Upon the filing of a complaint 
                under this subsection, the following procedures shall 
                apply:
                            (i) Complainant notice.--The Director shall 
                        serve notice upon the complainant acknowledging 
                        receipt of such filing and advising the 
                        complainant of the time limits and procedures 
                        provided under this section.
                            (ii) Respondent notice.--The Director 
                        shall, not later than 30 days after receipt of 
                        such filing--
                                    (I) serve on the respondent a 
                                notice of the complaint, together with 
                                a copy of the original complaint; and
                                    (II) advise the respondent of the 
                                procedural rights and obligations of 
                                respondents under this section.
                            (iii) Answer.--The respondent may file, not 
                        later than 60 days after receipt of the notice 
                        from the Director, an answer to such complaint.
                            (iv) Investigative duties.--The Director 
                        shall--
                                    (I) make an investigation of the 
                                alleged inequitable provision of health 
                                care; and
                                    (II) complete such investigation 
                                within 180 days (unless it is 
                                impracticable to complete such 
                                investigation within 180 days) after 
                                the filing of the complaint.
                    (B) Investigations.--
                            (i) Pattern or practice.--In the course of 
                        investigating the complaint, the Director may 
                        seek records of care provided to patients other 
                        than the complainant if necessary to 
                        demonstrate or disprove an allegation of 
                        inequitable provision of health care or to 
                        determine whether there is a pattern or 
                        practice of such care.
                            (ii) Accounting for social determinants of 
                        health.--In investigating the complaint and 
                        reaching a determination on the validity of the 
                        complaint, the Director shall account for 
                        social determinants of health and the effect of 
                        such social determinants on health care 
                        outcomes.
                            (iii) Inability to complete 
                        investigation.--If the Director is unable to 
                        complete (or finds it is impracticable to 
                        complete) the investigation within 180 days 
                        after the filing of the complaint (or, if the 
                        Secretary takes further action under paragraph 
                        (6)(B) with respect to a complaint, within 180 
                        days after the commencement of such further 
                        action), the Director shall notify the 
                        complainant and respondent in writing of the 
                        reasons involved.
                            (iv) Report to state licensing 
                        authorities.--On concluding each investigation 
                        under this subparagraph, the Director shall 
                        provide to the State licensing authorities that 
                        were notified under subparagraph (A), 
                        information specifying the results of the 
                        investigation.
                    (C) Report.--
                            (i) Final report.--On completing each 
                        investigation under this paragraph, the 
                        Director shall prepare a final investigative 
                        report.
                            (ii) Modification of report.--A final 
                        report under this subparagraph may be modified 
                        if additional evidence is later discovered.
            (3) Conciliation.--
                    (A) In general.--During the period beginning on the 
                date on which a complaint is filed under this 
                subsection and ending on the date of final disposition 
                of such complaint (including during an investigation 
                under paragraph (2)(B)), the Director shall, to the 
                extent feasible, engage in conciliation with respect to 
                such complaint.
                    (B) Conciliation agreement.--A conciliation 
                agreement arising out of such conciliation shall be an 
                agreement between the respondent and the complainant, 
                and shall be subject to approval by the Director.
                    (C) Rights protected.--The Director shall approve a 
                conciliation agreement only if the agreement protects 
                the rights of the complainant and other persons 
                similarly situated.
                    (D) Publicly available agreement.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary shall make available to the 
                        public a copy of a conciliation agreement 
                        entered into pursuant to this subsection unless 
                        the complainant and respondent otherwise agree, 
                        and the Secretary determines, that disclosure 
                        is not required to further the purposes of this 
                        subsection.
                            (ii) Limitation.--A conciliation agreement 
                        that is made available to the public pursuant 
                        to clause (i) may not disclose individually 
                        identifiable health information.
            (4) Failure to comply with conciliation agreement.--
        Whenever the Director has reasonable cause to believe that a 
        respondent has breached a conciliation agreement, the Director 
        shall refer the matter to the Attorney General to consider 
        filing a civil action to enforce such agreement.
            (5) Written consent for disclosure of information.--Nothing 
        said or done in the course of conciliation under this 
        subsection may be made public, or used as evidence in a 
        subsequent proceeding under this subsection, without the 
        written consent of the parties to the conciliation.
            (6) Prompt judicial action.--
                    (A) In general.--If the Director determines at any 
                time following the filing of a complaint under this 
                subsection that prompt judicial action is necessary to 
                carry out the purposes of this subsection, the Director 
                may recommend that the Attorney General promptly 
                commence a civil action under subsection (d).
                    (B) Immediate suit.--If the Director determines at 
                any time following the filing of a complaint under this 
                subsection that the public interest would be served by 
                allowing the complainant to bring a civil action under 
                subsection (c) in a State or Federal court immediately, 
                the Director shall certify that the administrative 
                process has concluded and that the complainant may file 
                such a suit immediately.
            (7) Annual report.--Not later than 1 year after the date of 
        enactment of this Act, and annually thereafter, the Director 
        shall make publicly available a report detailing the activities 
        of the Office for Civil Rights and Health Equity under this 
        subsection, including--
                    (A) the number of complaints filed and the basis on 
                which the complaints were filed;
                    (B) the number of investigations undertaken as a 
                result of such complaints; and
                    (C) the disposition of all such investigations.
    (c) Enforcement by Private Persons.--
            (1) In general.--
                    (A) Civil action.--
                            (i) In suit.--A complainant under 
                        subsection (b) may commence a civil action to 
                        obtain appropriate relief with respect to an 
                        alleged violation of subsection (a), or for 
                        breach of a conciliation agreement under 
                        subsection (b), in an appropriate district 
                        court of the United States or State court--
                                    (I) not sooner than the earliest 
                                of--
                                            (aa) the date a 
                                        conciliation agreement is 
                                        reached under subsection (b);
                                            (bb) the date of a final 
                                        disposition of a complaint 
                                        under subsection (b); or
                                            (cc) 180 days after the 
                                        first day of the alleged 
                                        violation; and
                                    (II) not later than 2 years after 
                                the final day of the alleged violation.
                            (ii) Statute of limitations.--The 
                        computation of such 2-year period shall not 
                        include any time during which an administrative 
                        proceeding (including investigation or 
                        conciliation) under subsection (b) was pending 
                        with respect to a complaint under such 
                        subsection.
                    (B) Barring suit.--If the Director has obtained a 
                conciliation agreement under subsection (b) regarding 
                an alleged violation of subsection (a), no action may 
                be filed under this paragraph by the complainant 
                involved with respect to the alleged violation except 
                for the purpose of enforcing the terms of such an 
                agreement.
            (2) Relief which may be granted.--
                    (A) In general.--In a civil action under paragraph 
                (1), if the court finds that a violation of subsection 
                (a) or breach of a conciliation agreement has occurred, 
                the court may award to the plaintiff actual and 
                punitive damages, and may grant as relief, as the court 
                determines to be appropriate, any permanent or 
                temporary injunction, temporary restraining order, or 
                other order (including an order enjoining the defendant 
                from engaging in a practice violating subsection (a) or 
                ordering such affirmative action as may be 
                appropriate).
                    (B) Fees and costs.--In a civil action under 
                paragraph (1), the court, in its discretion, may allow 
                the prevailing party, other than the United States, a 
                reasonable attorney's fee and costs. The United States 
                shall be liable for such fees and costs to the same 
                extent as a private person.
            (3) Intervention by attorney general.--Upon timely 
        application, the Attorney General may intervene in a civil 
        action under paragraph (1), if the Attorney General certifies 
        that the case is of general public importance.
    (d) Enforcement by the Attorney General.--
            (1) Commencement of actions.--
                    (A) Pattern or practice cases.--The Attorney 
                General may commence a civil action in any appropriate 
                district court of the United States if the Attorney 
                General has reasonable cause to believe that any health 
                care provider covered by subsection (a)--
                            (i) is engaged in a pattern or practice 
                        that violates such subsection; or
                            (ii) is engaged in a violation of such 
                        subsection that raises an issue of significant 
                        public importance.
                    (B) Cases by referral.--The Director may determine, 
                based on a pattern of complaints, a pattern of 
                violations, a review of data reported by a health care 
                provider covered by subsection (a), or any other means, 
                that there is reasonable cause to believe a health care 
                provider is engaged in a pattern or practice that 
                violates subsection (a). If the Director makes such a 
                determination, the Director shall refer the related 
                findings to the Attorney General. If the Attorney 
                General finds that such reasonable cause exists, the 
                Attorney General may commence a civil action in any 
                appropriate district court of the United States.
            (2) Enforcement of subpoenas.--The Attorney General, on 
        behalf of the Director, or another party at whose request a 
        subpoena is issued under this subsection, may enforce such 
        subpoena in appropriate proceedings in the district court of 
        the United States for the district in which the person to whom 
        the subpoena was addressed resides, was served, or transacts 
        business.
            (3) Relief which may be granted in civil actions.--
                    (A) In general.--In a civil action under paragraph 
                (1), the court--
                            (i) may award such preventive relief, 
                        including a permanent or temporary injunction, 
                        temporary restraining order, or other order 
                        against the person responsible for a violation 
                        of subsection (a) as is necessary to assure the 
                        full enjoyment of the rights granted by this 
                        subsection;
                            (ii) may award such other relief as the 
                        court determines to be appropriate, including 
                        monetary damages, to aggrieved persons; and
                            (iii) may, to vindicate the public 
                        interest, assess punitive damages against the 
                        respondent--
                                    (I) in an amount not exceeding 
                                $500,000, for a first violation; and
                                    (II) in an amount not exceeding 
                                $1,000,000, for any subsequent 
                                violation.
                    (B) Fees and costs.--In a civil action under this 
                subsection, the court, in its discretion, may allow the 
                prevailing party, other than the United States, a 
                reasonable attorney's fee and costs. The United States 
                shall be liable for such fees and costs to the extent 
                provided by section 2412 of title 28, United States 
                Code.
            (4) Intervention in civil actions.--Upon timely 
        application, any person may intervene in a civil action 
        commenced by the Attorney General under paragraphs (1) and (2) 
        if the action involves an alleged violation of subsection (a) 
        with respect to which such person is an aggrieved person 
        (including a person who is a complainant under subsection (b)) 
        or a conciliation agreement to which such person is a party.
    (e) Definitions.--In this section:
            (1) Aggrieved person.--The term ``aggrieved person'' 
        means--
                    (A) a person who believes that the person was or 
                will be injured in violation of subsection (a); or
                    (B) the personal representative or estate of a 
                deceased person who was injured in violation of 
                subsection (a).
            (2) Director.--The term ``Director'' refers to the Director 
        for Civil Rights and Health Equity of the Department of Health 
        and Human Services.
            (3) Disability.--The term ``disability'' has the meaning 
        given such term in section 3 of the Americans with Disabilities 
        Act of 1990 (42 U.S.C. 12102).
            (4) Conciliation.--The term ``conciliation'' means the 
        attempted resolution of issues raised by a complaint, or by the 
        investigation of such complaint, through informal negotiations 
        involving the complainant, the respondent, and the Secretary.
            (5) Conciliation agreement.--The term ``conciliation 
        agreement'' means a written agreement setting forth the 
        resolution of the issues in conciliation.
            (6) Individually identifiable health information.--The term 
        ``individually identifiable health information'' means any 
        information, including demographic information collected from 
        an individual--
                    (A) that is created or received by a health care 
                provider covered by subsection (a), health plan, 
                employer, or health care clearinghouse;
                    (B) that relates to the past, present, or future 
                physical or mental health or condition of, the 
                provision of health care to, or the past, present, or 
                future payment for the provision of health care to, the 
                individual; and
                    (C)(i) that identifies the individual; or
                    (ii) with respect to which there is a reasonable 
                basis to believe that the information can be used to 
                identify the individual.
            (7) Provision of inequitable health care.--The term 
        ``provision of inequitable health care'' means the provision of 
        any health care service, by a health care provider in a manner 
        that--
                    (A) fails to meet a high-quality care standard, 
                meaning the health care provider fails to--
                            (i) avoid harm to patients as a result of 
                        the health services that are intended to help 
                        the patient;
                            (ii) provide health services based on 
                        scientific knowledge to all and to all patients 
                        who benefit;
                            (iii) refrain from providing services to 
                        patients not likely to benefit;
                            (iv) provide care that is responsive to 
                        patient preferences, needs, and values; and
                            (v) avoids waits or delays in care; and
                    (B) is discriminatory in intent or effect based at 
                least in part on a basis specified in subsection (a).
            (8) Respondent.--The term ``respondent'' means the person 
        or other entity accused in a complaint of a violation of 
        subsection (a).
            (9) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (10) Social determinants of health.--The term ``social 
        determinants of health'' means conditions in the environments 
        in which individuals live, work, attend school, and worship, 
        that affect a wide range of health, functioning, and quality-
        of-life outcomes and risks.
    (f) Rule of Construction.--Nothing in this section shall be 
construed as repealing or limiting the effect of title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000b et seq.), section 1557 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18116), section 
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or the Age 
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.).

SEC. 4507. FEDERAL HEALTH EQUITY COMMISSION.

    (a) Establishment of Commission.--
            (1) In general.--There is established the Federal Health 
        Equity Commission (in this section referred to as the 
        ``Commission'').
            (2) Membership.--
                    (A) In general.--The Commission shall be composed 
                of--
                            (i) 8 voting members appointed under 
                        subparagraph (B); and
                            (ii) the nonvoting, ex officio members 
                        listed in subparagraph (C).
                    (B) Voting members.--Not more than 4 of the members 
                described in subparagraph (A)(i) shall at any one time 
                be of the same political party. Such members shall have 
                recognized expertise in and personal experience with 
                racial and ethnic health inequities, health care needs 
                of vulnerable and marginalized populations, and health 
                equity as a vehicle for improving health status and 
                health outcomes. Such members shall be appointed to the 
                Commission as follows:
                            (i) 4 members of the Commission shall be 
                        appointed by the President.
                            (ii) 2 members of the Commission shall be 
                        appointed by the President pro tempore of the 
                        Senate, upon the recommendations of the 
                        majority leader and the minority leader of the 
                        Senate. Each member appointed to the Commission 
                        under this clause shall be appointed from a 
                        different political party.
                            (iii) 2 members of the Commission shall be 
                        appointed by the Speaker of the House of 
                        Representatives upon the recommendations of the 
                        majority leader and the minority leader of the 
                        House of Representatives. Each member appointed 
                        to the Commission under this clause shall be 
                        appointed from a different political party.
                    (C) Ex officio member.--The Commission shall have 
                the following nonvoting, ex officio members:
                            (i) The Director for Civil Rights and 
                        Health Equity of the Department of Health and 
                        Human Services.
                            (ii) The Deputy Assistant Secretary for 
                        Minority Health of the Department of Health and 
                        Human Services.
                            (iii) The Director of the National 
                        Institute on Minority Health and Health 
                        Disparities.
                            (iv) The Chairperson of the Advisory 
                        Committee on Minority Health established under 
                        section 1707(c) of the Public Health Service 
                        Act (42 U.S.C. 300u-6(c)).
            (3) Terms.--The term of office of each member appointed 
        under paragraph (2)(B) of the Commission shall be 6 years.
            (4) Chairperson; vice chairperson.--
                    (A) Chairperson.--The President shall, with the 
                concurrence of a majority of the members of the 
                Commission appointed under paragraph (2)(B), designate 
                a Chairperson from among the members of the Commission 
                appointed under such paragraph.
                    (B) Vice chairperson.--
                            (i) Designation.--The Speaker of the House 
                        of Representatives shall, in consultation with 
                        the majority leaders and the minority leaders 
                        of the Senate and the House of Representatives 
                        and with the concurrence of a majority of the 
                        members of the Commission appointed under 
                        paragraph (2)(B), designate a Vice Chairperson 
                        from among the members of the Commission 
                        appointed under such paragraph. The Vice 
                        Chairperson may not be a member of the same 
                        political party as the Chairperson.
                            (ii) Duty.--The Vice Chairperson shall act 
                        in place of the Chairperson in the absence of 
                        the Chairperson.
            (5) Removal of members.--The President may remove a member 
        of the Commission only for neglect of duty or malfeasance in 
        office.
            (6) Quorum.--A majority of members of the Commission 
        appointed under paragraph (2)(B) shall constitute a quorum of 
        the Commission, but a lesser number of members may hold 
        hearings.
    (b) Duties of the Commission.--
            (1) In general.--The Commission shall--
                    (A) monitor and report on the implementation of 
                this Act; and
                    (B) investigate, monitor, and report on progress 
                towards health equity and the elimination of health 
                disparities.
            (2) Annual report.--The Commission shall--
                    (A) submit to the President and Congress at least 
                one report annually on health equity and health 
                disparities; and
                    (B) include in such report--
                            (i) a description of actions taken by the 
                        Department of Health and Human Services and any 
                        other Federal agency related to health equity 
                        or health disparities; and
                            (ii) recommendations on ensuring equitable 
                        health care and eliminating health disparities.
    (c) Powers.--
            (1) Hearings.--
                    (A) In general.--The Commission or, at the 
                direction of the Commission, any subcommittee or member 
                of the Commission, may, for the purpose of carrying out 
                this section, as the Commission or the subcommittee or 
                member considers advisable--
                            (i) hold such hearings, meet and act at 
                        such times and places, take such testimony, 
                        receive such evidence, and administer such 
                        oaths; and
                            (ii) require, by subpoena or otherwise, the 
                        attendance and testimony of such witnesses and 
                        the production of such books, records, 
                        correspondence, memoranda, papers, documents, 
                        tapes, and materials.
                    (B) Limitation on hearings.--The Commission may 
                hold a hearing under subparagraph (A)(i) only if the 
                hearing is approved--
                            (i) by a majority of the members of the 
                        Commission appointed under subsection 
                        (a)(2)(B); or
                            (ii) by a majority of such members present 
                        at a meeting when a quorum is present.
            (2) Issuance and enforcement of subpoenas.--
                    (A) Issuance.--A subpoena issued under paragraph 
                (1) shall--
                            (i) bear the signature of the Chairperson 
                        of the Commission; and
                            (ii) be served by any person or class of 
                        persons designated by the Chairperson for that 
                        purpose.
                    (B) Enforcement.--In the case of contumacy or 
                failure to obey a subpoena issued under paragraph (1), 
                the United States district court for the district in 
                which the subpoenaed person resides, is served, or may 
                be found may issue an order requiring the person to 
                appear at any designated place to testify or to produce 
                documentary or other evidence.
                    (C) Noncompliance.--Any failure to obey the order 
                of the court may be punished by the court as a contempt 
                of court.
            (3) Witness allowances and fees.--
                    (A) In general.--Section 1821 of title 28, United 
                States Code, shall apply to a witness requested or 
                subpoenaed to appear at a hearing of the Commission.
                    (B) Expenses.--The per diem and mileage allowances 
                for a witness shall be paid from funds available to pay 
                the expenses of the Commission.
            (4) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other agencies of the Federal Government.
            (5) Gifts.--The Commission may accept, use, and dispose of 
        gifts or donations of services or property.
    (d) Administrative Provisions.--
            (1) Staff.--
                    (A) Director.--There shall be a full-time staff 
                director for the Commission who shall--
                            (i) serve as the administrative head of the 
                        Commission; and
                            (ii) be appointed by the Chairperson with 
                        the concurrence of the Vice Chairperson.
                    (B) Other personnel.--The Commission may--
                            (i) appoint such other personnel as it 
                        considers advisable, subject to the provisions 
                        of title 5, United States Code, governing 
                        appointments in the competitive service, and 
                        the provisions of chapter 51 and subchapter III 
                        of chapter 53 of that title relating to 
                        classification and General Schedule pay rates; 
                        and
                            (ii) may procure temporary and intermittent 
                        services under section 3109(b) of title 5, 
                        United States Code, at rates for individuals 
                        not in excess of the daily equivalent paid for 
                        positions at the maximum rate for GS-15 of the 
                        General Schedule under section 5332 of title 5, 
                        United States Code.
            (2) Compensation of members.--
                    (A) Non-federal employees.--Each member of the 
                Commission who is not an officer or employee of the 
                Federal Government shall be compensated at a rate equal 
                to the daily equivalent of the annual rate of basic pay 
                prescribed for level IV of the Executive Schedule under 
                section 5315 of title 5, United States Code, for each 
                day (including travel time) during which the member is 
                engaged in the performance of the duties of the 
                Commission.
                    (B) Federal employees.--Each member of the 
                Commission who is an officer or employee of the Federal 
                Government shall serve without compensation in addition 
                to the compensation received for the services of the 
                member as an office or employee of the Federal 
                Government.
                    (C) Travel expenses.--A member of the Commission 
                shall be allowed travel expenses, including per diem in 
                lieu of subsistence, at rates authorized for an 
                employee of an agency under subchapter I of chapter 57 
                of title 5, United States Code, while away from the 
                home or regular place of business of the member in the 
                performance of the duties of the Commission.
            (3) Cooperation.--The Commission may secure directly from 
        any Federal department or agency such information as the 
        Commission considers necessary to carry out this Act. Upon 
        request of the Chairman of the Commission, the head of such 
        department or agency shall furnish such information to the 
        Commission.
    (e) Permanent Commission.--Section 14 of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall not apply to the Commission.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated for fiscal year 2022 and each fiscal year thereafter such 
sums as may be necessary to carry out the duties of the Commission.

SEC. 4508. GRANTS FOR HOSPITALS TO PROMOTE EQUITABLE HEALTH CARE AND 
              OUTCOMES.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall award grants to 
hospitals to promote equitable health care treatment and services, and 
reduce disparities in care and outcomes.
    (b) Consultation.--In establishing the criteria for grants under 
this section and evaluating applications for such grants, the Secretary 
shall consult with the Director for Civil Rights and Health Equity of 
the Department of Health and Human Services.
    (c) Use of Funds.--A hospital shall use funds received from a grant 
under this section to establish or expand programs to provide equitable 
health care to all patients and to ensure equitable health care 
outcomes. Such uses may include--
            (1) providing explicit and implicit bias training to 
        medical providers and staff;
            (2) providing translation or interpretation services for 
        patients;
            (3) recruiting and training a diverse workforce;
            (4) tracking data related to care and outcomes; and
            (5) training on cultural sensitivity.
    (d) Priority.--In awarding grants under this section, the Secretary 
shall give priority to hospitals that have received disproportionate 
share hospital payments under section 1886(r) of the Social Security 
Act (42 U.S.C. 1395ww(r)) or section 1923 of such Act (42 U.S.C. 1396r-
4) with respect to fiscal year 2021.
    (e) Supplement, Not Supplant.--Grants awarded under this section 
shall be used to supplement, not supplant, any nongovernment efforts, 
or other Federal, State, or local funds provided to a recipient.
    (f) Equitable Health Care Defined.--The term ``equitable health 
care'' has the meaning given such term in section 
1886(b)(3)(B)(viii)(XIII)(cc) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)(viii)(XIII)(cc)), as added by section 4(a).
    (g) 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 2022 through 2027.

                    Subtitle G--Investing in Equity

SEC. 4601. DEFINITIONS.

    In this subtitle:
            (1) Advisory council.--The term ``Advisory Council'' means 
        the Pay for Equity Council convened under section 4603.
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (3) Strategy.--The term ``Strategy'' means the Pay for 
        Equity Strategy set forth under section 4602.

SEC. 4602. STRATEGY TO INCENTIVIZE HEALTH EQUITY.

    (a) In General.--The Secretary, in consultation with the heads of 
other appropriate Federal agencies, shall develop jointly with the 
Advisory Council and submit to 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, and make publicly available on 
the internet website of the Department of Health and Human Services, a 
Pay for Equity Strategy.
    (b) Contents.--The Strategy shall establish goals for Federal 
programs, including those authorized under titles XVIII and XIX of the 
Social Security Act, to incentivize health equity, which may include at 
least--
            (1) incorporating measures of equity into all payment 
        models by 2025;
            (2) tying a percentage of reimbursement in value-based 
        payment models to equity measure performance by 2028; and
            (3) increasing the number of safety net providers 
        participating in value-based payment by a set percentage by 
        2030.
    (c) Duties of the Secretary.--The Secretary, in carrying out 
subsection (a), shall oversee the following:
            (1) Collecting and making publicly available information 
        submitted by the Advisory Council.
            (2) Coordinating and assessing existing Federal Government 
        programs and activities to assess capacity to meet equity 
        goals.
            (3) Providing technical assistance, as appropriate, such as 
        disseminating identified best practices and information sharing 
        based on reports developed as a result of this subtitle.
    (d) Initial Strategy; Updates.--The Secretary shall--
            (1) not later than 18 months after the date of enactment of 
        this Act, develop, publish, and submit to 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 the strategy outlined in subsection (a); and
            (2) biennially update, publish, and submit to Congress an 
        updated strategy to--
                    (A) reflect new developments, challenges, 
                opportunities, and solutions; and
                    (B) review progress and, based on the results of 
                such review, recommend priority actions for improving 
                the implementation of such recommendations, as 
                appropriate.
    (e) Process for Public Input.--The Secretary shall establish a 
process for public input to inform the development of, and updates to, 
the Strategy, including a process for the public to submit 
recommendations to the Advisory Council and an opportunity for public 
comment on the proposed Strategy.

SEC. 4603. PAY FOR EQUITY ADVISORY COUNCIL.

    (a) Convening.--The Secretary shall convene a Pay for Equity 
Advisory Council to advise and provide recommendations, including 
identified best practices, to the Secretary on the Pay for Equity 
Strategy.
    (b) Membership.--
            (1) In general.--The members of the Advisory Council shall 
        consist of--
                    (A) the appointed members under paragraph (2); and
                    (B) the Federal members under paragraph (3).
            (2) Appointed members.--In addition to the Federal members 
        under paragraph (3), the Secretary shall appoint not more than 
        15 voting members of the Advisory Council who are not 
        representatives of Federal departments or agencies and who 
        shall include at least 1 representative of each of the 
        following:
                    (A) Beneficiaries of Medicare and Medicaid.
                    (B) Safety net health care providers.
                    (C) Value-based payment experts.
                    (D) Other members with expertise and lived 
                experience the Secretary deems appropriate.
            (3) Federal members.--The Federal members of the Advisory 
        Council, who shall be nonvoting members, shall consist of the 
        following:
                    (A) The Administrator of the Centers for Medicare & 
                Medicaid Services (or the Administrator's designee).
                    (B) The Administrator of the Health Resources and 
                Services Administration.
            (4) Diverse representation.--The Secretary shall ensure 
        that the membership of the Advisory Council reflects the 
        diversity of individuals impacted by Federal health payment 
        programs.
    (c) Meetings.--The Advisory Council shall meet quarterly during the 
1-year period beginning on the date of enactment of this Act and at 
least 3 times during each year thereafter. Meetings of the Advisory 
Council shall be open to the public.

  TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES

                         Subtitle A--In General

SEC. 5001. GRANTS TO PROMOTE HEALTH FOR UNDERSERVED COMMUNITIES.

    Part Q of title III of the Public Health Service Act (42 U.S.C. 
280h et seq.) is amended by adding at the end the following:

``SEC. 399Z-3. GRANTS TO PROMOTE HEALTH FOR UNDERSERVED COMMUNITIES.

    ``(a) Grants Authorized.--The Secretary, in collaboration with the 
Administrator of the Health Resources and Services Administration and 
other Federal officials determined appropriate by the Secretary, is 
authorized to award grants to eligible entities--
            ``(1) to promote health for medically underserved 
        communities, with preference given to projects that benefit 
        racial and ethnic minority women, racial and ethnic minority 
        children, adolescents, and lesbian, gay, bisexual, transgender, 
        queer, nonbinary, gender-nonconforming, or questioning 
        communities; and
            ``(2) to strengthen health outreach initiatives in 
        medically underserved communities, including linguistically 
        isolated populations.
    ``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may 
be used to support the activities of community health workers, 
including such activities--
            ``(1) to educate and provide outreach regarding enrollment 
        in health insurance including the State Children's Health 
        Insurance Program under title XXI of the Social Security Act, 
        Medicare under title XVIII of such Act, and Medicaid under 
        title XIX of such Act;
            ``(2) to educate and provide outreach in a community 
        setting regarding health problems prevalent among medically 
        underserved communities, and especially among racial and ethnic 
        minority women, racial and ethnic minority children, 
        adolescents, and lesbian, gay, bisexual, transgender, queer, 
        nonbinary, gender-nonconforming, or questioning communities;
            ``(3) to educate and provide experiential learning 
        opportunities and target risk factors and healthy behaviors 
        that impede or contribute to achieving positive health 
        outcomes, including--
                    ``(A) healthy nutrition;
                    ``(B) physical activity;
                    ``(C) overweight or obesity;
                    ``(D) tobacco use, including the use of e-
                cigarettes and vaping;
                    ``(E) alcohol and substance use;
                    ``(F) injury and violence;
                    ``(G) sexual health;
                    ``(H) mental health;
                    ``(I) musculoskeletal health and arthritis;
                    ``(J) prenatal and postnatal care;
                    ``(K) dental and oral health;
                    ``(L) understanding informed consent;
                    ``(M) stigma; and
                    ``(N) environmental hazards;
            ``(4) to promote community wellness and awareness; and
            ``(5) to educate and refer target populations to 
        appropriate health care agencies and community-based programs 
        and organizations in order to increase access to quality health 
        care services, including preventive health services.
    ``(c) Application.--
            ``(1) In general.--Each eligible entity that desires to 
        receive a grant under subsection (a) shall submit an 
        application to the Secretary, at such time, in such manner, and 
        accompanied by such additional information as the Secretary may 
        require.
            ``(2) Contents.--Each application submitted pursuant to 
        paragraph (1) shall--
                    ``(A) describe the activities for which assistance 
                under this section is sought;
                    ``(B) contain an assurance that, with respect to 
                each community health worker program receiving funds 
                under the grant awarded, such program provides in-
                language training and supervision to community health 
                workers to enable such workers to provide authorized 
                program activities in (at least) the most commonly used 
                languages within a particular geographic region;
                    ``(C) contain an assurance that the applicant will 
                evaluate the effectiveness of community health worker 
                programs receiving funds under the grant;
                    ``(D) contain an assurance that each community 
                health worker program receiving funds under the grant 
                will provide culturally competent services in the 
                linguistic context most appropriate for the individuals 
                served by the program;
                    ``(E) contain a plan to document and disseminate 
                project descriptions and results to other States and 
                organizations as identified by the Secretary; and
                    ``(F) describe plans to enhance the capacity of 
                individuals to utilize health services and health-
                related social services under Federal, State, and local 
                programs by--
                            ``(i) assisting individuals in establishing 
                        eligibility under the programs and in receiving 
                        the services or other benefits of the programs; 
                        and
                            ``(ii) providing other services, as the 
                        Secretary determines to be appropriate, which 
                        may include transportation and translation 
                        services.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to those applicants--
            ``(1) who propose to target geographic areas that--
                    ``(A)(i) have a high percentage of residents who 
                are uninsured or underinsured (if the targeted 
                geographic area is located in a State that has elected 
                to make medical assistance available under section 
                1902(a)(10)(A)(i)(VIII) of the Social Security Act to 
                individuals described in such section);
                    ``(ii) have a high percentage of underinsured 
                residents in a particular geographic area (if the 
                targeted geographic area is located in a State that has 
                not so elected); or
                    ``(iii) have a high number of households 
                experiencing extreme poverty; and
                    ``(B) have a high percentage of families for whom 
                English is not their primary language or including 
                smaller limited English-proficient communities within 
                the region that are not otherwise reached by 
                linguistically appropriate health services;
            ``(2) with experience in providing health or health-related 
        social services to individuals who are underserved with respect 
        to such services; and
            ``(3) with documented community activity and experience 
        with community health workers.
    ``(e) Collaboration With Academic Institutions.--The Secretary 
shall encourage community health worker programs receiving funds under 
this section to collaborate with academic institutions, including 
minority-serving institutions. Nothing in this section shall be 
construed to require such collaboration.
    ``(f) Quality Assurance and Cost Effectiveness.--The Secretary 
shall establish guidelines for ensuring the quality of the training and 
supervision of community health workers under the programs funded under 
this section and for ensuring the cost effectiveness of such programs.
    ``(g) Monitoring.--The Secretary shall monitor community health 
worker programs identified in approved applications and shall determine 
whether such programs are in compliance with the guidelines established 
under subsection (f).
    ``(h) Technical Assistance.--The Secretary may provide technical 
assistance to community health worker programs identified in approved 
applications with respect to planning, developing, and operating 
programs under the grant.
    ``(i) Report to Congress.--
            ``(1) In general.--Not later than 4 years after the date on 
        which the Secretary first awards grants under subsection (a), 
        the Secretary shall submit to Congress a report regarding the 
        grant project.
            ``(2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    ``(A) A description of the programs for which grant 
                funds were used.
                    ``(B) The number of individuals served.
                    ``(C) An evaluation of--
                            ``(i) the effectiveness of these programs;
                            ``(ii) the cost of these programs; and
                            ``(iii) the impact of these programs on the 
                        health outcomes of the community residents.
                    ``(D) Recommendations for sustaining the community 
                health worker programs developed or assisted under this 
                section.
                    ``(E) Recommendations regarding training to enhance 
                career opportunities for community health workers.
    ``(j) Definitions.--In this section:
            ``(1) Community health worker.--The term `community health 
        worker' means an individual who promotes health or nutrition 
        within the community in which the individual resides--
                    ``(A) by serving as a liaison between communities 
                and health care agencies;
                    ``(B) by providing guidance and social assistance 
                to community residents;
                    ``(C) by enhancing community residents' ability to 
                effectively communicate with health care providers;
                    ``(D) by providing culturally and linguistically 
                appropriate health or nutrition education;
                    ``(E) by advocating for individual and community 
                health, including dental, oral, mental, and 
                environmental health, or nutrition needs;
                    ``(F) by taking into consideration the needs of the 
                communities served, including the prevalence rates of 
                risk factors that impede achieving positive healthy 
                outcomes among pregnant, birthing, and postpartum 
                people and children, especially among racial and ethnic 
                minority pregnant, birthing, and postpartum people and 
                children; and
                    ``(G) by providing referral and followup services.
            ``(2) Community setting.--The term `community setting' 
        means a home or a community organization that serves a 
        population.
            ``(3) Eligible entity.--The term `eligible entity' means--
                    ``(A) a unit of State, territorial, local, or 
                Tribal government (including a federally recognized 
                Tribe or Alaska Native village); or
                    ``(B) a community-based organization.
            ``(4) Medically underserved community.--The term `medically 
        underserved community' means a community--
                    ``(A) that has a substantial number of individuals 
                who are members of a medically underserved population, 
                as defined by section 330(b)(3);
                    ``(B) a significant portion of which is a health 
                professional shortage area as designated under section 
                332; and
                    ``(C) that includes populations that are 
                linguistically isolated, such as geographic areas with 
                a shortage of health professionals able to provide 
                linguistically appropriate services.
            ``(5) Support.--The term `support' means the provision of 
        training, supervision, and materials needed to effectively 
        deliver the services described in subsection (b), reimbursement 
        for services, and other benefits.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $15,000,000 for each of fiscal 
years 2023 through 2027.''.

                    Subtitle B--Pregnancy Screening

SEC. 5101. PREGNANCY INTENTION SCREENING INITIATIVE DEMONSTRATION 
              PROGRAM.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 5203(c)(6), is further amended by 
adding at the end the following:

``SEC. 399V-8. PREGNANCY INTENTION SCREENING INITIATIVE DEMONSTRATION 
              PROGRAM.

    ``(a) Program Establishment.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
establish a demonstration program to facilitate the clinical adoption 
of pregnancy intention screening initiatives by health care and social 
services providers.
    ``(b) Grants.--The Secretary may carry out the demonstration 
program through awarding grants to eligible entities to implement 
pregnancy intention screening initiatives, collect data, and evaluate 
such initiatives.
    ``(c) Eligible Entities.--To be eligible to seek a grant under this 
section, an entity shall--
            ``(1) provide non-directive, comprehensive, medically 
        accurate information; and
            ``(2) be a community-based organization, voluntary health 
        organization, public health department, community health 
        center, or other interested public or private primary, 
        behavioral, or other health care or social service provider or 
        organization.
    ``(d) Pregnancy Intention Screening Initiative.--For purposes of 
this section, the term `pregnancy intention screening initiative' means 
any initiative by an eligible entity to routinely screen people with 
respect to their pregnancy intentions and goals to either prevent 
unintended pregnancies or improve the likelihood of healthy 
pregnancies, in order to better provide health care that meets the 
contraceptive or pre-pregnancy needs and goals of such people.
    ``(e) Evaluation.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall, by grant or contract, and after consultation as 
        described in paragraph (2), conduct an evaluation of the 
        demonstration program, with respect to pregnancy intention 
        screening initiatives, conducted under this section. Such 
        evaluation shall include:
                    ``(A) Assessment of the implementation of pregnancy 
                intention screening protocols among a diverse group of 
                patients and providers, including collecting data on 
                the experiences and outcomes for diverse patient 
                populations in a variety of clinical settings.
                    ``(B) Analysis of outcome measures that will 
                facilitate effective and widespread adoption of such 
                protocols by health care providers for inquiring about 
                and responding to pregnancy goals of people with both 
                contraceptive and pre-pregnancy care.
                    ``(C) Consideration of health inequities among the 
                population served.
                    ``(D) Assessment of the equitable and voluntary 
                application of such initiatives to minority and 
                medically underserved communities.
                    ``(E) Assessment of the training, capacity, and 
                ongoing technical assistance needed for providers to 
                effectively implement such pregnancy intention 
                screening protocols.
                    ``(F) Assessment of whether referral systems for 
                selected protocols follow evidence-based standards that 
                ensure access to comprehensive health services and 
                appropriate follow-up care.
                    ``(G) Measuring through rigorous methods the effect 
                of such initiatives on key health outcomes.
            ``(2) Consultation with independent, expert advisory 
        panel.--In conducting the evaluation under paragraph (1), the 
        Director of the Centers for Disease Control and Prevention 
        shall consult with physicians, physician assistants, advanced 
        practice registered nurses, nurse midwives, and other health 
        care providers who specialize in women's health, and other 
        experts in public health, clinical practice, program 
        evaluation, and research.
            ``(3) Report.--Not later than one year after the last day 
        of the demonstration program under this section, the Director 
        of the Centers for Disease Control and Prevention shall--
                    ``(A) submit to Congress a report on the results of 
                the evaluation conducted under paragraph (1); and
                    ``(B) make the report publicly available.
    ``(f) Funding.--
            ``(1) Authorization of appropriations.--To carry out this 
        section, there is authorized to be appropriated $10,000,000 for 
        each of fiscal years 2023 through 2027.
            ``(2) Limitation.--Not more than 20 percent of funds 
        appropriated to carry out this section pursuant to paragraph 
        (1) for a fiscal year may be used for purposes of the 
        evaluation under subsection (e).''.

SEC. 5102. BIRTH DEFECTS PREVENTION, RISK REDUCTION, AND AWARENESS.

    (a) In General.--The Secretary shall establish and implement a 
birth defects prevention and public awareness program, consisting of 
the activities described in subsections (c) and (d).
    (b) Definitions.--In this section:
            (1) Maternal.--The term ``maternal'' refers to people who 
        are pregnant or breastfeeding.
            (2) Pregnancy and breastfeeding information services.--The 
        term ``pregnancy and breastfeeding information services'' 
        includes only--
                    (A) information services to provide accurate, 
                evidence-based, clinical information regarding maternal 
                exposures during pregnancy or breastfeeding that may be 
                associated with birth defects, health risks to a 
                breastfed infant, or other health risks, such as 
                exposures to medications, chemicals, infections, 
                foodborne pathogens, illnesses, nutrition, lifestyle, 
                or climate- and weather-related factors;
                    (B) the provision of accurate, evidence-based 
                information weighing risks of exposures during 
                breastfeeding against the benefits of breastfeeding; 
                and
                    (C) the provision of information described in 
                subparagraph (A), (B), or (C) through counselors, 
                websites, fact sheets, telephonic or electronic 
                communication, community outreach efforts, or other 
                appropriate means.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services, acting through the Director of 
        the Centers for Disease Control and Prevention.
    (c) Nationwide Media Campaign.--In carrying out subsection (a), the 
Secretary shall conduct or support a nationwide media campaign to 
increase awareness among health care providers and at-risk populations 
about pregnancy and breastfeeding information services.
    (d) Grants for Pregnancy and Breastfeeding Information Services.--
            (1) In general.--In carrying out subsection (a), the 
        Secretary shall award grants to State or regional agencies or 
        organizations for any of the following:
                    (A) Information services.--The provision of, or 
                campaigns to increase awareness about, pregnancy and 
                breastfeeding information services.
                    (B) Surveillance and research.--The conduct or 
                support of--
                            (i) surveillance of or research on--
                                    (I) maternal exposures and maternal 
                                health conditions that may influence 
                                the risk of birth defects, prematurity, 
                                or other adverse pregnancy outcomes; 
                                and
                                    (II) maternal exposures that may 
                                influence health risks to a breastfed 
                                infant; or
                            (ii) networking to facilitate surveillance 
                        or research described in this subparagraph.
            (2) Preference for certain states.--The Secretary, in 
        making any grant under this subsection, shall give preference 
        to States, otherwise equally qualified, that have pregnancy and 
        breastfeeding information services in place.
            (3) Matching funds.--The Secretary may only award a grant 
        under this subsection to a State or regional agency or 
        organization that agrees, with respect to the costs to be 
        incurred in carrying out the grant activities, to make 
        available (directly or through donations from public or private 
        entities) non-Federal funds toward such costs in an amount 
        equal to not less than 25 percent of the amount of the grant.
            (4) Coordination.--The Secretary shall ensure that 
        activities funded through a grant under this subsection are 
        coordinated, to the maximum extent practicable, with other 
        birth defects prevention and environmental health activities of 
        the Federal Government, including with respect to pediatric 
        environmental health specialty units and children's 
        environmental health centers.
    (e) Evaluation.--The Secretary shall provide for an evaluation of 
pregnancy and breastfeeding information services carried out by States 
to identify efficient and effective models of--
            (1) providing information;
            (2) raising awareness and increasing knowledge about birth 
        defects prevention measures and targeting education to at-risk 
        groups;
            (3) modifying risk behaviors; or
            (4) other outcome measures as determined appropriate by the 
        Secretary.
    (f) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated--
            (1) $5,000,000 for fiscal year 2023;
            (2) $6,000,000 for fiscal year 2024;
            (3) $7,000,000 for fiscal year 2025;
            (4) $8,000,000 for fiscal year 2026; and
            (5) $9,000,000 for fiscal year 2027.

                   Subtitle C--Pregnancy-Related Care

SEC. 5201. MOTHERS AND OFFSPRING MORTALITY AND MORBIDITY AWARENESS.

    (a) Improving Federal Efforts With Respect to Prevention of 
Maternal Mortality.--
            (1) Technical assistance for states with respect to 
        reporting maternal mortality.--Not later than one year after 
        the date of enactment of this Act, the Director of the Centers 
        for Disease Control and Prevention (referred to in this section 
        as the ``Director''), in consultation with the Administrator of 
        the Health Resources and Services Administration, shall provide 
        technical assistance to States that elect to report 
        comprehensive data on maternal mortality and factors relating 
        to such mortality (including oral and mental health), intimate 
        partner violence, and breastfeeding health information, for the 
        purpose of encouraging uniformity in the reporting of such data 
        and to encourage the sharing of such data among the respective 
        States.
            (2) Best practices relating to prevention of maternal 
        mortality.--
                    (A) In general.--Not later than one year after the 
                date of enactment of this Act--
                            (i) the Director, in consultation with 
                        relevant patient and provider groups, shall 
                        issue best practices to State maternal 
                        mortality review committees on how best to 
                        identify and review maternal mortality cases, 
                        taking into account any data made available by 
                        States relating to maternal mortality, 
                        including data on oral, mental, and 
                        breastfeeding health, and utilization of any 
                        emergency services; and
                            (ii) the Director, working in collaboration 
                        with the Health Resources and Services 
                        Administration, shall issue best practices to 
                        hospitals, State professional society groups, 
                        and perinatal quality collaboratives on how 
                        best to prevent maternal mortality.
                    (B) Authorization of appropriations.--For purposes 
                of carrying out this paragraph, there is authorized to 
                be appropriated $5,000,000 for each of fiscal years 
                2023 through 2027.
            (3) Alliance for innovation on maternal health grant 
        program.--
                    (A) In general.--Not later than one year after the 
                date of enactment of this Act, the Secretary of Health 
                and Human Services, acting through the Associate 
                Administrator of the Maternal and Child Health Bureau 
                of the Health Resources and Services Administration 
                (referred to in this paragraph as the ``Secretary''), 
                shall establish a grant program to be known as the 
                Alliance for Innovation on Maternal Health Grant 
                Program (referred to in this subsection as ``AIM'') 
                under which the Secretary shall award grants to 
                eligible entities for the purpose of--
                            (i) directing widespread adoption and 
                        implementation of maternal safety bundles 
                        through collaborative State-based teams; and
                            (ii) collecting and analyzing process, 
                        structure, and outcome data to drive continuous 
                        improvement in the implementation of such 
                        safety bundles by such State-based teams with 
                        the ultimate goal of eliminating preventable 
                        maternal mortality and severe maternal 
                        morbidity in the United States.
                    (B) Eligible entities.--In order to be eligible for 
                a grant under subparagraph (A), an entity shall--
                            (i) submit to the Secretary an application 
                        at such time, in such manner, and containing 
                        such information as the Secretary may require; 
                        and
                            (ii) demonstrate in such application that 
                        the entity is an interdisciplinary, multi-
                        stakeholder, national organization with a 
                        national data-driven maternal safety and 
                        quality improvement initiative based on 
                        implementation approaches that have been proven 
                        to improve maternal safety and outcomes in the 
                        United States.
                    (C) Use of funds.--An eligible entity that receives 
                a grant under subparagraph (A) shall use such grant 
                funds--
                            (i) to develop and implement, through a 
                        robust, multi-stakeholder process, maternal 
                        safety bundles to assist States, perinatal 
                        quality collaboratives, and health care systems 
                        in aligning national, State, and hospital-level 
                        quality improvement efforts to improve maternal 
                        health outcomes, specifically the reduction of 
                        maternal mortality and severe maternal 
                        morbidity;
                            (ii) to ensure, in developing and 
                        implementing maternal safety bundles under 
                        clause (i), that such maternal safety bundles--
                                    (I) satisfy the quality improvement 
                                needs of a State, perinatal quality 
                                collaborative, or health care system by 
                                factoring in the results and findings 
                                of relevant data reviews, such as 
                                reviews conducted by a State maternal 
                                mortality review committee; and
                                    (II) address topics which may 
                                include--
                                            (aa) information on 
                                        evidence-based practices to 
                                        improve the quality and safety 
                                        of maternal health care in 
                                        hospitals and other health care 
                                        settings of a State or health 
                                        care system, including by 
                                        addressing topics commonly 
                                        associated with health 
                                        complications or risks related 
                                        to prenatal care, labor care, 
                                        birthing, and postpartum care;
                                            (bb) best practices for 
                                        improving maternal health care 
                                        based on data findings and 
                                        reviews conducted by a State 
                                        maternal mortality review 
                                        committee that address topics 
                                        of relevance to common 
                                        complications or health risks 
                                        related to prenatal care, labor 
                                        care, birthing, and postpartum 
                                        care;
                                            (cc) information on 
                                        addressing determinants of 
                                        health that impact maternal 
                                        health outcomes for people 
                                        before, during, and after 
                                        pregnancy;
                                            (dd) obstetric hemorrhage;
                                            (ee) obstetric and 
                                        postpartum care for people with 
                                        substance use disorders, 
                                        including opioid use disorder;
                                            (ff) maternal 
                                        cardiovascular system;
                                            (gg) maternal mental 
                                        health;
                                            (hh) postpartum care basics 
                                        for maternal safety;
                                            (ii) reduction of 
                                        peripartum racial and ethnic 
                                        inequities;
                                            (jj) reduction of primary 
                                        caesarean birth;
                                            (kk) severe hypertension in 
                                        pregnancy;
                                            (ll) severe maternal 
                                        morbidity reviews;
                                            (mm) support after a severe 
                                        maternal morbidity event;
                                            (nn) thromboembolism;
                                            (oo) optimization of 
                                        support for breastfeeding;
                                            (pp) maternal oral health; 
                                        and
                                            (qq) intimate partner 
                                        violence; and
                            (iii) to provide ongoing technical 
                        assistance at the national and State levels to 
                        support implementation of maternal safety 
                        bundles under clause (i).
                    (D) Maternal safety bundle defined.--For purposes 
                of this paragraph, the term ``maternal safety bundle'' 
                means standardized, evidence-informed processes for 
                maternal health care.
                    (E) Authorization of appropriations.--For purposes 
                of carrying out this paragraph, there is authorized to 
                be appropriated $10,000,000 for each of fiscal years 
                2023 through 2027.
            (4) Funding for state-based perinatal quality 
        collaboratives development and sustainability.--
                    (A) In general.--Not later than one year after the 
                date of enactment of this Act, the Secretary of Health 
                and Human Services (referred to in this paragraph as 
                the ``Secretary''), acting through the Division of 
                Reproductive Health of the Centers for Disease Control 
                and Prevention, shall establish a grant program to be 
                known as the State-Based Perinatal Quality 
                Collaborative grant program under which the Secretary 
                awards grants to eligible entities for the purpose of 
                development and sustainability of perinatal quality 
                collaboratives in every State, the District of 
                Columbia, and eligible territories, in order to 
                measurably improve perinatal care and perinatal health 
                outcomes for pregnant and postpartum people and their 
                infants.
                    (B) Grant amounts.--Grants awarded under this 
                paragraph shall be in amounts not to exceed $250,000 
                per year, for the duration of the grant period.
                    (C) State-based perinatal quality collaborative 
                defined.--For purposes of this paragraph, the term 
                ``State-based perinatal quality collaborative'' means a 
                network of teams that--
                            (i) is multidisciplinary in nature and 
                        includes the full range of perinatal and 
                        maternity care providers;
                            (ii) works to improve measurable outcomes 
                        for maternal and infant health by advancing 
                        evidence-informed clinical practices using 
                        quality improvement principles;
                            (iii) works with hospital-based or 
                        outpatient facility-based clinical teams, 
                        experts, and stakeholders, including patients 
                        and families, to spread best practices and 
                        optimize resources to improve perinatal care 
                        and outcomes;
                            (iv) employs strategies that include the 
                        use of the collaborative learning model to 
                        provide opportunities for hospitals and 
                        clinical teams to collaborate on improvement 
                        strategies, rapid-response data to provide 
                        timely feedback to hospital and other clinical 
                        teams to track progress, and quality 
                        improvement science to provide support and 
                        coaching to hospital and clinical teams;
                            (v) has the goal of improving population-
                        level outcomes in maternal and infant health; 
                        and
                            (vi) has the goal of improving outcomes of 
                        all birthing people, through the coordination, 
                        integration, and collaboration across birth 
                        settings.
                    (D) Authorization of appropriations.--For purposes 
                of carrying out this paragraph, there is authorized to 
                be appropriated $14,000,000 per year for each of fiscal 
                years 2023 through 2027.
            (5) Expansion of medicaid and chip coverage for pregnant 
        and postpartum people.--
                    (A) Requiring coverage of oral health services for 
                pregnant and postpartum people.--
                            (i) Medicaid.--Section 1905 of the Social 
                        Security Act (42 U.S.C. 1396d) is amended--
                                    (I) in subsection (a)(4)--
                                            (aa) by redesignating 
                                        subparagraphs (E) and (F) as 
                                        subparagraphs (F) and (G), 
                                        respectively;
                                            (bb) by striking ``; and 
                                        (F)'' and inserting ``; (F)'';
                                            (cc) by inserting ``; and 
                                        (G) oral health services for 
                                        pregnant and postpartum people 
                                        (as defined in subsection 
                                        (ii))'' before the semicolon at 
                                        the end; and
                                    (II) by adding at the end the 
                                following new subsection:
    ``(jj) Oral Health Services for Pregnant and Postpartum People.--
            ``(1) In general.--For purposes of this title, the term 
        `oral health services for pregnant and postpartum people' means 
        dental services necessary to prevent disease and promote oral 
        health, restore oral structures to health and function, and 
        treat emergency conditions that are furnished to a person 
        during pregnancy (or during the 1-year period beginning on the 
        last day of the pregnancy).
            ``(2) Coverage requirements.--To satisfy the requirement to 
        provide oral health services for pregnant and postpartum 
        people, a State shall provide coverage for preventive, 
        diagnostic, periodontal, and restorative care consistent with 
        recommendations for perinatal oral health care and dental care 
        during pregnancy from the American Academy of Pediatric 
        Dentistry and the American College of Obstetricians and 
        Gynecologists.''.
                            (ii) CHIP.--Section 2103(c)(6)(A) of the 
                        Social Security Act (42 U.S.C. 1397cc(c)(6)(A)) 
                        is amended by inserting ``or a targeted low-
                        income pregnant person'' after ``targeted low-
                        income child''.
                    (B) Extending medicaid coverage for pregnant and 
                postpartum people.--Section 1902 of the Social Security 
                Act (42 U.S.C. 1396a) is amended--
                            (i) in subsection (e)--
                                    (I) in paragraph (5)--
                                            (aa) by inserting 
                                        ``(including oral health 
                                        services for pregnant and 
                                        postpartum people (as defined 
                                        in section 1905(jj)))'' after 
                                        ``postpartum medical assistance 
                                        under the plan''; and
                                            (bb) by striking ``60-day'' 
                                        and inserting ``1-year''; and
                                    (II) in paragraph (6), by striking 
                                ``60-day'' and inserting ``1-year''; 
                                and
                            (ii) in subsection (l)(1)(A), by striking 
                        ``60-day'' and inserting ``1-year''.
                    (C) Extending medicaid coverage for lawful 
                residents.--Section 1903(v)(4)(A)(i) of the Social 
                Security Act (42 U.S.C. 1396b(v)(4)(A)(i)) is amended 
                by striking ``60-day'' and inserting ``1-year''.
                    (D) Extending chip coverage for pregnant and 
                postpartum people.--Section 2112(d)(2)(A) of the Social 
                Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by 
                striking ``60-day'' and inserting ``1-year''.
                    (E) Maintenance of effort.--
                            (i) Medicaid.--Section 1902(l) of the 
                        Social Security Act (42 U.S.C. 1396a(l)) is 
                        amended by adding at the end the following new 
                        paragraph:
    ``(5) During the period that begins on the date of enactment of 
this paragraph and ends on the date that is five years after such date 
of enactment, as a condition for receiving any Federal payments under 
section 1903(a) for calendar quarters occurring during such period, a 
State shall not have in effect, with respect to people who are eligible 
for medical assistance under the State plan or under a waiver of such 
plan on the basis of being pregnant or having been pregnant, 
eligibility standards, methodologies, or procedures under the State 
plan or waiver that are more restrictive than the eligibility 
standards, methodologies, or procedures, respectively, under such plan 
or waiver that are in effect on the date of enactment of this 
paragraph.''.
                            (ii) CHIP.--Section 2105(d) of the Social 
                        Security Act (42 U.S.C. 1397ee(d)) is amended 
                        by adding at the end the following new 
                        paragraph:
            ``(4) In eligibility standards for targeted low-income 
        pregnant people.--During the period that begins on the date of 
        enactment of this paragraph and ends on the date that is five 
        years after such date of enactment, as a condition of receiving 
        payments under subsection (a) and section 1903(a), a State that 
        elects to provide assistance to people on the basis of being 
        pregnant (including pregnancy-related assistance provided to 
        targeted low-income pregnant people (as defined in section 
        2112(d)), pregnancy-related assistance provided to people who 
        are eligible for such assistance through application of section 
        1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
        assistance under the State child health plan (or a waiver of 
        such plan) which is provided to people on the basis of being 
        pregnant) shall not have in effect, with respect to such 
        people, eligibility standards, methodologies, or procedures 
        under such plan (or waiver) that are more restrictive than the 
        eligibility standards, methodologies, or procedures, 
        respectively, under such plan (or waiver) that are in effect on 
        the date of enactment of this paragraph.''.
                    (F) Information on benefits.--The Secretary of 
                Health and Human Services shall make publicly available 
                on the internet website of the Department of Health and 
                Human Services, information regarding benefits 
                available to pregnant and postpartum people and under 
                the Medicaid program and the Children's Health 
                Insurance Program, including information on--
                            (i) benefits that States are required to 
                        provide to pregnant and postpartum people under 
                        such programs;
                            (ii) optional benefits that States may 
                        provide to pregnant and postpartum people under 
                        such programs; and
                            (iii) the availability of different kinds 
                        of benefits for pregnant and postpartum people, 
                        including oral health and mental health 
                        benefits, under such programs.
                    (G) Federal funding for cost of extended medicaid 
                and chip coverage for postpartum people.--
                            (i) Medicaid.--Section 1905 of the Social 
                        Security Act (42 U.S.C. 1396d), as amended by 
                        subparagraph (A), is further amended--
                                    (I) in subsection (b), by striking 
                                ``and (ii)'' and inserting ``(ii), and 
                                (kk)''; and
                                    (II) by adding at the end the 
                                following:
    ``(kk) Increased FMAP for Extended Medical Assistance for 
Postpartum People.--Notwithstanding subsection (b), the Federal medical 
assistance percentage for a State, with respect to amounts expended by 
such State for medical assistance for a person who is eligible for such 
assistance on the basis of being pregnant or having been pregnant that 
is provided during the period that begins on the 60th day after the 
last day of their pregnancy (including any such assistance provided 
during the month in which such period ends), shall be equal to--
            ``(1) 100 percent for the first 20 calendar quarters during 
        which this subsection is in effect; and
            ``(2) 90 percent for calendar quarters thereafter.''.
                            (ii) CHIP.--Section 2105(c) of the Social 
                        Security Act (42 U.S.C. 1397ee(c)) is amended 
                        by adding at the end the following new 
                        paragraph:
            ``(13) Enhanced payment for extended assistance provided to 
        pregnant people.--Notwithstanding subsection (b), the enhanced 
        FMAP, with respect to payments under subsection (a) for 
        expenditures under the State child health plan (or a waiver of 
        such plan) for assistance provided under the plan (or waiver) 
        to a person who is eligible for such assistance on the basis of 
        being pregnant (including pregnancy-related assistance provided 
        to a targeted low-income pregnant person (as defined in section 
        2112(d)), pregnancy-related assistance provided to a person who 
        is eligible for such assistance through application of section 
        1902(v)(4)(A)(i) under section 2107(e)(1), or any other 
        assistance under the plan (or waiver) provided to a person who 
        is eligible for such assistance on the basis of being pregnant) 
        during the 305-day period that begins on the 60th day after the 
        last day of her pregnancy (including any such assistance 
        provided during the month in which such period ends), shall be 
        equal to--
                    ``(A) 100 percent for the first 20 calendar 
                quarters during which this paragraph is in effect; and
                    ``(B) 90 percent for calendar quarters 
                thereafter.''.
                    (H) Guidance on state options for medicaid coverage 
                of doula services.--Not later than 1 year after the 
                date of the enactment of this Act, the Secretary of 
                Health and Human Services, acting through the 
                Administrator of the Centers for Medicare & Medicaid 
                Services, shall issue guidance for the States 
                concerning options for Medicaid coverage and payment 
                for support services provided by doulas.
                    (I) Effective date.--
                            (i) In general.--Subject to clause (ii), 
                        the amendments made by this paragraph shall 
                        take effect on the first day of the first 
                        calendar quarter that begins on or after the 
                        date that is one year after the date of 
                        enactment of this Act.
                            (ii) Exception for state legislation.--In 
                        the case of a State plan under title XIX of the 
                        Social Security Act or a State child health 
                        plan under title XXI of such Act that the 
                        Secretary of Health and Human Services 
                        determines requires State legislation in order 
                        for the respective plan to meet any requirement 
                        imposed by amendments made by this paragraph, 
                        the respective plan shall not be regarded as 
                        failing to comply with the requirements of such 
                        title solely on the basis of its failure to 
                        meet such an additional requirement before the 
                        first day of the first calendar quarter 
                        beginning after the close of the first regular 
                        session of the State legislature that begins 
                        after the date of enactment of this Act. For 
                        purposes of the previous sentence, in the case 
                        of a State that has a 2-year legislative 
                        session, each year of the session shall be 
                        considered to be a separate regular session of 
                        the State legislature.
            (6) Regional centers of excellence.--Part P of title III of 
        the Public Health Service Act (42 U.S.C. 280g et seq.), as 
        amended by section 5101, is further amended by adding at the 
        end the following new section:

``SEC. 399V-9. REGIONAL CENTERS OF EXCELLENCE ADDRESSING IMPLICIT BIAS 
              AND CULTURAL COMPETENCY IN PATIENT-PROVIDER INTERACTIONS 
              EDUCATION.

    ``(a) In General.--Not later than one year after the date of 
enactment of this section, the Secretary, in consultation with such 
other agency heads as the Secretary determines appropriate, shall award 
cooperative agreements for the establishment or support of regional 
centers of excellence addressing implicit bias, cultural competency, 
and respectful care practices in patient-provider interactions 
education for the purpose of enhancing and improving how health care 
professionals are educated in implicit bias and delivering culturally 
competent health care.
    ``(b) Eligibility.--To be eligible to receive a cooperative 
agreement under subsection (a), an entity shall--
            ``(1) be a public or other nonprofit entity specified by 
        the Secretary that provides educational and training 
        opportunities for students and health care professionals, which 
        may be a health system, teaching hospital, community health 
        center, medical school, school of public health, school of 
        nursing, dental school, social work school, school of 
        professional psychology, or any other health professional 
        school or program at an institution of higher education (as 
        defined in section 101 of the Higher Education Act of 1965) 
        focused on the prevention, treatment, or recovery of health 
        conditions that contribute to maternal mortality and the 
        prevention of maternal mortality and severe maternal morbidity;
            ``(2) demonstrate community engagement and participation, 
        such as through partnerships with home visiting and case 
        management programs;
            ``(3) demonstrate engagement with groups engaged in the 
        implementation of health care professional training in implicit 
        bias and delivering culturally competent care, such as 
        departments of public health, perinatal quality collaboratives, 
        hospital systems, and health care professional groups, in order 
        to obtain input on resources needed for effective 
        implementation strategies; and
            ``(4) provide to the Secretary such information, at such 
        time and in such manner, as the Secretary may require.
    ``(c) Diversity.--In awarding a cooperative agreement under 
subsection (a), the Secretary shall take into account any regional 
differences among eligible entities and make an effort to ensure 
geographic diversity among award recipients.
    ``(d) Dissemination of Information.--
            ``(1) Public availability.--The Secretary shall make 
        publicly available on the internet website of the Department of 
        Health and Human Services information submitted to the 
        Secretary under subsection (b)(3).
            ``(2) Evaluation.--The Secretary shall evaluate each 
        regional center of excellence established or supported pursuant 
        to subsection (a) and disseminate the findings resulting from 
        each such evaluation to the appropriate public and private 
        entities.
            ``(3) Distribution.--The Secretary shall share evaluations 
        and overall findings with State departments of health and other 
        relevant State level offices to inform State and local best 
        practices.
    ``(e) Maternal Mortality Defined.--In this section, the term 
`maternal mortality' means death of a person that occurs during 
pregnancy or within the one-year period following the end of such 
pregnancy.
    ``(f) Authorization of Appropriations.--For purposes of carrying 
out this section, there is authorized to be appropriated $5,000,000 for 
each of fiscal years 2023 through 2027.''.
            (7) Special supplemental nutrition program for people, 
        infants, and children.--Section 17(d)(3)(A)(ii) of the Child 
        Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is 
        amended--
                    (A) by striking the clause designation and heading 
                and all that follows through ``A State'' and inserting 
                the following:
                            ``(ii) Pregnant and postpartum people.--
                                    ``(I) Breastfeeding people.--A 
                                State'';
                    (B) in subclause (I) (as so designated), by 
                striking ``1 year'' and all that follows through 
                ``earlier'' and inserting ``2 years postpartum''; and
                    (C) by adding at the end the following:
                                    ``(II) Postpartum people.--A State 
                                may elect to certify a postpartum 
                                person for a period of 2 years.''.
            (8) Definitions.--In this subsection:
                    (A) Maternal mortality.--The term ``maternal 
                mortality'' means death of a person that occurs during 
                pregnancy or within the one-year period following the 
                end of such pregnancy.
                    (B) Pregnancy related death.--The term ``pregnancy 
                related death'' includes the death of a person during 
                pregnancy or within one year of the end of pregnancy 
                from a pregnancy complication, a chain of events 
                initiated by pregnancy, or the aggravation of an 
                unrelated condition by the physiologic effects of 
                pregnancy.
                    (C) Severe maternal morbidity.--The term ``severe 
                maternal morbidity'' includes unexpected outcomes of 
                labor and delivery that result in significant short-
                term or long-term consequences to a person's health.
    (b) Increase in Tax on Certain Tobacco Products and Imposition of 
Tax on Nicotine.--
            (1) Increasing tax on cigarettes.--
                    (A) Small cigarettes.--Section 5701(b)(1) of the 
                Internal Revenue Code of 1986 is amended by striking 
                ``$50.33'' and inserting ``$100.66''.
                    (B) Large cigarettes.--Section 5701(b)(2) of the 
                Internal Revenue Code of 1986 is amended by striking 
                ``$105.69'' and inserting ``$211.39''.
            (2) Tax parity for small cigars.--Section 5701(a)(1) of the 
        Internal Revenue Code of 1986 is amended by striking ``$50.33'' 
        and inserting ``$100.66''.
            (3) Tax parity for large cigars.--Section 5701(a)(2) of the 
        Internal Revenue Code of 1986 is amended by striking ``52.75 
        percent'' and all that follows through the period and inserting 
        ``$49.56 per pound and a proportionate tax at the like rate on 
        all fractional parts of a pound but not less than 10.06 cents 
        per cigar.''.
            (4) Tax parity for smokeless tobacco.--
                    (A) Section 5701(e) of the Internal Revenue Code of 
                1986 is amended--
                            (i) in paragraph (1), by striking ``$1.51'' 
                        and inserting ``$26.84'';
                            (ii) in paragraph (2), by striking ``50.33 
                        cents'' and inserting ``$10.70''; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(3)  Smokeless tobacco sold in discrete single-use 
        units.--On discrete single-use units, $100 per thousand.''.
                    (B) Section 5702(m) of the Internal Revenue Code of 
                1986 is amended--
                            (i) in paragraph (1), by striking ``or 
                        chewing tobacco'' and inserting ``, chewing 
                        tobacco, or discrete single-use unit'';
                            (ii) in paragraphs (2) and (3), by 
                        inserting ``and that is not a discrete single-
                        use unit'' before the period at the end of each 
                        such paragraph; and
                            (iii) by adding at the end the following 
                        new paragraph:
            ``(4) Discrete single-use unit.--The term `discrete single-
        use unit' means any product containing tobacco that--
                    ``(A) is not intended to be smoked, and
                    ``(B) is in the form of a lozenge, tablet, pill, 
                pouch, dissolvable strip, or other discrete single-use 
                or single-dose unit.''.
            (5) Tax parity for pipe tobacco.--Section 5701(f) of the 
        Internal Revenue Code of 1986 is amended by striking ``$2.8311 
        cents'' and inserting ``$49.56''.
            (6) Tax parity for roll-your-own tobacco.--Section 5701(g) 
        of the Internal Revenue Code of 1986 is amended by striking 
        ``$24.78'' and inserting ``$49.56''.
            (7) Tax parity for roll-your-own tobacco and certain 
        processed tobacco.--Section 5702(o) of the Internal Revenue 
        Code of 1986 is amended by inserting ``, and includes processed 
        tobacco that is removed for delivery or delivered to a person 
        other than a person with a permit provided under section 5713, 
        but does not include removals of processed tobacco for 
        exportation'' after ``wrappers thereof''.
            (8) Imposition of tax on nicotine for use in vaping, etc.--
                    (A) In general.--Section 5701 of the Internal 
                Revenue Code of 1986 is amended by redesignating 
                subsection (h) as subsection (i) and by inserting after 
                subsection (g) the following new subsection:
    ``(h) Nicotine.--On taxable nicotine, manufactured in or imported 
into the United States, there shall be imposed a tax equal to the 
dollar amount specified in section 5701(b)(1) per 1,810 milligrams of 
nicotine (and a proportionate tax at the like rate on any fractional 
part thereof).''.
                    (B) Taxable nicotine.--Section 5702 of the Internal 
                Revenue Code of 1986 is amended by adding at the end 
                the following new subsection:
    ``(q) Taxable Nicotine.--
            ``(1) In general.--Except as otherwise provided in this 
        subsection, the term `taxable nicotine' means any nicotine 
        which has been extracted, concentrated, or synthesized.
            ``(2) Exception for products approved by food and drug 
        administration.--Such term shall not include any nicotine if 
        the manufacturer or importer thereof demonstrates to the 
        satisfaction of the Secretary of Health and Human Services that 
        such nicotine will be used in--
                    ``(A) a drug--
                            ``(i) that is approved under section 505 of 
                        the Federal Food, Drug, and Cosmetic Act or 
                        licensed under section 351 of the Public Health 
                        Service Act; or
                            ``(ii) for which an investigational use 
                        exemption has been authorized under section 
                        505(i) of the Federal Food, Drug, and Cosmetic 
                        Act or under section 351(a) of the Public 
                        Health Service Act; or
                    ``(B) a combination product (as described in 
                section 503(g) of the Federal Food, Drug, and Cosmetic 
                Act), the constituent parts of which were approved or 
                cleared under section 505, 510(k), or 515 of such Act.
            ``(3) Coordination with taxation of other tobacco 
        products.--Tobacco products meeting the definition of cigars, 
        cigarettes, smokeless tobacco, pipe tobacco, and roll-your-own 
        tobacco in this section shall be classified and taxed as such 
        despite any concentration of the nicotine inherent in those 
        products or any addition of nicotine to those products during 
        the manufacturing process.
            ``(4) Regulations.--The Secretary shall prescribe such 
        regulations or other guidance as is necessary or appropriate to 
        carry out the purposes of this subsection, including 
        regulations or other guidance for coordinating the taxation of 
        tobacco products and taxable nicotine to protect revenue and 
        prevent double taxation.''.
                    (C) Taxable nicotine treated as a tobacco 
                product.--Section 5702(c) of the Internal Revenue Code 
                of 1986 is amended by striking ``and roll-your-own 
                tobacco'' and inserting ``roll-your-own tobacco, and 
                taxable nicotine''.
                    (D) Manufacturer of taxable nicotine.--Section 5702 
                of the Internal Revenue Code of 1986, as amended by 
                subparagraph (B), is amended by adding at the end the 
                following new subsection:
    ``(r) Manufacturer of Taxable Nicotine.--
            ``(1) In general.--Any person who extracts, concentrates, 
        or synthesizes nicotine shall be treated as a manufacturer of 
        taxable nicotine (and as manufacturing such taxable nicotine).
            ``(2) Application of rules related to manufacturers of 
        tobacco products.--Any reference to a manufacturer of tobacco 
        products, or to manufacturing tobacco products, shall be 
        treated as including a reference to a manufacturer of taxable 
        nicotine, or to manufacturing taxable nicotine, 
        respectively.''.
            (9) Repeal of special rules for determining price of 
        cigars.--Section 5702 of the Internal Revenue Code of 1986 is 
        amended by striking subsection (l).
            (10) Floor stocks taxes.--
                    (A) Imposition of tax.--On covered tobacco 
                products, and cigarette papers and tubes, manufactured 
                in or imported into the United States which are removed 
                before the tax increase date and held on such date for 
                sale by any person, there is hereby imposed a tax in an 
                amount equal to the excess of--
                            (i) the tax which would be imposed under 
                        section 5701 of the Internal Revenue Code of 
                        1986 on the article if the article had been 
                        removed on such date; over
                            (ii) the prior tax (if any) imposed under 
                        section 5701 of such Code on such article.
                    (B) Covered tobacco products.--For purposes of this 
                paragraph, the term ``covered tobacco products'' means 
                any tobacco product other than--
                            (i) cigars described in section 5701(a)(2) 
                        of the Internal Revenue Code of 1986;
                            (ii) discrete single-use units (as defined 
                        in section 5702(m)(4) of such Code, as amended 
                        by this subsection); and
                            (iii) taxable nicotine (as defined in 
                        section 5702(q) of such Code, as amended by 
                        this subsection).
                    (C) Credit against tax.--Each person shall be 
                allowed as a credit against the taxes imposed by 
                subparagraph (A) an amount equal to the lesser of 
                $1,000 or the amount of such taxes. For purposes of the 
                preceding sentence, all persons treated as a single 
                employer under subsection (b), (c), (m), or (o) of 
                section 414 of the Internal Revenue Code of 1986 shall 
                be treated as 1 person for purposes of this 
                subparagraph.
                    (D) Liability for tax and method of payment.--
                            (i) Liability for tax.--The person referred 
                        to in subparagraph (A) shall be liable for the 
                        tax imposed by such subparagraph.
                            (ii) Method of payment.--The tax imposed by 
                        subparagraph (A) shall be paid in such manner 
                        as the Secretary may provide.
                    (E) Articles in foreign trade zones.--
                            (i) In general.--Notwithstanding the Act of 
                        June 18, 1934 (commonly known as the Foreign 
                        Trade Zone Act, 48 Stat. 998, 19 U.S.C. 81a et 
                        seq.) or any other provision of law, any 
                        covered tobacco products, or cigarette papers 
                        and tubes, which are located in a foreign trade 
                        zone on the tax increase date, shall be subject 
                        to the tax imposed by subparagraph (A) if--
                                    (I) internal revenue taxes have 
                                been determined, or customs duties 
                                liquidated, with respect to such 
                                article before such date pursuant to a 
                                request made under the 1st proviso of 
                                section 3(a) of such Act; or
                                    (II) such article is held on such 
                                date under the supervision of an 
                                officer of the United States Customs 
                                and Border Protection of the Department 
                                of Homeland Security pursuant to the 2d 
                                proviso of such section 3(a).
                    (F) Tax increase date.--For purposes of this 
                paragraph, the term ``tax increase date'' means the 
                first day of the first calendar quarter described in 
                paragraph (11)(A).
                    (G) Certain other definitions.--Terms used in this 
                paragraph which are also used in section 5702 of the 
                Internal Revenue Code of 1986 shall have the same 
                meaning as when used in such section.
            (11) Effective date.--
                    (A) In general.--Except as otherwise provided in 
                this paragraph, the amendments made by this subsection 
                shall apply to articles removed in calendar quarters 
                beginning after the date of the enactment of this Act.
                    (B) Delayed effective date for certain products.--
                The amendments made by paragraphs (3), (4)(A)(iii), 
                (4)(B), and (8) shall apply to articles removed in 
                calendar quarters beginning after the date which is 180 
                days after the date of the enactment of this Act.
            (12) Transition rule for permit and bond requirements.--A 
        person which is lawfully engaged in business as a manufacturer 
        or importer of taxable nicotine (within the meaning of 
        subchapter A of chapter 52 of the Internal Revenue Code of 
        1986, as amended by this subsection) on the date of the 
        enactment of this Act, first becomes subject to the 
        requirements of subchapter B of chapter 52 of such Code by 
        reason of the amendments made by this subsection, and submits 
        an application under such subchapter B to engage in such 
        business not later than 90 days after the date of the enactment 
        of this Act, shall not be denied the right to carry on such 
        business by reason of such requirements before final action on 
        such application.

SEC. 5202. MOMMIES.

    (a) GAO Study and Report.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Comptroller General of the 
        United States shall submit to Congress a report on the gaps in 
        coverage with respect to--
                    (A) pregnant individuals enrolled under a State 
                plan (or waiver of such plan) under title XIX of the 
                Social Security Act (42 U.S.C. 1396 et seq.) and the 
                Children's Health Insurance Program under title XXI of 
                the Social Security Act (42 U.S.C. 1397aa et seq.); and
                    (B) postpartum individuals enrolled under a State 
                plan (or waiver of such plan) under title XIX of the 
                Social Security Act (42 U.S.C. 1396 et seq.) and the 
                Children's Health Insurance Program under title XXI of 
                the Social Security Act (42 U.S.C. 1397aa et seq.) who 
                received assistance under either such program during 
                their pregnancy.
            (2) Content of report.--The report required under this 
        paragraph shall include the following:
                    (A) Information about the abilities and successes 
                of State Medicaid agencies in determining whether 
                pregnant and postpartum individuals are eligible under 
                another insurance affordability program, and in 
                transitioning any such individuals who are so eligible 
                to coverage under such a program at the end of their 
                period of eligibility for medical assistance, pursuant 
                to section 435.1200 of the title 42, Code of Federal 
                Regulations (as in effect on September 1, 2018).
                    (B) Information on factors contributing to gaps in 
                coverage that disproportionately impact underserved 
                populations, including low-income individuals, Black, 
                Indigenous, and other individuals of color, individuals 
                who reside in a health professional shortage area (as 
                defined in section 332(a)(1)(A) of the Public Health 
                Service Act (42 U.S.C. 254e(a)(1)(A))) or individuals 
                who are members of a medically underserved population 
                (as defined by section 330(b)(3) of such Act (42 U.S.C. 
                254b(b)(3)(A))).
                    (C) Recommendations for addressing and reducing 
                such gaps in coverage.
                    (D) Such other information as the Comptroller 
                General deems necessary.
            (3) Data disaggregation.--To the greatest extent possible, 
        the Comptroller General shall disaggregate data presented in 
        the report, including by age, gender identity, race, ethnicity, 
        income level, and other demographic factors.
    (b) Maternity Care Home Demonstration Project.--Title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.) is amended by inserting 
the following new section after section 1947:

``SEC. 1948. MATERNITY CARE HOME DEMONSTRATION PROJECT.

    ``(a) In General.--Not later than 1 year after the date of the 
enactment of this section, the Secretary shall establish a 
demonstration project (in this section referred to as the 
`demonstration project') under which the Secretary shall provide grants 
to States to enter into arrangements with eligible entities to 
implement or expand a maternity care home model for eligible 
individuals.
    ``(b) Goals of Demonstration Project.--The goals of the 
demonstration project are the following:
            ``(1) To improve--
                    ``(A) maternity and infant care outcomes;
                    ``(B) birth equity;
                    ``(C) health equity for--
                            ``(i) Black, Indigenous, and other people 
                        of color;
                            ``(ii) lesbian, gay, bisexual, transgender, 
                        queer, non-binary, and gender nonconfirming 
                        individuals;
                            ``(iii) people with disabilities; and
                            ``(iv) other underserved populations;
                    ``(D) communication by maternity, infant care, and 
                social services providers;
                    ``(E) integration of perinatal support services, 
                including community health workers, doulas, social 
                workers, public health nurses, peer lactation 
                counselors, lactation consultants, childbirth 
                educators, peer mental health workers, and others, into 
                health care entities and organizations;
                    ``(F) care coordination between maternity, infant 
                care, oral health services, and social services 
                providers within the community;
                    ``(G) the quality and safety of maternity and 
                infant care;
                    ``(H) the experience of individuals receiving 
                maternity care, including by increasing the ability of 
                an individual to develop and follow their own birthing 
                plans; and
                    ``(I) access to adequate prenatal and postpartum 
                care, including--
                            ``(i) prenatal care that is initiated in a 
                        timely manner;
                            ``(ii) not fewer than 5 post-pregnancy 
                        visits to a maternity care provider; and
                            ``(iii) interpregnancy care.
            ``(2) To provide coordinated, evidence-based, respectful, 
        culturally and linguistically appropriate, and person-centered 
        maternity care management.
            ``(3) To decrease--
                    ``(A) severe and preventable maternal morbidity and 
                maternal mortality;
                    ``(B) overall health care spending;
                    ``(C) unnecessary emergency department visits;
                    ``(D) inequities in maternal and infant care 
                outcomes, including racial, economic, disability, 
                gender-based, and geographical inequities;
                    ``(E) racial, gender, economic, and other 
                discrimination among health care professionals;
                    ``(F) racism, discrimination, disrespect, and abuse 
                in maternity care settings;
                    ``(G) the rate of cesarean deliveries for low-risk 
                pregnancies;
                    ``(H) the rate of pre-term births and infants born 
                with low birth weight; and
                    ``(I) the rate of avoidable maternal and newborn 
                hospitalizations and admissions to intensive care 
                units.
    ``(c) Consultation.--In designing and implementing the 
demonstration project the Secretary shall consult with stakeholders, 
including--
            ``(1) States;
            ``(2) organizations representing relevant health care 
        professionals, including oral health services professionals;
            ``(3) organizations, particularly reproductive justice and 
        birth justice organizations led by people of color, that 
        represent consumers of maternal health care, including 
        consumers of maternal health care who are disproportionately 
        impacted by poor maternal health outcomes;
            ``(4) representatives with experience implementing other 
        maternity care home models, including representatives from the 
        Center for Medicare and Medicaid Innovation;
            ``(5) community-based health care professionals, including 
        doulas, lactation consultants, and other stakeholders;
            ``(6) experts in promoting health equity and combating 
        racial bias in health care settings; and
            ``(7) Black, Indigenous, and other maternal health care 
        consumers of color who have experienced severe maternal 
        morbidity.
    ``(d) Application and Selection of States.--
            ``(1) In general.--A State seeking to participate in the 
        demonstration project shall submit an application to the 
        Secretary at such time and in such manner as the Secretary 
        shall require.
            ``(2) Selection of states.--
                    ``(A) In general.--The Secretary shall select at 
                least 10 States to participate in the demonstration 
                project.
                    ``(B) Selection requirements.--In selecting States 
                to participate in the demonstration project, the 
                Secretary shall--
                            ``(i) ensure that there is geographic and 
                        regional diversity in the areas in which 
                        activities will be carried out under the 
                        project;
                            ``(ii) ensure that States with significant 
                        inequities in maternal and infant health 
                        outcomes, including severe maternal morbidity, 
                        and other inequities based on race, income, or 
                        access to maternity care, are included; and
                            ``(iii) ensure that at least 1 territory is 
                        included.
    ``(e) Grants.--
            ``(1) In general.--From amounts appropriated under 
        subsection (l), the Secretary shall award 1 grant for each year 
        of the demonstration project to each State that is selected to 
        participate in the demonstration project.
            ``(2) Use of grant funds.--A State may use funds received 
        under this section to--
                    ``(A) award grants or make payments to eligible 
                entities as part of an arrangement described in 
                subsection (f)(2);
                    ``(B) provide financial incentives to health care 
                professionals, including community-based health care 
                workers and community-based doulas, who participate in 
                the State's maternity care home model;
                    ``(C) provide adequate training for health care 
                professionals, including community-based health care 
                workers, doulas, and care coordinators, who participate 
                in the State's maternity care home model, which may 
                include training for cultural humility and antiracism, 
                racial bias, health equity, reproductive and birth 
                justice, trauma-informed care, home visiting skills, 
                and respectful communication and listening skills, 
                particularly in regards to maternal health;
                    ``(D) pay for personnel and administrative expenses 
                associated with designing, implementing, and operating 
                the State's maternity care home model;
                    ``(E) pay for items and services that are furnished 
                under the State's maternity care home model and for 
                which payment is otherwise unavailable under this 
                title;
                    ``(F) pay for services and materials to ensure 
                culturally and linguistically appropriate 
                communication, including--
                            ``(i) language services such as 
                        interpreters and translation of written 
                        materials; and
                            ``(ii) development of culturally and 
                        linguistically appropriate materials; and 
                        auxiliary aids and services; and
                    ``(G) pay for other costs related to the State's 
                maternity care home model, as determined by the 
                Secretary.
            ``(3) Grant for national independent evaluator.--
                    ``(A) In general.--From the amounts appropriated 
                under subsection (l), prior to awarding any grants 
                under paragraph (1), the Secretary shall enter into a 
                contract with a national external entity to create a 
                single, uniform process to--
                            ``(i) ensure that States that receive 
                        grants under paragraph (1) comply with the 
                        requirements of this section; and
                            ``(ii) evaluate the outcomes of the 
                        demonstration project in each participating 
                        State.
                    ``(B) Annual report.--The contract described in 
                subparagraph (A) shall require the national external 
                entity to submit to the Secretary--
                            ``(i) a yearly evaluation report for each 
                        year of the demonstration project; and
                            ``(ii) a final impact report after the 
                        demonstration project has concluded.
                    ``(C) Secretary's authority.--Nothing in this 
                paragraph shall prevent the Secretary from making a 
                determination that a State is not in compliance with 
                the requirements of this section without the national 
                external entity making such a determination.
    ``(f) Partnership With Eligible Entities.--
            ``(1) In general.--As a condition of receiving a grant 
        under this section, a State shall enter into an arrangement 
        with one or more eligible entities that meets the requirements 
        of paragraph (2).
            ``(2) Arrangements with eligible entities.--Under an 
        arrangement between a State and an eligible entity under this 
        subsection, the eligible entity shall perform the following 
        functions, with respect to eligible individuals enrolled with 
        the entity under the State's maternity care home model--
                    ``(A) provide culturally and linguistically 
                appropriate congruent care, which may include prenatal 
                care, family planning services, medical care, mental 
                and behavioral care, postpartum care, and oral health 
                services to such eligible individuals through a team of 
                health care professionals, which may include 
                obstetrician-gynecologists, maternal-fetal medicine 
                specialists, family physicians, primary care providers, 
                oral health providers, physician assistants, advanced 
                practice registered nurses such as nurse practitioners 
                and certified nurse midwives, certified midwives, 
                certified professional midwives, physical therapists, 
                social workers, traditional and community-based doulas, 
                lactation consultants, childbirth educators, community 
                health workers, peer mental health supporters, and 
                other health care professionals;
                    ``(B) conduct a risk assessment of each such 
                eligible individual to determine if their pregnancy is 
                high or low risk, and establish a tailored pregnancy 
                care plan, which takes into consideration the 
                individual's own preferences and pregnancy care and 
                birthing plans and determines the appropriate support 
                services to reduce the individual's medical, social, 
                and environmental risk factors, for each such eligible 
                individual based on the results of such risk 
                assessment;
                    ``(C) assign each such eligible individual to a 
                culturally and linguistically appropriate care 
                coordinator, which may be a nurse, social worker, 
                traditional or community-based doula, community health 
                worker, midwife, or other health care provider, who is 
                responsible for ensuring that such eligible individual 
                receives the necessary medical care and connections to 
                essential support services;
                    ``(D) provide, or arrange for the provision of, 
                essential support services, such as services that 
                address--
                            ``(i) food access, nutrition, and exercise;
                            ``(ii) smoking cessation;
                            ``(iii) substance use disorder and 
                        addiction treatment;
                            ``(iv) anxiety, depression, trauma, and 
                        other mental and behavioral health issues;
                            ``(v) breast feeding, chestfeeding, or 
                        other infant feeding options supports, 
                        initiation, continuation, and duration;
                            ``(vi) stable, affordable, safe, and 
                        healthy housing;
                            ``(vii) transportation;
                            ``(viii) intimate partner violence;
                            ``(ix) community and police violence;
                            ``(x) home visiting services;
                            ``(xi) childbirth and newborn care 
                        education;
                            ``(xii) oral health education;
                            ``(xiii) continuous labor support;
                            ``(xiv) group prenatal care;
                            ``(xv) family planning and contraceptive 
                        care and supplies; and
                            ``(xvi) affordable child care;
                    ``(E) as appropriate, facilitate connections to a 
                usual primary care provider, which may be a 
                reproductive health care provider;
                    ``(F) refer to guidelines and opinions of medical 
                associations when determining whether an elective 
                delivery should be performed on an eligible individual 
                before 39 weeks of gestation;
                    ``(G) provide such eligible individual with 
                evidence-based and culturally and linguistically 
                appropriate education and resources to identify 
                potential warning signs of pregnancy and postpartum 
                complications and when and how to obtain medical 
                attention;
                    ``(H) provide, or arrange for the provision of, 
                culturally and linguistically appropriate pregnancy and 
                postpartum health services, including family planning 
                counseling and services, to eligible individuals;
                    ``(I) track and report postpartum health and birth 
                outcomes of such eligible individuals and their 
                children;
                    ``(J) ensure that care is person-centered, 
                culturally and linguistically appropriate, and patient-
                led, including by engaging eligible individuals in 
                their own care, including through communication and 
                education; and
                    ``(K) ensure adequate training for appropriately 
                serving the population of individuals eligible for 
                medical assistance under the State plan (or waiver of 
                such plan), including through reproductive justice, 
                birth justice, birth equity, and anti-racist 
                frameworks, home visiting skills, and knowledge of 
                social services.
    ``(g) Term of Demonstration Project.--The Secretary shall conduct 
the demonstration project for a period of 5 years.
    ``(h) Report.--Not later than 18 months after the date of the 
enactment of this section and annually thereafter for each year of the 
demonstration project term, the Secretary shall submit a report to 
Congress on the results of the demonstration project, including--
            ``(1) the results of the final report of the national 
        external entity required under subsection (e)(3)(B)(ii); and
            ``(2) recommendations on whether the model studied in the 
        demonstration project should be continued or more widely 
        adopted, including by private health plans.
    ``(i) Waiver Authority.--To the extent that the Secretary 
determines necessary in order to carry out the demonstration project, 
the Secretary may waive section 1902(a)(1) (relating to statewideness) 
and section 1902(a)(10)(B) (relating to comparability).
    ``(j) Technical Assistance.--The Secretary shall establish a 
process to provide technical assistance to States that are awarded 
grants under this section and to eligible entities and other providers 
participating in a State maternity care home model funded by such a 
grant.
    ``(k) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means an 
        entity or organization that provides medically accurate, 
        comprehensive maternity services to individuals who are 
        eligible for medical assistance under a State plan under this 
        title or a waiver of such a plan, and may include:
                    ``(A) A freestanding birth center.
                    ``(B) An entity or organization receiving 
                assistance under section 330 of the Public Health 
                Service Act.
                    ``(C) A federally qualified health center.
                    ``(D) A rural health clinic.
                    ``(E) A health facility operated by an Indian tribe 
                or tribal organization (as those terms are defined in 
                section 4 of the Indian Health Care Improvement Act).
            ``(2) Eligible individual.--The term `eligible individual' 
        means a pregnant individual or a formerly pregnant individual 
        during the 1-year period beginning on the last day of the 
        pregnancy, or such longer period beginning on such day as a 
        State may elect, who is--
                    ``(A) enrolled in a State plan under this title, a 
                waiver of such a plan, or a State child health plan 
                under title XXI; and
                    ``(B) a patient of an eligible entity which has 
                entered into an arrangement with a State under 
                subsection (g).
    ``(l) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary, for each of fiscal years 2023 through 
2030, such sums as may be necessary to carry out this section.''.
    (c) Reapplication of Medicare Payment Rate Floor to Primary Care 
Services Furnished Under Medicaid and Inclusion of Additional 
Providers.--
            (1) Reapplication of payment floor; additional providers.--
                    (A) In general.--Section 1902(a)(13) of the Social 
                Security Act (42 U.S.C. 1396a(a)(13)) is amended--
                            (i) in subparagraph (B), by striking ``; 
                        and'' and inserting a semicolon;
                            (ii) in subparagraph (C), by striking the 
                        semicolon and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(D) payment for primary care services (as defined 
                in subsection (jj)(1)) furnished in the period that 
                begins on the first day of the first month that begins 
                after the date of enactment of this subparagraph by a 
                provider described in subsection (jj)(2)--
                            ``(i) at a rate that is not less than 100 
                        percent of the payment rate that applies to 
                        such services and the provider of such services 
                        under part B of title XVIII (or, if greater, 
                        the payment rate that would be applicable under 
                        such part if the conversion factor under 
                        section 1848(d) for the year were the 
                        conversion factor under such section for 2009);
                            ``(ii) in the case of items and services 
                        that are not items and services provided under 
                        such part, at a rate to be established by the 
                        Secretary; and
                            ``(iii) in the case of items and services 
                        that are furnished in rural areas (as defined 
                        in section 1886(d)(2)(D)), health professional 
                        shortage areas (as defined in section 
                        332(a)(1)(A) of the Public Health Service Act 
                        (42 U.S.C. 254e(a)(1)(A))), or medically 
                        underserved areas (according to a designation 
                        under section 330(b)(3)(A) of the Public Health 
                        Service Act (42 U.S.C. 254b(b)(3)(A))), at the 
                        rate otherwise applicable to such items or 
                        services under clause (i) or (ii) increased, at 
                        the Secretary's discretion, by not more than 25 
                        percent;''.
                    (B) Conforming amendments.--
                            (i) Section 1902(a)(13)(C) of the Social 
                        Security Act (42 U.S.C. 1396a(a)(13)(C)) is 
                        amended by striking ``subsection (jj)'' and 
                        inserting ``subsection (jj)(1)''.
                            (ii) Section 1905(dd) of the Social 
                        Security Act (42 U.S.C. 1396d(dd)) is amended--
                                    (I) by striking ``Notwithstanding'' 
                                and inserting the following:
            ``(1) In general.--Notwithstanding'';
                                    (II) by striking ``section 
                                1902(a)(13)(C)'' and inserting 
                                ``subparagraph (C) of section 
                                1902(a)(13)'';
                                    (III) by inserting ``or for 
                                services described in subparagraph (D) 
                                of section 1902(a)(13) furnished during 
                                an additional period specified in 
                                paragraph (2),'' after ``2015,'';
                                    (IV) by striking ``under such 
                                section'' and inserting ``under 
                                subparagraph (C) or (D) of section 
                                1902(a)(13), as applicable''; and
                                    (V) by adding at the end the 
                                following:
            ``(2) Additional periods.--For purposes of paragraph (1), 
        the following are additional periods:
                    ``(A) The period that begins on the first day of 
                the first month that begins after the date of enactment 
                of this paragraph.''.
            (2) Improved targeting of primary care.--Section 1902(jj) 
        of the Social Security Act (42 U.S.C. 1396a(jj)) is amended--
                    (A) by redesignating paragraphs (1) and (2) as 
                clauses (i) and (ii), respectively, and realigning the 
                left margins accordingly;
                    (B) by striking ``For purposes of subsection 
                (a)(13)(C)'' and inserting the following:
            ``(1) In general.--
                    ``(A) Definition.--For purposes of subparagraphs 
                (C) and (D) of subsection (a)(13)''; and
                    (C) by inserting after clause (ii) (as so 
                redesignated) the following:
                    ``(B) Exclusions.--Such term does not include any 
                services described in subparagraph (A) or (B) of 
                paragraph (1) if such services are provided in an 
                emergency department of a hospital.
            ``(2) Additional providers.--For purposes of subparagraph 
        (D) of subsection (a)(13), a provider described in this 
        paragraph is any of the following:
                    ``(A) A physician with a primary specialty 
                designation of family medicine, general internal 
                medicine, or pediatric medicine, or obstetrics and 
                gynecology.
                    ``(B) An advanced practice clinician, as defined by 
                the Secretary, that works under the supervision of--
                            ``(i) a physician that satisfies the 
                        criteria specified in subparagraph (A);
                            ``(ii) a nurse practitioner or a physician 
                        assistant (as such terms are defined in section 
                        1861(aa)(5)(A)) who is working in accordance 
                        with State law; or
                            ``(iii) or a certified nurse-midwife (as 
                        defined in section 1861(gg)) or a certified 
                        professional midwife who is working in 
                        accordance with State law.
                    ``(C) A rural health clinic, federally qualified 
                health center, health center that receives funding 
                under title X of the Public Health Service Act, or 
                other health clinic that receives reimbursement on a 
                fee schedule applicable to a physician.
                    ``(D) An advanced practice clinician supervised by 
                a physician described in subparagraph (A), another 
                advanced practice clinician, or a certified nurse-
                midwife.
                    ``(E) A midwife who is working in accordance with 
                State law.''.
            (3) Ensuring payment by managed care entities.--
                    (A) In general.--Section 1903(m)(2)(A) of the 
                Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is 
                amended--
                            (i) in clause (xii), by striking ``and'' 
                        after the semicolon;
                            (ii) by realigning the left margin of 
                        clause (xiii) so as to align with the left 
                        margin of clause (xii) and by striking the 
                        period at the end of clause (xiii) and 
                        inserting ``; and''; and
                            (iii) by inserting after clause (xiii) the 
                        following:
            ``(xiv) such contract provides that (I) payments to 
        providers specified in section 1902(a)(13)(D) for primary care 
        services (as defined in section 1902(jj)) that are furnished 
        during a year or period (as specified in section 1902(a)(13)(D) 
        and section 1905(dd)) are at least equal to the amounts set 
        forth and required by the Secretary by regulation; (II) the 
        entity shall, upon request, provide documentation to the State, 
        sufficient to enable the State and the Secretary to ensure 
        compliance with subclause (I); and (III) the Secretary shall 
        approve payments described in subclause (I) that are furnished 
        through an agreed upon capitation, partial capitation, or other 
        value-based payment arrangement if the capitation, partial 
        capitation, or other value-based payment arrangement is based 
        on a reasonable methodology and the entity provides 
        documentation to the State sufficient to enable the State and 
        the Secretary to ensure compliance with subclause (I).''.
                    (B) Conforming amendment.--Section 1932(f) of the 
                Social Security Act (42 U.S.C. 1396u-2(f)) is amended--
                            (i) by striking ``section 1902(a)(13)(C)'' 
                        and inserting ``subsections (C) and (D) of 
                        section 1902(a)(13)''; and
                            (ii) by inserting ``, and clause (xiv) of 
                        section 1903(m)(2)(A)'' before the period.
    (d) MACPAC Report and CMS Guidance on Increasing Access to Doula 
Services for Medicaid Beneficiaries.--
            (1) MACPAC report.--
                    (A) In general.--Not later than 1 year after the 
                date of the enactment of this Act, the Medicaid and 
                CHIP Payment and Access Commission (referred to in this 
                subsection as ``MACPAC'') shall publish a report on the 
                coverage of doula services under State Medicaid 
                programs, which shall at a minimum include the 
                following:
                            (i) Information about coverage for doula 
                        services under State Medicaid programs that 
                        currently provide coverage for such care, 
                        including the type of doula services offered 
                        (such as prenatal, labor and delivery, 
                        postpartum support, and also community-based 
                        and traditional doula services).
                            (ii) An analysis of barriers to covering 
                        doula services under State Medicaid programs.
                            (iii) An identification of effective 
                        strategies to increase the use of doula 
                        services in order to provide better care and 
                        achieve better maternal and infant health 
                        outcomes, including strategies that States may 
                        use to recruit, train, and certify a diverse 
                        doula workforce, particularly from underserved 
                        communities, communities of color, and 
                        communities facing linguistic or cultural 
                        barriers.
                            (iv) Recommendations for legislative and 
                        administrative actions to increase access to 
                        doula services in State Medicaid programs, 
                        including actions that ensure doulas may earn a 
                        living wage that accounts for their time and 
                        costs associated with providing care and 
                        community-based doula program administration 
                        and operation.
                    (B) Stakeholder consultation.--In developing the 
                report required under subparagraph (A), MACPAC shall 
                consult with relevant stakeholders, including--
                            (i) States;
                            (ii) organizations, especially reproductive 
                        justice and birth justice organizations led by 
                        people of color, representing consumers of 
                        maternal health care, including those that are 
                        disproportionately impacted by poor maternal 
                        health outcomes;
                            (iii) organizations and individuals 
                        representing doulas, including community-based 
                        doula programs and those who serve underserved 
                        communities, including communities of color, 
                        and communities facing linguistic or cultural 
                        barriers;
                            (iv) organizations representing health care 
                        providers; and
                            (v) Black, Indigenous, and other maternal 
                        health care consumers of color who have 
                        experienced severe maternal morbidity.
            (2) CMS guidance.--
                    (A) In general.--Not later than 1 year after the 
                date that MACPAC publishes the report required under 
                paragraph (1)(A), the Administrator of the Centers for 
                Medicare & Medicaid Services shall issue guidance to 
                States on increasing access to doula services under 
                Medicaid. Such guidance shall at a minimum include--
                            (i) options for States to provide medical 
                        assistance for doula services under State 
                        Medicaid programs;
                            (ii) best practices for ensuring that 
                        doulas, including community-based doulas, 
                        receive reimbursement for doula services 
                        provided under a State Medicaid program, at a 
                        level that allows doulas to earn a living wage 
                        that accounts for their time and costs 
                        associated with providing care and community-
                        based doula program administration; and
                            (iii) best practices for increasing access 
                        to doula services, including services provided 
                        by community-based doulas, under State Medicaid 
                        programs.
                    (B) Stakeholder consultation.--In developing the 
                guidance required under subparagraph (A), the 
                Administrator of the Centers for Medicare & Medicaid 
                Services shall consult with MACPAC and other relevant 
                stakeholders, including--
                            (i) State Medicaid officials;
                            (ii) organizations representing consumers 
                        of maternal health care, including those that 
                        are disproportionately impacted by poor 
                        maternal health outcomes;
                            (iii) organizations representing doulas, 
                        including community-based doulas and those who 
                        serve underserved communities, such as 
                        communities of color and communities facing 
                        linguistic or cultural barriers; and
                            (iv) organizations representing medical 
                        professionals.
    (e) GAO Report on State Medicaid Programs' Use of Telehealth To 
Increase Access to Maternity Care.--Not later than 1 year after the 
date of the enactment of this Act, the Comptroller General of the 
United States shall submit a report to Congress on State Medicaid 
programs' use of telehealth to increase access to maternity care. Such 
report shall include the following:
            (1) The number of State Medicaid programs that utilize 
        telehealth that increases access to maternity care.
            (2) With respect to State Medicaid programs that utilize 
        telehealth that increases access to maternity care, information 
        about--
                    (A) common characteristics of such programs' 
                approaches to utilizing telehealth that increases 
                access to maternity care;
                    (B) differences in States' approaches to utilizing 
                telehealth to improve access to maternity care, and the 
                resulting differences in State maternal health 
                outcomes, as determined by factors described in 
                subsection (C); and
                    (C) when compared to patients who receive maternity 
                care in-person, what is known about--
                            (i) the demographic characteristics, such 
                        as race, ethnicity, sex, sexual orientation, 
                        gender identity, disability status, age, and 
                        preferred language of the individuals enrolled 
                        in such programs who use telehealth to access 
                        maternity care;
                            (ii) health outcomes for such individuals, 
                        including frequency of mortality and severe 
                        morbidity, as compared to individuals with 
                        similar characteristics who did not use 
                        telehealth to access maternity care;
                            (iii) the services provided to individuals 
                        through telehealth, including family planning 
                        services, mental health care services, and oral 
                        health services;
                            (iv) the devices and equipment provided to 
                        individuals for remote patient monitoring and 
                        telehealth, including blood pressure monitors 
                        and blood glucose monitors;
                            (v) the quality of maternity care provided 
                        through telehealth, including whether maternity 
                        care provided through telehealth is culturally 
                        and linguistically appropriate;
                            (vi) the level of patient satisfaction with 
                        maternity care provided through telehealth to 
                        individuals enrolled in State Medicaid 
                        programs;
                            (vii) the impact of utilizing telehealth to 
                        increase access to maternity care on spending, 
                        cost savings, access to care, and utilization 
                        of care under State Medicaid programs; and
                            (viii) the accessibility and effectiveness 
                        of telehealth for maternity care during the 
                        COVID-19 pandemic.
            (3) An identification and analysis of the barriers to using 
        telehealth to increase access to maternity care under State 
        Medicaid programs.
            (4) Recommendations for such legislative and administrative 
        actions related to increasing access to telehealth maternity 
        services under Medicaid as the Comptroller General deems 
        appropriate.

SEC. 5203. JUSTICE FOR INCARCERATED MOMS.

    (a) Sense of Congress.--It is the sense of Congress that--
            (1) the respect and proper care that birthing people 
        deserve is inclusive; and
            (2) regardless of race, ethnicity, gender identity, sexual 
        orientation, religion, marital status, familial status, 
        socioeconomic status, immigration status, incarceration status, 
        or disability, all deserve dignity.
    (b) Ending the Shackling of Pregnant Individuals.--
            (1) In general.--Beginning on the date that is 6 months 
        after the date of enactment of this Act, and annually 
        thereafter, in each State that receives a grant under subpart 1 
        of part E of title I of the Omnibus Crime Control and Safe 
        Streets Act of 1968 (34 U.S.C. 10151 et seq.) (commonly 
        referred to as the ``Edward Byrne Memorial Justice Grant 
        Program'') and that does not have in effect throughout the 
        State for such fiscal year laws restricting the use of 
        restraints on pregnant individuals in prison that are 
        substantially similar to the rights, procedures, requirements, 
        effects, and penalties set forth in section 4322 of title 18, 
        United States Code, the amount of such grant that would 
        otherwise be allocated to such State under such subpart for the 
        fiscal year shall be decreased by 25 percent.
            (2) Reallocation.--Amounts not allocated to a State for 
        failure to comply with paragraph (1) shall be reallocated in 
        accordance with subpart 1 of part E of title I of the Omnibus 
        Crime Control and Safe Streets Act of 1968 (34 U.S.C. 10151 et 
        seq.) to States that have complied with such paragraph.
    (c) Creating Model Programs for the Care of Incarcerated 
Individuals in the Prenatal and Postpartum Periods.--
            (1) In general.--Not later than 1 year after the date of 
        enactment of this Act, the Attorney General, acting through the 
        Director of the Bureau of Prisons (in this subsection referred 
        to as the ``Director''), shall establish, in not fewer than 6 
        Bureau of Prisons facilities, programs to optimize maternal 
        health outcomes for pregnant and postpartum individuals 
        incarcerated in such facilities. The Attorney General shall 
        establish such programs in consultation with stakeholders such 
        as--
                    (A) relevant community-based organizations, 
                particularly organizations that represent incarcerated 
                and formerly incarcerated individuals and organizations 
                that seek to improve maternal health outcomes for 
                pregnant and postpartum individuals from racial and 
                ethnic minority groups;
                    (B) relevant organizations representing patients, 
                with a particular focus on patients from racial and 
                ethnic minority groups;
                    (C) organizations representing maternity care 
                providers and maternal health care education programs;
                    (D) perinatal health workers; and
                    (E) researchers and policy experts in fields 
                related to maternal health care for incarcerated 
                individuals.
            (2) Start date.--Each selected facility shall begin 
        facility programs not later than 18 months after the date of 
        enactment of this Act.
            (3) Facility priority.--In carrying out paragraph (1), the 
        Director shall give priority to a facility based on--
                    (A) the number of pregnant and postpartum 
                individuals incarcerated in such facility and, among 
                such individuals, the number of pregnant and postpartum 
                individuals from racial and ethnic minority groups; and
                    (B) the extent to which the leaders of such 
                facility have demonstrated a commitment to developing 
                exemplary programs for pregnant and postpartum 
                individuals incarcerated in such facility.
            (4) Program duration.--The programs established under this 
        subsection shall be for a 5-year period.
            (5) Programs.--Bureau of Prisons facilities selected by the 
        Director shall establish programs for pregnant and postpartum 
        incarcerated individuals, and such programs may--
                    (A) provide access to perinatal health workers from 
                pregnancy through the postpartum period;
                    (B) provide access to healthy foods and counseling 
                on nutrition, recommended activity levels, and safety 
                measures throughout pregnancy;
                    (C) train correctional officers to ensure that 
                pregnant incarcerated individuals receive safe and 
                respectful treatment;
                    (D) train medical personnel to ensure that pregnant 
                incarcerated individuals receive trauma-informed, 
                culturally congruent care that promotes the health and 
                safety of the pregnant individuals;
                    (E) provide counseling and treatment for 
                individuals who have suffered from--
                            (i) diagnosed mental or behavioral health 
                        conditions, including trauma and substance use 
                        disorders;
                            (ii) trauma or violence, including domestic 
                        violence;
                            (iii) human immunodeficiency virus;
                            (iv) sexual abuse;
                            (v) pregnancy or infant loss; or
                            (vi) chronic conditions;
                    (F) provide evidence-based pregnancy and childbirth 
                education, parenting support, and other relevant forms 
                of health literacy;
                    (G) provide clinical education opportunities to 
                maternity care providers in training to expand pathways 
                into maternal health care careers serving incarcerated 
                individuals;
                    (H) offer opportunities for postpartum individuals 
                to maintain contact with the individual's newborn child 
                to promote bonding, including enhanced visitation 
                policies, access to prison nursery programs, or 
                breastfeeding support;
                    (I) provide reentry assistance, particularly to--
                            (i) ensure access to health insurance 
                        coverage and transfer of health records to 
                        community providers if an incarcerated 
                        individual exits the criminal justice system 
                        during such individual's pregnancy or in the 
                        postpartum period; and
                            (ii) connect individuals exiting the 
                        criminal justice system during pregnancy or in 
                        the postpartum period to community-based 
                        resources, such as referrals to health care 
                        providers, substance use disorder treatments, 
                        and social services that address social 
                        determinants of maternal health; or
                    (J) establish partnerships with local public 
                entities, private community entities, community-based 
                organizations, Indian Tribes and tribal organizations 
                (as such terms are defined in section 4 of the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 5304)), and urban Indian organizations (as such 
                term is defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)) to establish or 
                expand pretrial diversion programs as an alternative to 
                incarceration for pregnant and postpartum individuals, 
                including--
                            (i) evidence-based childbirth education or 
                        parenting classes;
                            (ii) prenatal health coordination;
                            (iii) family and individual counseling;
                            (iv) evidence-based screenings, education, 
                        and, as needed, treatment for mental and 
                        behavioral health conditions, including drug 
                        and alcohol treatments;
                            (v) family case management services;
                            (vi) domestic violence education and 
                        prevention;
                            (vii) physical and sexual abuse counseling; 
                        and
                            (viii) programs to address social 
                        determinants of health such as employment, 
                        housing, education, transportation, and 
                        nutrition.
            (6) Implementation and reporting.--A selected facility 
        shall be responsible for--
                    (A) implementing programs, which may include the 
                programs described in paragraph (5); and
                    (B) not later than 3 years after the date of 
                enactment of this Act, and 6 years after the date of 
                enactment of this Act, reporting results of the 
                programs to the Director, including information 
                describing--
                            (i) relevant quantitative indicators of 
                        success in improving the standard of care and 
                        health outcomes for pregnant and postpartum 
                        incarcerated individuals in the facility, 
                        including data stratified by race, ethnicity, 
                        sex, gender, age, geography, disability status, 
                        the category of the criminal charge against 
                        such individual, rates of pregnancy-related 
                        deaths, pregnancy-associated deaths, cases of 
                        infant mortality and morbidity, rates of pre-
                        term births and low-birthweight births, cases 
                        of severe maternal morbidity, cases of violence 
                        against pregnant or postpartum individuals, 
                        diagnoses of maternal mental or behavioral 
                        health conditions, and other such information 
                        as appropriate;
                            (ii) relevant qualitative and quantitative 
                        evaluations from pregnant and postpartum 
                        incarcerated individuals who participated in 
                        such programs, including measures of patient-
                        reported experience of care; and
                            (iii) strategies to sustain such programs 
                        after fiscal year 2027 and expand such programs 
                        to other facilities.
            (7) Report.--Not later than 6 years after the date of 
        enactment of this Act, the Director shall submit to the 
        Attorney General and to the Congress a report describing the 
        results of the programs funded under this subsection.
            (8) Oversight.--Not later than 1 year after the date of 
        enactment of this Act, the Attorney General shall award a 
        contract to an independent organization or independent 
        organizations to conduct oversight of the programs described in 
        paragraph (5).
            (9) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2023 through 2027.
    (d) Grant Program To Improve Maternal Health Outcomes for 
Individuals in State and Local Prisons and Jails.--
            (1) Establishment.--Not later than 1 year after the date of 
        enactment of this section, the Attorney General, acting through 
        the Director of the Bureau of Justice Assistance (in this 
        subsection referred to as the ``Director''), shall award 
        Justice for Incarcerated Moms grants to States to establish or 
        expand programs in State and local prisons and jails for 
        pregnant and postpartum incarcerated individuals. The Attorney 
        General shall award such grants in consultation with 
        stakeholders such as--
                    (A) relevant community-based organizations, 
                particularly organizations that represent incarcerated 
                and formerly incarcerated individuals and organizations 
                that seek to improve maternal health outcomes for 
                pregnant and postpartum individuals from racial and 
                ethnic minority groups;
                    (B) relevant organizations representing patients, 
                with a particular focus on patients from racial and 
                ethnic minority groups;
                    (C) organizations representing maternity care 
                providers and maternal health care education programs;
                    (D) perinatal health workers; and
                    (E) researchers and policy experts in fields 
                related to maternal health care for incarcerated 
                individuals.
            (2) Applications.--Each applicant for a grant under this 
        subsection shall submit to the Director an application at such 
        time, in such manner, and containing such information as the 
        Director may require.
            (3) Use of funds.--A State that is awarded a grant under 
        this subsection shall use such grant to establish or expand 
        programs for pregnant and postpartum incarcerated individuals, 
        and such programs may--
                    (A) provide access to perinatal health workers from 
                pregnancy through the postpartum period;
                    (B) provide access to healthy foods and counseling 
                on nutrition, recommended activity levels, and safety 
                measures throughout pregnancy;
                    (C) train correctional officers to ensure that 
                pregnant incarcerated individuals receive safe and 
                respectful treatment;
                    (D) train medical personnel to ensure that pregnant 
                incarcerated individuals receive trauma-informed, 
                culturally congruent care that promotes the health and 
                safety of the pregnant individuals;
                    (E) provide counseling and treatment for 
                individuals who have suffered from--
                            (i) diagnosed mental or behavioral health 
                        conditions, including trauma and substance use 
                        disorders;
                            (ii) trauma or violence, including domestic 
                        violence;
                            (iii) human immunodeficiency virus;
                            (iv) sexual abuse;
                            (v) pregnancy or infant loss; or
                            (vi) chronic conditions;
                    (F) provide evidence-based pregnancy and childbirth 
                education, parenting support, and other relevant forms 
                of health literacy;
                    (G) provide clinical education opportunities to 
                maternity care providers in training to expand pathways 
                into maternal health care careers serving incarcerated 
                individuals;
                    (H) offer opportunities for postpartum individuals 
                to maintain contact with the individual's newborn child 
                to promote bonding, including enhanced visitation 
                policies, access to prison nursery programs, or 
                breastfeeding support;
                    (I) provide reentry assistance, particularly to--
                            (i) ensure access to health insurance 
                        coverage and transfer of health records to 
                        community providers if an incarcerated 
                        individual exits the criminal justice system 
                        during such individual's pregnancy or in the 
                        postpartum period; and
                            (ii) connect individuals exiting the 
                        criminal justice system during pregnancy or in 
                        the postpartum period to community-based 
                        resources, such as referrals to health care 
                        providers, substance use disorder treatments, 
                        and social services that address social 
                        determinants of maternal health; or
                    (J) establish partnerships with local public 
                entities, private community entities, community-based 
                organizations, Indian Tribes and tribal organizations 
                (as such terms are defined in section 4 of the Indian 
                Self-Determination and Education Assistance Act (25 
                U.S.C. 5304)), and urban Indian organizations (as such 
                term is defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603)) to establish or 
                expand pretrial diversion programs as an alternative to 
                incarceration for pregnant and postpartum individuals, 
                including--
                            (i) evidence-based childbirth education or 
                        parenting classes;
                            (ii) prenatal health coordination;
                            (iii) family and individual counseling;
                            (iv) evidence-based screenings, education, 
                        and, as needed, treatment for mental and 
                        behavioral health conditions, including drug 
                        and alcohol treatments;
                            (v) family case management services;
                            (vi) domestic violence education and 
                        prevention;
                            (vii) physical and sexual abuse counseling; 
                        and
                            (viii) programs to address social 
                        determinants of health such as employment, 
                        housing, education, transportation, and 
                        nutrition.
            (4) Priority.--In awarding grants under this subsection, 
        the Director shall give priority to applicants based on--
                    (A) the number of pregnant and postpartum 
                individuals incarcerated in the State and, among such 
                individuals, the number of pregnant and postpartum 
                individuals from racial and ethnic minority groups; and
                    (B) the extent to which the State has demonstrated 
                a commitment to developing exemplary programs for 
                pregnant and postpartum individuals incarcerated in the 
                prisons and jails in such State.
            (5) Grant duration.--A grant awarded under this subsection 
        shall be for a 5-year period.
            (6) Implementing and reporting.--A State that receives a 
        grant under this subsection shall be responsible for--
                    (A) implementing the program funded by the grant; 
                and
                    (B) not later than 3 years after the date of 
                enactment of this section, and 6 years after the date 
                of enactment of this section, reporting results of such 
                program to the Attorney General, including information 
                describing--
                            (i) relevant quantitative indicators of the 
                        program's success in improving the standard of 
                        care and health outcomes for pregnant and 
                        postpartum incarcerated individuals in the 
                        facility, including data stratified by race, 
                        ethnicity, sex, gender, age, geography, 
                        disability status, category of the criminal 
                        charge against such individual, incidence rates 
                        of pregnancy-related deaths, pregnancy-
                        associated deaths, cases of infant mortality 
                        and morbidity, rates of pre-term births and 
                        low-birthweight births, cases of severe 
                        maternal morbidity, cases of violence against 
                        pregnant or postpartum individuals, diagnoses 
                        of maternal mental or behavioral health 
                        conditions, and other such information as 
                        appropriate;
                            (ii) relevant qualitative and quantitative 
                        evaluations from pregnant and postpartum 
                        incarcerated individuals who participated in 
                        such programs, including measures of patient-
                        reported experience of care; and
                            (iii) strategies to sustain such programs 
                        beyond the duration of the grant and expand 
                        such programs to other facilities.
            (7) Report.--Not later than 6 years after the date of 
        enactment of this Act, the Attorney General shall submit to the 
        Congress a report describing the results of such grant 
        programs.
            (8) Oversight.--Not later than 1 year after the date of 
        enactment of this Act, the Attorney General shall award a 
        contract to an independent organization or independent 
        organizations to conduct oversight of the programs described in 
        paragraph (3).
            (9) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2023 through 2027.
    (e) GAO Report.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this section, the Comptroller General of the 
        United States shall submit to the Congress a report on adverse 
        maternal and infant health outcomes among incarcerated 
        individuals and infants born to such individuals, with a 
        particular focus on racial and ethnic inequities in maternal 
        and infant health outcomes for incarcerated individuals.
            (2) Contents of report.--The report described in this 
        subsection shall include--
                    (A) to the extent practicable--
                            (i) the number of pregnant individuals who 
                        are incarcerated in Bureau of Prisons 
                        facilities;
                            (ii) the number of incarcerated 
                        individuals, including those incarcerated in 
                        Federal, State, and local correctional 
                        facilities, who have experienced a pregnancy-
                        related death, pregnancy-associated death, or 
                        the death of an infant in the most recent 10 
                        years of available data;
                            (iii) the number of cases of severe 
                        maternal morbidity among incarcerated 
                        individuals, including those incarcerated in 
                        Federal, State, and local detention facilities, 
                        in the most recent 10 years of available data;
                            (iv) the number of pre-term and low-
                        birthweight births of infants born to 
                        incarcerated individuals, including those 
                        incarcerated in Federal, State, and local 
                        correctional facilities, in the most recent 10 
                        years of available data; and
                            (v) statistics on the racial and ethnic 
                        inequities in maternal and infant health 
                        outcomes and severe maternal morbidity rates 
                        among incarcerated individuals, including those 
                        incarcerated in Federal, State, and local 
                        detention facilities;
                    (B) in the case that the Comptroller General of the 
                United States is unable determine the information 
                required in clauses (i) through (iii) of subparagraph 
                (A), an assessment of the barriers to determining such 
                information and recommendations for improvements in 
                tracking maternal health outcomes among incarcerated 
                individuals, including those incarcerated in Federal, 
                State, and local detention facilities;
                    (C) causes of adverse maternal health outcomes that 
                are unique to incarcerated individuals, including those 
                incarcerated in Federal, State, and local detention 
                facilities;
                    (D) causes of adverse maternal health outcomes and 
                severe maternal morbidity that are unique to 
                incarcerated individuals from racial and ethnic 
                minority groups;
                    (E) recommendations to reduce maternal mortality 
                and severe maternal morbidity among incarcerated 
                individuals and to address racial and ethnic inequities 
                in maternal health outcomes for incarcerated 
                individuals in Bureau of Prisons facilities and State 
                and local prisons and jails; and
                    (F) such other information as may be appropriate to 
                reduce the occurrence of adverse maternal health 
                outcomes among incarcerated individuals and to address 
                racial and ethnic inequities in maternal health 
                outcomes for such individuals.
    (f) MACPAC Report.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this section, the Medicaid and CHIP Payment and 
        Access Commission (referred to in this subsection as 
        ``MACPAC'') shall publish a report on the implications of 
        pregnant and postpartum incarcerated individuals being 
        ineligible for medical assistance under a State plan under 
        title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
        that contains the information described in paragraph (2).
            (2) Information described.--For purposes of paragraph (1), 
        the information described in this paragraph includes--
                    (A) information on the effect of ineligibility for 
                medical assistance under a State plan under title XIX 
                of the Social Security Act (42 U.S.C. 1396 et seq.) on 
                maternal health outcomes for pregnant and postpartum 
                incarcerated individuals, concentrating on the effects 
                of such ineligibility for pregnant and postpartum 
                individuals from racial and ethnic minority groups; and
                    (B) the potential implications on maternal health 
                outcomes resulting from suspending eligibility for 
                medical assistance under a State plan under such title 
                of such Act when a pregnant or postpartum individual is 
                incarcerated.
    (g) Definitions.--In this section:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (5) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (6) Pregnancy-associated death.--The term ``pregnancy-
        associated death'' means a death of a pregnant or postpartum 
        individual, by any cause, that occurs during, or within 1 year 
        following, the individual's pregnancy, regardless of the 
        outcome, duration, or site of the pregnancy.
            (7) Pregnancy-related death.--The term ``pregnancy-related 
        death'' means a death of a pregnant or postpartum individual 
        that occurs during, or within 1 year following, the 
        individual's pregnancy, from a pregnancy complication, a chain 
        of events initiated by pregnancy, or the aggravation of an 
        unrelated condition by the physiologic effects of pregnancy.
            (8) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (9) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (10) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.

SEC. 5204. IMPACT TO SAVE MOMS ACT.

    (a) Perinatal Care Alternative Payment Model Demonstration 
Project.--
            (1) In general.--For the period of fiscal years 2023 
        through 2027, the Secretary of Health and Human Services 
        (referred to in this subsection as the ``Secretary''), acting 
        through the Administrator of the Centers for Medicare & 
        Medicaid Services, shall establish and implement, in accordance 
        with the requirements of this subsection, a demonstration 
        project, to be known as the Perinatal Care Alternative Payment 
        Model Demonstration Project (referred to in this subsection as 
        the ``Demonstration Project''), for purposes of allowing States 
        to test payment models under their State plans under title XIX 
        of the Social Security Act (42 U.S.C. 1396 et seq.) and State 
        child health plans under title XXI of such Act (42 U.S.C. 
        1397aa et seq.) with respect to maternity care provided to 
        pregnant and postpartum individuals enrolled in such State 
        plans and State child health plans.
            (2) Coordination.--In establishing the Demonstration 
        Project, the Secretary shall coordinate with stakeholders such 
        as--
                    (A) State Medicaid programs;
                    (B) relevant organizations representing maternal 
                health care providers;
                    (C) relevant organizations representing patients, 
                with a particular focus on individuals from demographic 
                groups with disproportionate rates of adverse maternal 
                health outcomes;
                    (D) relevant community-based organizations, 
                particularly organizations that seek to improve 
                maternal health outcomes for individuals from 
                demographic groups with disproportionate rates of 
                adverse maternal health outcomes;
                    (E) non-clinical perinatal health workers such as 
                doulas, community health workers, peer supporters, 
                certified lactation consultants, nutritionists and 
                dieticians, social workers, home visitors, and 
                navigators;
                    (F) relevant health insurance issuers;
                    (G) hospitals, health systems, freestanding birth 
                centers (as such term is defined in paragraph (3)(B) of 
                section 1905(l) of the Social Security Act (42 U.S.C. 
                1396d(l))), Federally-qualified health centers (as such 
                term is defined in paragraph (2)(B) of such section), 
                and rural health clinics (as such term is defined in 
                section 1861(aa) of such Act (42 U.S.C. 1395x(aa)));
                    (H) researchers and policy experts in fields 
                related to maternity care payment models; and
                    (I) any other stakeholders as the Secretary 
                determines appropriate, with a particular focus on 
                stakeholders from demographic groups with 
                disproportionate rates of adverse maternal health 
                outcomes.
            (3) Considerations.--In establishing the Demonstration 
        Project, the Secretary shall consider each of the following:
                    (A) Findings from any evaluations of the Strong 
                Start for Mothers and Newborns initiative carried out 
                by the Centers for Medicare & Medicaid Services, the 
                Health Resources and Services Administration, and the 
                Administration on Children and Families.
                    (B) Any alternative payment model that--
                            (i) is designed to improve maternal health 
                        outcomes for racial and ethnic groups with 
                        disproportionate rates of adverse maternal 
                        health outcomes;
                            (ii) includes methods for stratifying 
                        patients by pregnancy risk level and, as 
                        appropriate, adjusting payments under such 
                        model to take into account pregnancy risk 
                        level;
                            (iii) establishes evidence-based quality 
                        metrics for such payments;
                            (iv) includes consideration of non-hospital 
                        birth settings such as freestanding birth 
                        centers (as so defined);
                            (v) includes consideration of social 
                        determinants of health that are relevant to 
                        maternal health outcomes such as housing, 
                        transportation, nutrition, and other non-
                        clinical factors that influence maternal health 
                        outcomes; or
                            (vi) includes diverse maternity care teams 
                        that include--
                                    (I) maternity care providers, 
                                including obstetrician-gynecologists, 
                                family physicians, physician 
                                assistants, midwives who meet, at a 
                                minimum, the international definition 
                                of the term ``midwife'' and global 
                                standards for midwifery education (as 
                                established by the International 
                                Confederation of Midwives), and nurse 
                                practitioners--
                                            (aa) from racially, 
                                        ethnically, and professionally 
                                        diverse backgrounds;
                                            (bb) with experience 
                                        practicing in racially and 
                                        ethnically diverse communities; 
                                        or
                                            (cc) who have undergone 
                                        trainings on racism, implicit 
                                        bias, and explicit bias; and
                                    (II) non-clinical perinatal health 
                                workers such as doulas, community 
                                health workers, peer supporters, 
                                certified lactation consultants, 
                                nutritionists and dieticians, social 
                                workers, home visitors, and navigators.
            (4) Eligibility.--To be eligible to participate in the 
        Demonstration Project, a State shall submit an application to 
        the Secretary at such time, in such manner, and containing such 
        information as the Secretary may require.
            (5) Evaluation.--The Secretary shall conduct an evaluation 
        of the Demonstration Project to determine the impact of the 
        Demonstration Project on--
                    (A) maternal health outcomes, with data stratified 
                by race, ethnicity, socioeconomic indicators, and any 
                other factors as the Secretary determines appropriate;
                    (B) spending on maternity care by States 
                participating in the Demonstration Project;
                    (C) to the extent practicable, subjective measures 
                of patient experience; and
                    (D) any other areas of assessment that the 
                Secretary determines relevant.
            (6) Report.--Not later than one year after the completion 
        or termination date of the Demonstration Project, the Secretary 
        shall submit to the Committee on Energy and Commerce, the 
        Committee on Ways and Means, and the Committee on Education and 
        Labor of the House of Representatives and the Committee on 
        Finance and the Committee on Health, Education, Labor, and 
        Pensions of the Senate, and make publicly available, a report 
        containing--
                    (A) the results of any evaluation conducted under 
                paragraph (5); and
                    (B) a recommendation regarding whether the 
                Demonstration Project should be continued after fiscal 
                year 2026 and expanded on a national basis.
            (7) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as are necessary to carry out this 
        subsection.
            (8) Definitions.--In this subsection:
                    (A) Alternative payment model.--The term 
                ``alternative payment model'' has the meaning given 
                such term in section 1833(z)(3)(C) of the Social 
                Security Act (42 U.S.C. 1395l(z)(3)(C)).
                    (B) Perinatal.--The term ``perinatal'' means the 
                period beginning on the day a person becomes pregnant 
                and ending on the last day of the 1-year period 
                beginning on the last day of such person's pregnancy.
    (b) MACPAC Report.--
            (1) In general.--Not later than two years after the date of 
        the enactment of this section, the Medicaid and CHIP Payment 
        and Access Commission shall publish a report on issues relating 
        to the continuity of coverage under State plans under title XIX 
        of the Social Security Act (42 U.S.C. 1396 et seq.) and State 
        child health plans under title XXI of such Act (42 U.S.C. 
        1397aa et seq.) for pregnant and postpartum individuals. Such 
        report shall, at a minimum, include the following:
                    (A) An assessment of any existing policies under 
                such State plans and such State child health plans 
                regarding presumptive eligibility for pregnant 
                individuals while their application for enrollment in 
                such a State plan or such a State child health plan is 
                being processed.
                    (B) An assessment of any existing policies under 
                such State plans and such State child health plans 
                regarding measures to ensure continuity of coverage 
                under such a State plan or such a State child health 
                plan for pregnant and postpartum individuals, including 
                such individuals who need to change their health 
                insurance coverage during their pregnancy or the 
                postpartum period following their pregnancy.
                    (C) An assessment of any existing policies under 
                such State plans and such State child health plans 
                regarding measures to automatically reenroll 
                individuals who are eligible to enroll under such a 
                State plan or such a State child health plan as a 
                parent.
                    (D) If determined appropriate by the Commission, 
                any recommendations for the Department of Health and 
                Human Services, or such State plans and such State 
                child health plans, to ensure continuity of coverage 
                under such a State plan or such a State child health 
                plan for pregnant and postpartum people.
            (2) Postpartum defined.--In this subsection, the term 
        ``postpartum'' means the 1-year period beginning on the last 
        day of a person's pregnancy.

SEC. 5205. PROTECTING MOMS AND BABIES AGAINST CLIMATE CHANGE.

    (a) Grant Program To Protect Vulnerable Mothers and Babies From 
Climate Change Risks.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this section, the Secretary of Health and 
        Human Services (in this section referred to as the 
        ``Secretary'') shall establish a grant program (in this 
        subsection referred to as the ``Program'') to protect 
        vulnerable individuals from risks associated with climate 
        change.
            (2) Grant authority.--In carrying out the Program, the 
        Secretary may award, on a competitive basis, grants to 10 
        covered entities.
            (3) Applications.--To be eligible for a grant under the 
        Program, a covered entity shall submit to the Secretary an 
        application at such time, in such form, and containing such 
        information as the Secretary may require, which shall include, 
        at a minimum, a description of the following:
                    (A) Plans for the use of grant funds awarded under 
                the Program and how patients and stakeholder 
                organizations were involved in the development of such 
                plans.
                    (B) How such grant funds will be targeted to 
                geographic areas that have disproportionately high 
                levels of risks associated with climate change for 
                vulnerable individuals.
                    (C) How such grant funds will be used to address 
                racial and ethnic inequities in--
                            (i) adverse maternal and infant health 
                        outcomes; and
                            (ii) exposure to risks associated with 
                        climate change for vulnerable individuals.
                    (D) Strategies to prevent an initiative assisted 
                with such grant funds from causing--
                            (i) adverse environmental impacts;
                            (ii) displacement of residents and 
                        businesses;
                            (iii) rent and housing price increases; or
                            (iv) disproportionate adverse impacts on 
                        racial and ethnic minority groups and other 
                        underserved populations.
            (4) Selection of grant recipients.--
                    (A) Timing.--Not later than 270 days after the date 
                of the enactment of this Act, the Secretary shall 
                select the recipients of grants under the Program.
                    (B) Consultation.--In selecting covered entities 
                for grants under the Program, the Secretary shall 
                consult with--
                            (i) representatives of stakeholder 
                        organizations;
                            (ii) the Administrator of the Environmental 
                        Protection Agency;
                            (iii) the Administrator of the National 
                        Oceanic and Atmospheric Administration; and
                            (iv) from the Department of Health and 
                        Human Services--
                                    (I) the Deputy Assistant Secretary 
                                for Minority Health;
                                    (II) the Administrator of the 
                                Centers for Medicare & Medicaid 
                                Services;
                                    (III) the Administrator of the 
                                Health Resources and Services 
                                Administration;
                                    (IV) the Director of the National 
                                Institutes of Health; and
                                    (V) the Director of the Centers for 
                                Disease Control and Prevention.
                    (C) Priority.--In selecting a covered entity to be 
                awarded a grant under the Program, the Secretary shall 
                give priority to covered entities that serve a county--
                            (i) designated, or located in an area 
                        designated, as a nonattainment area pursuant to 
                        section 107 of the Clean Air Act (42 U.S.C. 
                        7407) for any air pollutant for which air 
                        quality criteria have been issued under section 
                        108(a) of such Act (42 U.S.C. 7408(a));
                            (ii) with a level of vulnerability of 
                        moderate-to-high or higher, according to the 
                        Social Vulnerability Index of the Centers for 
                        Disease Control and Prevention; or
                            (iii) with temperatures that pose a risk to 
                        human health, as determined by the Secretary, 
                        in consultation with the Administrator of the 
                        National Oceanic and Atmospheric Administration 
                        and the Chair of the United States Global 
                        Change Research Program, based on the best 
                        available science.
                    (D) Limitation.--A recipient of grant funds under 
                the Program may not use such grant funds to serve a 
                county that is served by any other recipient of a grant 
                under the Program.
            (5) Use of funds.--A covered entity awarded grant funds 
        under the Program may only use such grant funds for the 
        following:
                    (A) Initiatives to identify risks associated with 
                climate change for vulnerable individuals and to 
                provide services and support to such individuals that 
                address such risks, which may include--
                            (i) training for health care providers, 
                        doulas, and other employees in hospitals, birth 
                        centers, midwifery practices, and other health 
                        care practices that provide prenatal or labor 
                        and delivery services to vulnerable individuals 
                        on the identification of, and patient 
                        counseling relating to, risks associated with 
                        climate change for vulnerable individuals;
                            (ii) hiring, training, or providing 
                        resources to community health workers and 
                        perinatal health workers who can help identify 
                        risks associated with climate change for 
                        vulnerable individuals, provide patient 
                        counseling about such risks, and carry out the 
                        distribution of relevant services and support;
                            (iii) enhancing the monitoring of risks 
                        associated with climate change for vulnerable 
                        individuals, including by--
                                    (I) collecting data on such risks 
                                in specific census tracts, 
                                neighborhoods, or other geographic 
                                areas; and
                                    (II) sharing such data with local 
                                health care providers, doulas, and 
                                other employees in hospitals, birth 
                                centers, midwifery practices, and other 
                                health care practices that provide 
                                prenatal or labor and delivery services 
                                to local vulnerable individuals; and
                            (iv) providing vulnerable individuals--
                                    (I) air conditioning units, 
                                residential weatherization support, 
                                filtration systems, household 
                                appliances, or related items;
                                    (II) direct financial assistance; 
                                and
                                    (III) services and support, 
                                including housing and transportation 
                                assistance, to prepare for or recover 
                                from extreme weather events, which may 
                                include floods, hurricanes, wildfires, 
                                droughts, and related events.
                    (B) Initiatives to mitigate levels of and exposure 
                to risks associated with climate change for vulnerable 
                individuals, which shall be based on the best available 
                science and which may include initiatives to--
                            (i) develop, maintain, or expand urban or 
                        community forestry initiatives and tree canopy 
                        coverage initiatives;
                            (ii) improve infrastructure, including 
                        buildings and paved surfaces;
                            (iii) develop or improve community outreach 
                        networks to provide culturally and 
                        linguistically appropriate information and 
                        notifications about risks associated with 
                        climate change for vulnerable individuals; and
                            (iv) provide enhanced services to racial 
                        and ethnic minority groups and other 
                        underserved populations.
            (6) Length of award.--A grant under this subsection shall 
        be disbursed over 4 fiscal years.
            (7) Technical assistance.--The Secretary shall provide 
        technical assistance to a covered entity awarded a grant under 
        the Program to support the development, implementation, and 
        evaluation of activities funded with such grant.
            (8) Reports to secretary.--
                    (A) Annual report.--For each fiscal year during 
                which a covered entity is disbursed grant funds under 
                the Program, such covered entity shall submit to the 
                Secretary a report that summarizes the activities 
                carried out by such covered entity with such grant 
                funds during such fiscal year, which shall include a 
                description of the following:
                            (i) The involvement of stakeholder 
                        organizations in the implementation of 
                        initiatives assisted with such grant funds.
                            (ii) Relevant health and environmental 
                        data, disaggregated, to the extent practicable, 
                        by race, ethnicity, gender, and pregnancy 
                        status.
                            (iii) Qualitative feedback received from 
                        vulnerable individuals with respect to 
                        initiatives assisted with such grant funds.
                            (iv) Criteria used in selecting the 
                        geographic areas assisted with such grant 
                        funds.
                            (v) Efforts to address racial and ethnic 
                        inequities in adverse maternal and infant 
                        health outcomes and in exposure to risks 
                        associated with climate change for vulnerable 
                        individuals.
                            (vi) Any negative and unintended impacts of 
                        initiatives assisted with such grant funds, 
                        including--
                                    (I) adverse environmental impacts;
                                    (II) displacement of residents and 
                                businesses;
                                    (III) rent and housing price 
                                increases; and
                                    (IV) disproportionate adverse 
                                impacts on racial and ethnic minority 
                                groups and other underserved 
                                populations.
                            (vii) How the covered entity will address 
                        and prevent any impacts described in clause 
                        (vi).
                    (B) Publication.--Not later than 30 days after the 
                date on which a report is submitted under subparagraph 
                (A), the Secretary shall publish such report on a 
                public website of the Department of Health and Human 
                Services.
            (9) Report to congress.--Not later than the date that is 5 
        years after the date on which the Program is established, the 
        Secretary shall submit to Congress and publish on a public 
        website of the Department of Health and Human Services a report 
        on the results of the Program, including the following:
                    (A) Summaries of the annual reports submitted under 
                paragraph (8).
                    (B) Evaluations of the initiatives assisted with 
                grant funds under the Program.
                    (C) An assessment of the effectiveness of the 
                Program in--
                            (i) identifying risks associated with 
                        climate change for vulnerable individuals;
                            (ii) providing services and support to such 
                        individuals;
                            (iii) mitigating levels of and exposure to 
                        such risks; and
                            (iv) addressing racial and ethnic 
                        inequities in adverse maternal and infant 
                        health outcomes and in exposure to such risks.
                    (D) A description of how the Program could be 
                expanded, including--
                            (i) monitoring efforts or data collection 
                        that would be required to identify areas with 
                        high levels of risks associated with climate 
                        change for vulnerable individuals;
                            (ii) how such areas could be identified 
                        using the strategy developed under subsection 
                        (d); and
                            (iii) recommendations for additional 
                        funding.
            (10) Covered entity defined.--In this subsection, the term 
        ``covered entity'' means a consortium of organizations serving 
        a county that--
                    (A) shall include a community-based organization; 
                and
                    (B) may include--
                            (i) another stakeholder organization;
                            (ii) the government of such county;
                            (iii) the governments of one or more 
                        municipalities within such county;
                            (iv) a State or local public health 
                        department or emergency management agency;
                            (v) a local health care practice, which may 
                        include a licensed and accredited hospital, 
                        birth center, midwifery practice, or other 
                        health care practice that provides prenatal or 
                        labor and delivery services to vulnerable 
                        individuals;
                            (vi) an Indian tribe or tribal organization 
                        (as such terms are defined in section 4 of the 
                        Indian Self-Determination and Education 
                        Assistance Act (25 U.S.C. 5304));
                            (vii) an Urban Indian organization (as 
                        defined in section 4 of the Indian Health Care 
                        Improvement Act (25 U.S.C. 1603)); and
                            (viii) an institution of higher education.
            (11) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $100,000,000 
        for fiscal years 2023 through 2026.
    (b) Grant Program for Education and Training at Health Profession 
Schools.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Secretary shall establish a 
        grant program (in this subsection referred to as the 
        ``Program'') to provide funds to health profession schools to 
        support the development and integration of education and 
        training programs for identifying and addressing risks 
        associated with climate change for vulnerable individuals.
            (2) Grant authority.--In carrying out the Program, the 
        Secretary may award, on a competitive basis, grants to health 
        profession schools.
            (3) Application.--To be eligible for a grant under the 
        Program, a health profession school shall submit to the 
        Secretary an application at such time, in such form, and 
        containing such information as the Secretary may require, which 
        shall include, at a minimum, a description of the following:
                    (A) How such health profession school will engage 
                with vulnerable individuals, and stakeholder 
                organizations representing such individuals, in 
                developing and implementing the education and training 
                programs supported by grant funds awarded under the 
                Program.
                    (B) How such health profession school will ensure 
                that such education and training programs will address 
                racial and ethnic inequities in exposure to, and the 
                effects of, risks associated with climate change for 
                vulnerable individuals.
            (4) Use of funds.--A health profession school awarded a 
        grant under the Program shall use the grant funds to develop, 
        and integrate into the curriculum and continuing education of 
        such health profession school, education and training on each 
        of the following:
                    (A) Identifying risks associated with climate 
                change for vulnerable individuals and individuals with 
                the intent to become pregnant.
                    (B) How risks associated with climate change affect 
                vulnerable individuals and individuals with the intent 
                to become pregnant.
                    (C) Racial and ethnic inequities in exposure to, 
                and the effects of, risks associated with climate 
                change for vulnerable individuals and individuals with 
                the intent to become pregnant.
                    (D) Patient counseling and mitigation strategies 
                relating to risks associated with climate change for 
                vulnerable individuals.
                    (E) Relevant services and support for vulnerable 
                individuals relating to risks associated with climate 
                change and strategies for ensuring vulnerable 
                individuals have access to such services and support.
                    (F) Implicit and explicit bias, racism, and 
                discrimination.
                    (G) Related topics identified by such health 
                profession school based on the engagement of such 
                health profession school with vulnerable individuals 
                and stakeholder organizations representing such 
                individuals.
            (5) Partnerships.--In carrying out activities with grant 
        funds, a health profession school awarded a grant under the 
        Program may partner with one or more of the following:
                    (A) A State or local public health department.
                    (B) A health care professional membership 
                organization.
                    (C) A stakeholder organization.
                    (D) A health profession school.
                    (E) An institution of higher education.
            (6) Reports to secretary.--
                    (A) Annual report.--For each fiscal year during 
                which a health profession school is disbursed grant 
                funds under the Program, such health profession school 
                shall submit to the Secretary a report that describes 
                the activities carried out with such grant funds during 
                such fiscal year.
                    (B) Final report.--Not later than the date that is 
                1 year after the end of the last fiscal year during 
                which a health profession school is disbursed grant 
                funds under the Program, the health profession school 
                shall submit to the Secretary a final report that 
                summarizes the activities carried out with such grant 
                funds.
            (7) Report to congress.--Not later than the date that is 6 
        years after the date on which the Program is established, the 
        Secretary shall submit to Congress and publish on a public 
        website of the Department of Health and Human Services a report 
        that includes the following:
                    (A) A summary of the reports submitted under 
                paragraph (6).
                    (B) Recommendations to improve education and 
                training programs at health profession schools with 
                respect to identifying and addressing risks associated 
                with climate change for vulnerable individuals.
            (8) Health profession school defined.--In this subsection, 
        the term ``health profession school'' means an accredited--
                    (A) medical school;
                    (B) school of nursing;
                    (C) midwifery program;
                    (D) physician assistant education program;
                    (E) teaching hospital;
                    (F) residency or fellowship program; or
                    (G) other school or program determined appropriate 
                by the Secretary.
            (9) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        fiscal years 2023 through 2026.
    (c) NIH Consortium on Birth and Climate Change Research.--
            (1) Establishment.--Not later than 1 year after the date of 
        the enactment of this Act, the Director of the National 
        Institutes of Health (in this subsection referred to as the 
        ``Director of NIH'') shall establish the Consortium on Birth 
        and Climate Change Research (in this subsection referred to as 
        the ``Consortium'').
            (2) Duties.--
                    (A) In general.--The Consortium shall coordinate, 
                across the institutes, centers, and offices of the 
                National Institutes of Health, research on the risks 
                associated with climate change for vulnerable 
                individuals.
                    (B) Required activities.--In carrying out 
                subparagraph (A), the Consortium shall--
                            (i) establish research priorities, 
                        including by prioritizing research that--
                                    (I) identifies the risks associated 
                                with climate change for vulnerable 
                                individuals with a particular focus on 
                                inequities in such risks among racial 
                                and ethnic minority groups and other 
                                underserved populations; and
                                    (II) identifies strategies to 
                                reduce levels of, and exposure to, such 
                                risks, with a particular focus on risks 
                                among racial and ethnic minority groups 
                                and other underserved populations;
                            (ii) identify gaps in available data 
                        related to such risks;
                            (iii) identify gaps in, and opportunities 
                        for, research collaborations;
                            (iv) identify funding opportunities for 
                        community-based organizations and researchers 
                        from racially, ethnically, and geographically 
                        diverse backgrounds; and
                            (v) publish annual reports on the work and 
                        findings of the Consortium on a public website 
                        of the National Institutes of Health.
            (3) Membership.--The Director of NIH shall appoint to the 
        Consortium representatives of such institutes, centers, and 
        offices of the National Institutes of Health as the Director of 
        NIH considers appropriate, including, at a minimum, 
        representatives of--
                    (A) the National Institute of Environmental Health 
                Sciences;
                    (B) the National Institute on Minority Health and 
                Health Disparities;
                    (C) the Eunice Kennedy Shriver National Institute 
                of Child Health and Human Development;
                    (D) the National Institute of Nursing Research; and
                    (E) the Office of Research on Women's Health.
            (4) Chairperson.--The Chairperson of the Consortium shall 
        be designated by the Director of NIH and selected from among 
        the representatives appointed under paragraph (3).
            (5) Consultation.--In carrying out the duties described in 
        paragraph (2), the Consortium shall consult with--
                    (A) the heads of relevant Federal agencies, 
                including--
                            (i) the Environmental Protection Agency;
                            (ii) the National Oceanic and Atmospheric 
                        Administration;
                            (iii) the Occupational Safety and Health 
                        Administration; and
                            (iv) from the Department of Health and 
                        Human Services--
                                    (I) the Office of Minority Health 
                                in the Office of the Secretary;
                                    (II) the Centers for Medicare & 
                                Medicaid Services;
                                    (III) the Health Resources and 
                                Services Administration;
                                    (IV) the Centers for Disease 
                                Control and Prevention;
                                    (V) the Indian Health Service; and
                                    (VI) the Administration for 
                                Children and Families; and
                    (B) representatives of--
                            (i) stakeholder organizations;
                            (ii) health care providers and professional 
                        membership organizations with expertise in 
                        maternal health or environmental justice;
                            (iii) State and local public health 
                        departments;
                            (iv) licensed and accredited hospitals, 
                        birth centers, midwifery practices, or other 
                        health care practices that provide prenatal or 
                        labor and delivery services to vulnerable 
                        individuals; and
                            (v) institutions of higher education, 
                        including such institutions that are minority-
                        serving institutions or have expertise in 
                        maternal health or environmental justice.
    (d) Strategy for Identifying Climate Change Risk Zones for 
Vulnerable Mothers and Babies.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        develop a strategy (in this subsection referred to as the 
        ``Strategy'') for designating areas that the Secretary 
        determines to have a high risk of adverse maternal and infant 
        health outcomes among vulnerable individuals as a result of 
        risks associated with climate change.
            (2) Strategy requirements.--
                    (A) In general.--In developing the Strategy, the 
                Secretary shall establish a process to identify areas 
                where vulnerable individuals are exposed to a high risk 
                of adverse maternal and infant health outcomes as a 
                result of risks associated with climate change in 
                conjunction with other factors that can impact such 
                health outcomes, including--
                            (i) the incidence of diseases associated 
                        with air pollution, extreme heat, and other 
                        environmental factors;
                            (ii) the availability and accessibility of 
                        maternal and infant health care providers;
                            (iii) English-language proficiency among 
                        people of reproductive age;
                            (iv) the health insurance status of people 
                        of reproductive age;
                            (v) the number of people of reproductive 
                        age who are members of racial or ethnic groups 
                        with disproportionately high rates of adverse 
                        maternal and infant health outcomes;
                            (vi) the socioeconomic status of people of 
                        reproductive age, including with respect to--
                                    (I) poverty;
                                    (II) unemployment;
                                    (III) household income; and
                                    (IV) educational attainment; and
                            (vii) access to quality housing, 
                        transportation, and nutrition.
                    (B) Resources.--In developing the Strategy, the 
                Secretary shall identify, and incorporate a description 
                of, the following:
                            (i) Existing mapping tools or Federal 
                        programs that identify--
                                    (I) risks associated with climate 
                                change for vulnerable individuals; and
                                    (II) other factors that can 
                                influence maternal and infant health 
                                outcomes, including the factors 
                                described in subparagraph (A).
                            (ii) Environmental, health, socioeconomic, 
                        and demographic data relevant to identifying 
                        risks associated with climate change for 
                        vulnerable individuals.
                            (iii) Existing monitoring networks that 
                        collect data described in clause (ii), and any 
                        gaps in such networks.
                            (iv) Federal, State, and local stakeholders 
                        involved in maintaining monitoring networks 
                        identified under clause (iii), and how such 
                        stakeholders are coordinating their monitoring 
                        efforts.
                            (v) Additional monitoring networks, and 
                        enhancements to existing monitoring networks, 
                        that would be required to address gaps 
                        identified under clause (iii), including at the 
                        subcounty and census tract level.
                            (vi) Funding amounts required to establish 
                        the monitoring networks identified under clause 
                        (v) and recommendations for Federal, State, and 
                        local coordination with respect to such 
                        networks.
                            (vii) Potential uses for data collected and 
                        generated as a result of the Strategy, 
                        including how such data may be used in 
                        determining recipients of grants under the 
                        program established by subsection (a) or other 
                        similar programs.
                            (viii) Other information the Secretary 
                        considers relevant for the development of the 
                        Strategy.
            (3) Coordination and consultation.--In developing the 
        Strategy, the Secretary shall--
                    (A) coordinate with the Administrator of the 
                Environmental Protection Agency and the Administrator 
                of the National Oceanic and Atmospheric Administration; 
                and
                    (B) consult with--
                            (i) stakeholder organizations;
                            (ii) health care providers and professional 
                        membership organizations with expertise in 
                        maternal health or environmental justice;
                            (iii) State and local public health 
                        departments;
                            (iv) licensed and accredited hospitals, 
                        birth centers, midwifery practices, or other 
                        health care providers that provide prenatal or 
                        labor and delivery services to vulnerable 
                        individuals; and
                            (v) institutions of higher education, 
                        including such institutions that are minority-
                        serving institutions or have expertise in 
                        maternal health or environmental justice.
            (4) Notice and comment.--At least 240 days before the date 
        on which the Strategy is published in accordance with paragraph 
        (5), the Secretary shall provide--
                    (A) notice of the Strategy on a public website of 
                the Department of Health and Human Services; and
                    (B) an opportunity for public comment of at least 
                90 days.
            (5) Publication.--Not later than 18 months after the date 
        of the enactment of this Act, the Secretary shall publish on a 
        public website of the Department of Health and Human Services--
                    (A) the Strategy;
                    (B) the public comments received under paragraph 
                (4); and
                    (C) the responses of the Secretary to such public 
                comments.
    (e) Definitions.--In this section, the following definitions apply:
            (1) Adverse maternal and infant health outcomes.--The term 
        ``adverse maternal and infant health outcomes'' includes the 
        outcomes of pre-term birth, low birth weight, stillbirth, 
        infant or maternal mortality, and severe maternal morbidity.
            (2) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given such 
        term in section 101 of the Higher Education Act of 1965 (20 
        U.S.C. 1001).
            (3) Minority-serving institution.--The term ``minority-
        serving institution'' means an entity specified in any of 
        paragraphs (1) through (7) of section 371(a) of the Higher 
        Education Act of 1965 (20 U.S.C. 1067q(a)).
            (4) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)).
            (5) Risks associated with climate change.--The term ``risks 
        associated with climate change'' includes risks associated with 
        extreme heat, air pollution, extreme weather events, and other 
        environmental issues associated with climate change that can 
        result in adverse maternal and infant health outcomes.
            (6) Stakeholder organization.--The term ``stakeholder 
        organization'' means--
                    (A) a community-based organization with expertise 
                in providing assistance to vulnerable individuals;
                    (B) a nonprofit organization with expertise in 
                maternal or infant health or environmental justice; and
                    (C) a patient advocacy organization representing 
                vulnerable individuals.
            (7) Vulnerable individual.--The term ``vulnerable 
        individual'' means--
                    (A) an individual who is pregnant;
                    (B) an individual who was pregnant during any 
                portion of the preceding 1-year period; and
                    (C) an individual under 3 years of age.

SEC. 5206. TECH TO SAVE MOMS.

    (a) Definitions.--In this section:
            (1) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (2) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (3) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (4) Social determinants of maternal health.--The term 
        ``social determinants of maternal health'' means non-clinical 
        factors that impact maternal health outcomes, including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.
    (b) Integrated Telehealth Models in Maternity Care Services.--
            (1) In general.--Section 1115A(b)(2)(B) of the Social 
        Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at 
        the end the following:
                            ``(xxviii) Focusing on title XIX, providing 
                        for the adoption of and use of telehealth tools 
                        that allow for screening, monitoring, and 
                        management of common health complications with 
                        respect to an individual receiving medical 
                        assistance during such individual's pregnancy 
                        and for not more than a 1-year period beginning 
                        on the last day of the pregnancy.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect 1 year after the date of the enactment of 
        this section.
    (c) Grants To Expand the Use of Technology-Enabled Collaborative 
Learning and Capacity Models for Pregnant and Postpartum Individuals.--
Title III of the Public Health Service Act is amended by inserting 
after section 330N (42 U.S.C. 254c-20) the following new section:

``SEC. 330. EXPANDING CAPACITY FOR MATERNAL HEALTH OUTCOMES.

    ``(a) Establishment.--Beginning not later than 1 year after the 
date of enactment of this section, the Secretary shall award grants to 
eligible entities to evaluate, develop, and expand the use of 
technology-enabled collaborative learning and capacity building models 
and improve maternal health outcomes--
            ``(1) in health professional shortage areas;
            ``(2) in areas with high rates of maternal mortality and 
        severe maternal morbidity;
            ``(3) in areas with significant racial and ethnic 
        inequities in maternal health outcomes; and
            ``(4) for medically underserved populations and American 
        Indians and Alaska Natives, including Indian Tribes, Tribal 
        organizations, and Urban Indian organizations.
    ``(b) Use of Funds.--
            ``(1) Required uses.--Recipients of grants under this 
        section shall use the grants to--
                    ``(A) train maternal health care providers, 
                students, and other similar professionals through 
                models that include--
                            ``(i) methods to increase safety and health 
                        care quality;
                            ``(ii) training to increase awareness of, 
                        and eliminate implicit bias, racism, and 
                        discrimination in the provision of health care;
                            ``(iii) best practices in screening for 
                        and, as needed, evaluating and treating 
                        maternal mental health conditions and substance 
                        use disorders;
                            ``(iv) training on best practices in 
                        maternity care for pregnant and postpartum 
                        individuals during the COVID-19 public health 
                        emergency or future public health emergencies;
                            ``(v) methods to screen for social 
                        determinants of maternal health risks in the 
                        prenatal and postpartum periods; and
                            ``(vi) the use of remote patient monitoring 
                        tools for pregnancy-related complications 
                        described in section 1115A(b)(2)(B)(xxviii) of 
                        the Social Security Act;
                    ``(B) evaluate and collect information on the 
                effect of such models on--
                            ``(i) access to, and quality of, care;
                            ``(ii) outcomes with respect to the health 
                        of an individual; and
                            ``(iii) the experience of individuals who 
                        receive pregnancy-related health care;
                    ``(C) develop qualitative and quantitative measures 
                to identify best practices for the expansion and use of 
                such models;
                    ``(D) study the effect of such models on patient 
                outcomes and maternity care providers; and
                    ``(E) conduct any other activity, as determined by 
                the Secretary.
            ``(2) Permissible uses.--Recipients of grants under this 
        section may use grants to support--
                    ``(A) the use and expansion of technology-enabled 
                collaborative learning and capacity building models, 
                including hardware and software that--
                            ``(i) enables distance learning and 
                        technical support; and
                            ``(ii) supports the secure exchange of 
                        electronic health information; and
                    ``(B) maternity care providers, students, and other 
                similar professionals in the provision of maternity 
                care through such models.
    ``(c) Application.--
            ``(1) In general.--An eligible entity seeking a grant under 
        subsection (a) shall submit to the Secretary an application, at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            ``(2) Assurance.--An application under paragraph (1) shall 
        include an assurance that such entity shall collect information 
        on, and assess the effect of, the use of technology-enabled 
        collaborative learning and capacity building models, including 
        with respect to--
                    ``(A) maternal health outcomes;
                    ``(B) access to maternal health care services;
                    ``(C) quality of maternal health care; and
                    ``(D) retention of maternity care providers serving 
                areas and populations described in subsection (a).
    ``(d) Limitations.--
            ``(1) Number.--The Secretary may not award more than 1 
        grant under this section to an eligible entity.
            ``(2) Duration.--A grant awarded under this section shall 
        be for a 5-year period.
    ``(e) Access to Broadband.--In administering grants under this 
section, the Secretary may coordinate with other agencies to ensure 
that funding opportunities are available to support access to reliable, 
high-speed internet for grantees.
    ``(f) Technical Assistance.--The Secretary shall provide (either 
directly or by contract) technical assistance to eligible entities, 
including recipients of grants under subsection (a), on the 
development, use, and sustainability of technology-enabled 
collaborative learning and capacity building models to expand access to 
maternal health care services provided by such entities, including--
            ``(1) in health professional shortage areas;
            ``(2) in areas with high rates of maternal mortality and 
        severe maternal morbidity or significant racial and ethnic 
        inequities in maternal health outcomes; and
            ``(3) for medically underserved populations or American 
        Indians and Alaska Natives.
    ``(g) Research and Evaluation.--The Secretary, in consultation with 
experts, shall develop a strategic plan to research and evaluate the 
evidence for such models.
    ``(h) Reporting.--
            ``(1) Eligible entities.--An eligible entity that receives 
        a grant under subsection (a) shall submit to the Secretary a 
        report, at such time, in such manner, and containing such 
        information as the Secretary may require.
            ``(2) Secretary.--Not later than 4 years after the date of 
        enactment of this section, the Secretary shall submit to the 
        Congress, and make available on the website of the Department 
        of Health and Human Services, a report that includes--
                    ``(A) a description of grants awarded under 
                subsection (a) and the purpose and amounts of such 
                grants;
                    ``(B) a summary of--
                            ``(i) the evaluations conducted under 
                        subsection (b)(1)(B);
                            ``(ii) any technical assistance provided 
                        under subsection (g); and
                            ``(iii) the activities conducted under 
                        subsection (a); and
                    ``(C) a description of any significant findings 
                with respect to--
                            ``(i) patient outcomes; and
                            ``(ii) best practices for expanding, using, 
                        or evaluating technology-enabled collaborative 
                        learning and capacity building models.
    ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $6,000,000 for each of fiscal 
years 2023 through 2027.
    ``(j) Definitions.--In this section:
            ``(1) Eligible entity.--
                    ``(A) In general.--The term `eligible entity' means 
                an entity that provides, or supports the provision of, 
                maternal health care services or other evidence-based 
                services for pregnant and postpartum individuals--
                            ``(i) in health professional shortage 
                        areas;
                            ``(ii) in areas with high rates of adverse 
                        maternal health outcomes or significant racial 
                        and ethnic inequities in maternal health 
                        outcomes; or
                            ``(iii) who are--
                                    ``(I) members of medically 
                                underserved populations; or
                                    ``(II) American Indians and Alaska 
                                Natives, including Indian Tribes, 
                                Tribal organizations, and Urban Indian 
                                organizations.
                    ``(B) Inclusions.--An eligible entity may include 
                entities that lead, or are capable of leading a 
                technology-enabled collaborative learning and capacity 
                building model.
            ``(2) Health professional shortage area.--The term `health 
        professional shortage area' means a health professional 
        shortage area designated under section 332.
            ``(3) Indian tribe.--The term `Indian Tribe' has the 
        meaning given such term in section 4 of the Indian Self-
        Determination and Education Assistance Act.
            ``(4) Maternal mortality.--The term `maternal mortality' 
        means a death occurring during or within 1-year period after 
        pregnancy caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy or childbirth 
        complications.
            ``(5) Medically underserved population.--The term 
        `medically underserved population' has the meaning given such 
        term in section 330(b)(3).
            ``(6) Postpartum.--The term `postpartum' means the 1-year 
        period beginning on the last date of an individual's pregnancy.
            ``(7) Severe maternal morbidity.--The term `severe maternal 
        morbidity' means a health condition, including a mental health 
        or substance use disorder, attributed to or aggravated by 
        pregnancy or childbirth that results in significant short-term 
        or long-term consequences to the health of the individual who 
        was pregnant.
            ``(8) Technology-enabled collaborative learning and 
        capacity building model.--The term `technology-enabled 
        collaborative learning and capacity building model' means a 
        distance health education model that connects health care 
        professionals, and other specialists, through simultaneous 
        interactive videoconferencing for the purpose of facilitating 
        case-based learning, disseminating best practices, and 
        evaluating outcomes in the context of maternal health care.
            ``(9) Tribal organization.--The term `Tribal organization' 
        has the meaning given such term in section 4 of the Indian 
        Self-Determination and Education Assistance Act.
            ``(10) Urban indian organization.--The term `Urban Indian 
        organization' has the meaning given such term in section 4 of 
        the Indian Health Care Improvement Act.''.
    (d) Grants To Promote Equity in Maternal Health Outcomes Through 
Digital Tools.--
            (1) In general.--Beginning not later than 1 year after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services shall make grants to eligible entities to reduce 
        racial and ethnic inequities in maternal health outcomes by 
        increasing access to digital tools related to maternal health 
        care.
            (2) Applications.--To be eligible to receive a grant under 
        this subsection, an eligible entity shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may require.
            (3) Prioritization.--In awarding grants under this 
        subsection, the Secretary shall prioritize an eligible entity--
                    (A) in an area with high rates of adverse maternal 
                health outcomes or significant racial and ethnic 
                inequities in maternal health outcomes;
                    (B) in a health professional shortage area 
                designated under section 332 of the Public Health 
                Service Act (42 U.S.C. 254e); and
                    (C) that promotes technology that addresses racial 
                and ethnic inequities in maternal health outcomes.
            (4) Limitations.--
                    (A) Number.--The Secretary may award not more than 
                1 grant under this subsection to an eligible entity.
                    (B) Duration.--A grant awarded under this 
                subsection shall be for a 5-year period.
            (5) Technical assistance.--The Secretary shall provide 
        technical assistance to an eligible entity on the development, 
        use, evaluation, and post-grant sustainability of digital tools 
        for purposes of promoting equity in maternal health outcomes.
            (6) Reporting.--
                    (A) Eligible entities.--An eligible entity that 
                receives a grant under paragraph (1) shall submit to 
                the Secretary a report, at such time, in such manner, 
                and containing such information as the Secretary may 
                require.
                    (B) Secretary.--Not later than 4 years after the 
                date of the enactment of this Act, the Secretary shall 
                submit to Congress a report that includes--
                            (i) an evaluation on the effectiveness of 
                        grants awarded under this subsection to improve 
                        health outcomes for pregnant and postpartum 
                        individuals from racial and ethnic minority 
                        groups;
                            (ii) recommendations on new grant programs 
                        that promote the use of technology to improve 
                        such maternal health outcomes; and
                            (iii) recommendations with respect to--
                                    (I) technology-based privacy and 
                                security safeguards in maternal health 
                                care;
                                    (II) reimbursement rates for 
                                maternal telehealth services;
                                    (III) the use of digital tools to 
                                analyze large data sets to identify 
                                potential pregnancy-related 
                                complications;
                                    (IV) barriers that prevent 
                                maternity care providers from providing 
                                telehealth services across States;
                                    (V) the use of consumer digital 
                                tools such as mobile phone 
                                applications, patient portals, and 
                                wearable technologies to improve 
                                maternal health outcomes;
                                    (VI) barriers that prevent access 
                                to telehealth services, including a 
                                lack of access to reliable, high-speed 
                                internet or electronic devices;
                                    (VII) barriers to data sharing 
                                between the Special Supplemental 
                                Nutrition Program for Women, Infants, 
                                and Children program and maternity care 
                                providers, and recommendations for 
                                addressing such barriers; and
                                    (VIII) lessons learned from 
                                expanded access to telehealth related 
                                to maternity care during the COVID-19 
                                public health emergency.
            (7) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $6,000,000 for 
        each of fiscal years 2023 through 2027.
    (e) Report on the Use of Technology in Maternity Care.--
            (1) In general.--Not later than 60 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall enter into an agreement with the National 
        Academies of Sciences, Engineering, and Medicine (referred to 
        in this section as the ``National Academies'') under which the 
        National Academies shall conduct a study on the use of 
        technology and patient monitoring devices in maternity care.
            (2) Content.--The agreement entered into pursuant to 
        paragraph (1) shall provide for the study of the following:
                    (A) The use of innovative technology (including 
                artificial intelligence) in maternal health care, 
                including the extent to which such technology has 
                affected racial or ethnic biases in maternal health 
                care.
                    (B) The use of patient monitoring devices 
                (including pulse oximeter devices) in maternal health 
                care, including the extent to which such devices have 
                affected racial or ethnic biases in maternal health 
                care.
                    (C) Best practices for reducing and preventing 
                racial or ethnic biases in the use of innovative 
                technology and patient monitoring devices in maternity 
                care.
                    (D) Best practices in the use of innovative 
                technology and patient monitoring devices for pregnant 
                and postpartum individuals from racial and ethnic 
                minority groups.
                    (E) Best practices with respect to privacy and 
                security safeguards in such use.
            (3) Report.--Not later than 24 months after the date of 
        enactment of this Act, the National Academies shall complete 
        the study under this subsection, and transmit a report the 
        results of such study to Congress.

SEC. 5207. SOCIAL DETERMINANTS FOR MOMS.

    (a) Task Force To Develop a Strategy To Address Social Determinants 
of Maternal Health.--
            (1) In general.--The Secretary of Health and Human Services 
        shall convene a task force (in this subsection referred to as 
        the ``Task Force'') to develop a strategy to coordinate efforts 
        between Federal agencies to address social determinants of 
        maternal health with respect to pregnant and postpartum 
        individuals.
            (2) Ex officio members.--The ex officio members of the Task 
        Force shall consist of the following:
                    (A) The Secretary of Health and Human Services (or 
                a designee thereof).
                    (B) The Secretary of Housing and Urban Development 
                (or a designee thereof).
                    (C) The Secretary of Transportation (or a designee 
                thereof).
                    (D) The Secretary of Agriculture (or a designee 
                thereof).
                    (E) The Secretary of Labor (or a designee thereof).
                    (F) The Administrator of the Environmental 
                Protection Agency (or a designee thereof).
                    (G) The Assistant Secretary for the Administration 
                for Children and Families (or a designee thereof).
                    (H) The Administrator of the Centers for Medicare & 
                Medicaid Services (or a designee thereof).
                    (I) The Director of the Indian Health Service (or a 
                designee thereof).
                    (J) The Director of the National Institutes of 
                Health (or a designee thereof).
                    (K) The Administrator of the Health Resources and 
                Services Administration (or a designee thereof).
                    (L) The Deputy Assistant Secretary for Minority 
                Health of the Department of Health and Human Services 
                (or a designee thereof).
                    (M) The Deputy Assistant Secretary for Women's 
                Health of the Department of Health and Human Services 
                (or a designee thereof).
                    (N) The Director of the Centers for Disease Control 
                and Prevention (or a designee thereof).
                    (O) The Director of the Office on Violence Against 
                Women at the Department of Justice (or a designee 
                thereof).
            (3) Appointed members.--In addition to the ex officio 
        members of the Task Force, the Secretary of Health and Human 
        Services shall appoint the following members of the Task Force:
                    (A) At least two representatives of patients, to 
                include--
                            (i) a representative of patients who have 
                        suffered from severe maternal morbidity; or
                            (ii) a representative of patients who is a 
                        family member of an individual who suffered a 
                        pregnancy-related death.
                    (B) At least two leaders of community-based 
                organizations that address maternal mortality and 
                severe maternal morbidity with a specific focus on 
                racial and ethnic inequities. In appointing such 
                leaders under this subparagraph, the Secretary of 
                Health and Human Services shall give priority to 
                individuals who are leaders of organizations led by 
                individuals from racial and ethnic minority groups.
                    (C) At least two perinatal health workers.
                    (D) A professionally diverse panel of maternity 
                care providers.
            (4) Chair.--The Secretary of Health and Human Services 
        shall select the chair of the Task Force from among the members 
        of the Task Force.
            (5) Report.--Not later than 2 years after the date of the 
        enactment of this Act, the Task Force shall submit to Congress 
        a report on--
                    (A) the strategy developed under paragraph (1);
                    (B) recommendations on funding amounts with respect 
                to implementing such strategy; and
                    (C) recommendations for how to expand coverage of 
                social services to address social determinants of 
                maternal health under Medicaid managed care 
                organizations and State Medicaid programs.
            (6) Termination.--Section 14 of the Federal Advisory 
        Committee Act (5 U.S.C. App.) shall not apply to the Task Force 
        with respect to termination.
    (b) Housing for Moms Grant Program.--
            (1) In general.--The Secretary of Housing and Urban 
        Development shall establish a Housing for Moms grant program 
        under this subsection to make grants to eligible entities to 
        increase access to safe, stable, affordable, and adequate 
        housing for pregnant and postpartum individuals and their 
        families.
            (2) Application.--To be eligible to receive a grant under 
        this subsection, an eligible entity shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may provide.
            (3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to an eligible entity that--
                    (A) is a community-based organization or will 
                partner with a community-based organization to 
                implement initiatives to increase access to safe, 
                stable, affordable, and adequate housing for pregnant 
                and postpartum individuals and their families;
                    (B) is operating in an area with high rates of 
                adverse maternal health outcomes or significant racial 
                or ethnic inequities in maternal health outcomes, to 
                the extent such data are available; and
                    (C) is operating in an area with a high poverty 
                rate or significant number of individuals who lack 
                consistent access to safe, stable, affordable, and 
                adequate housing.
            (4) Use of funds.--An eligible entity that receives a grant 
        under this subsection shall use funds under the grant for the 
        purposes of--
                    (A) identifying and conducting outreach to pregnant 
                and postpartum individuals who are low-income and lack 
                consistent access to safe, stable, affordable, and 
                adequate housing;
                    (B) providing safe, stable, affordable, and 
                adequate housing options to such individuals;
                    (C) connecting such individuals with local 
                organizations offering safe, stable, affordable, and 
                adequate housing options;
                    (D) providing application assistance to such 
                individuals seeking to enroll in programs offering 
                safe, stable, affordable, and adequate housing options;
                    (E) providing direct financial assistance to such 
                individuals for the purposes of maintaining safe, 
                stable, and adequate housing for the duration of the 
                individual's pregnancy and postpartum periods; and
                    (F) working with relevant stakeholders to ensure 
                that local housing and homeless shelter infrastructure 
                is supportive to pregnant and postpartum individuals, 
                including through--
                            (i) health-promoting housing codes;
                            (ii) enforcement of housing codes;
                            (iii) proactive rental inspection programs;
                            (iv) code enforcement officer training; and
                            (v) partnerships between regional offices 
                        of the Department of Housing and Urban 
                        Development and community-based organizations 
                        to ensure housing laws are understood and 
                        violations are discovered.
            (5) Reporting.--
                    (A) Eligible entities.--The Secretary shall require 
                each eligible entity receiving a grant under this 
                subsection to annually submit to the Secretary and make 
                publicly available a report on the status of activities 
                conducted using the grant.
                    (B) Secretary.--Not later than the end of each 
                fiscal year in which grants are made under this 
                subsection, the Secretary shall submit to the Congress 
                and make publicly available a report that--
                            (i) summarizes the reports received under 
                        subparagraph (A);
                            (ii) evaluates the effectiveness of grants 
                        awarded under this subsection in increasing 
                        access to safe, stable, affordable, and 
                        adequate housing for pregnant and postpartum 
                        individuals and their families; and
                            (iii) makes recommendations with respect to 
                        ensuring activities described paragraph (4) 
                        continue after grant amounts made available 
                        under this subsection are expended.
            (6) Definitions.--In this subsection:
                    (A) Eligible entity.--The term ``eligible entity'' 
                means--
                            (i) a community-based organization;
                            (ii) a State or local governmental entity, 
                        including a State or local public health 
                        department;
                            (iii) an Indian tribe or tribal 
                        organization (as such terms are defined in 
                        section 4 of the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 5304)); or
                            (iv) an Urban Indian organization (as such 
                        term is defined in section 4 of the Indian 
                        Health Care Improvement Act (25 U.S.C. 1603)).
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Housing and Urban Development.
            (7) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        fiscal year 2022, which shall remain available until expended.
    (c) Department of Transportation.--
            (1) Report.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Transportation shall 
        submit to Congress and make publicly available a report 
        containing--
                    (A) an assessment of transportation barriers 
                preventing individuals from attending prenatal and 
                postpartum appointments, accessing maternal health care 
                services, or accessing services and resources related 
                to social determinants maternal of health;
                    (B) recommendations on how to overcome the barriers 
                assessed under subparagraph (A); and
                    (C) an assessment of transportation safety risks 
                for pregnant individuals and recommendations on how to 
                mitigate such risks.
            (2) Considerations.--In carrying out paragraph (1), the 
        Secretary shall give special consideration to solutions for--
                    (A) pregnant and postpartum individuals living in a 
                health professional shortage area designated under 
                section 332 of the Public Health Service Act (42 U.S.C. 
                254e);
                    (B) pregnant and postpartum individuals living in 
                areas with high maternal mortality or severe morbidity 
                rates or significant racial or ethnic inequities in 
                maternal health outcomes; and
                    (C) pregnant and postpartum individuals with a 
                disability that impacts mobility.
    (d) Department of Agriculture.--
            (1) Special supplemental nutrition program.--
                    (A) Extension of postpartum period.--Section 
                17(b)(10) of the Child Nutrition Act of 1966 (42 U.S.C. 
                1786(b)(10)) is amended by striking ``six months'' and 
                inserting ``24 months''.
                    (B) Report.--Not later than 2 years after the date 
                of the enactment of this subsection, the Secretary 
                shall submit to Congress a report that includes an 
                evaluation of the effect of each of the amendments made 
                by this paragraph on--
                            (i) maternal and infant health outcomes, 
                        including racial and ethnic inequities with 
                        respect to such outcomes;
                            (ii) breastfeeding rates among postpartum 
                        individuals;
                            (iii) qualitative evaluations of family 
                        experiences under the special supplemental 
                        nutrition program under section 17 of the Child 
                        Nutrition Act of 1966 (42 U.S.C. 1786); and
                            (iv) other relevant information as 
                        determined by the Secretary.
            (2) Grant program for healthy food and clean water for 
        pregnant and postpartum individuals.--
                    (A) In general.--The Secretary shall establish a 
                program to award grants, on a competitive basis, to 
                eligible entities to carry out the activities described 
                in subparagraph (D).
                    (B) Application.--To be eligible for a grant under 
                this paragraph, an eligible entity shall submit to the 
                Secretary an application at such time, in such manner, 
                and containing such information as the Secretary 
                determines appropriate.
                    (C) Priority.--In awarding grants under this 
                paragraph, the Secretary shall give priority to an 
                eligible entity that--
                            (i) is, or will partner with, a community-
                        based organization; and
                            (ii) is operating in an area with high 
                        rates of--
                                    (I) adverse maternal health 
                                outcomes; or
                                    (II) significant racial or ethnic 
                                inequities in maternal health outcomes.
                    (D) Use of funds.--An eligible entity shall use 
                grant funds awarded under this paragraph to deliver 
                healthy food, infant formula, clean water, or diapers 
                to pregnant and postpartum individuals located in areas 
                that are food deserts, as determined by the Secretary 
                using data from the Food Access Research Atlas of the 
                Department of Agriculture.
                    (E) Reports.--
                            (i) Eligible entity.--Not later than 1 year 
                        after an eligible entity first receives a grant 
                        under this paragraph, and annually thereafter, 
                        an eligible entity shall submit to the 
                        Secretary a report on the status of activities 
                        conducted using the grant, which shall contain 
                        such information as the Secretary may require.
                            (ii) Secretary.--
                                    (I) In general.--Not later than 2 
                                years after the date on which the first 
                                grant is awarded under this paragraph, 
                                the Secretary shall submit to Congress 
                                a report that includes--
                                            (aa) a summary of the 
                                        reports submitted under clause 
                                        (i);
                                            (bb) an assessment of the 
                                        extent to which food 
                                        distributed through the grant 
                                        program was purchased from 
                                        local and regional food 
                                        systems;
                                            (cc) an evaluation of the 
                                        effect of the grant program 
                                        under this paragraph on 
                                        maternal and infant health 
                                        outcomes, including racial and 
                                        ethnic inequities with respect 
                                        to such outcomes; and
                                            (dd) recommendations with 
                                        respect to ensuring the 
                                        activities described in 
                                        subparagraph (D) continue after 
                                        the grant period funding such 
                                        activities expires.
                                    (II) Publication.--The Secretary 
                                shall make the report submitted under 
                                subclause (I) publicly available on the 
                                website of the Department of 
                                Agriculture.
                    (F) Authorization of appropriations.--There are 
                authorized to be appropriated $5,000,000 to carry out 
                this paragraph for fiscal years 2022 through 2024.
            (3) Definitions.--In this subsection:
                    (A) Eligible entity.--The term ``eligible entity'' 
                means--
                            (i) a community-based organization;
                            (ii) a State or local governmental entity, 
                        including a State or local public health 
                        department;
                            (iii) an Indian Tribe or Tribal 
                        organization (as such terms are defined in 
                        section 4 of the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 5304)); or
                            (iv) an Urban Indian organization (as such 
                        term is defined in section 4 of the Indian 
                        Health Care Improvement Act (25 U.S.C. 1603)).
                    (B) Secretary.--The term ``Secretary'' means the 
                Secretary of Agriculture.
    (e) Environmental Study Through National Academies.--
            (1) In general.--The Administrator of the Environmental 
        Protection Agency shall seek to enter an agreement, not later 
        than 60 days after the date of enactment of this Act, with the 
        National Academies of Sciences, Engineering, and Medicine 
        (referred to in this subsection as the ``National Academies'') 
        under which the National Academies agree to conduct a study on 
        the impacts of water and air quality, exposure to extreme 
        temperatures, environmental chemicals, environmental risks in 
        the workplace and the home, and pollution levels, on maternal 
        and infant health outcomes.
            (2) Study requirements.--The agreement under paragraph (1) 
        shall direct the National Academies to make recommendations 
        for--
                    (A) improving environmental conditions to improve 
                maternal and infant health outcomes; and
                    (B) reducing or eliminating racial and ethnic 
                inequities in such outcomes.
            (3) Report.--The agreement under paragraph (1) shall direct 
        the National Academies to complete the study under this 
        subsection, and transmit to the Congress and make publicly 
        available a report on the results of the study, not later than 
        12 months after the date of enactment of this Act.
    (f) Child Care Access.--
            (1) Grant program.--The Secretary of Health and Human 
        Services (in this subsection referred to as the ``Secretary'') 
        shall award grants to eligible organizations to provide 
        pregnant and postpartum individuals with free and accessible 
        drop-in child care services during prenatal and postpartum 
        appointments.
            (2) Application.--To be eligible to receive a grant under 
        this subsection, an eligible entity shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may require.
            (3) Eligible organizations.--
                    (A) Eligibility.--To be eligible to receive a grant 
                under this subsection, an organization shall be an 
                organization that--
                            (i) provides child care services; and
                            (ii) can carry out programs providing 
                        pregnant and postpartum individuals with free 
                        and accessible drop-in child care services 
                        during prenatal and postpartum appointments.
                    (B) Prioritization.--In selecting grant recipients 
                under this subsection, the Secretary shall give 
                priority to eligible organizations that operate in an 
                area, to the extent data with respect to such an area 
                are available--
                            (i) with high rates of adverse maternal 
                        health outcomes; or
                            (ii) significant racial or ethnic 
                        inequities in maternal health outcomes.
            (4) Timing.--The Secretary shall commence the grant program 
        under paragraph (1) not later than 1 year after the date of 
        enactment of this Act.
            (5) Reporting.--
                    (A) Grantees.--Each recipient of a grant under this 
                subsection shall annually submit to the Secretary and 
                make publicly available a report on the status of 
                activities conducted using the grant. Each such report 
                shall include--
                            (i) an analysis of the effect of the funded 
                        program on prenatal and postpartum appointment 
                        attendance rates;
                            (ii) summaries of qualitative assessments 
                        of the funded program from--
                                    (I) pregnant and postpartum 
                                individuals participating in the 
                                program; and
                                    (II) the families of such 
                                individuals; and
                            (iii) such additional information as the 
                        Secretary may require.
                    (B) Secretary.--Not later than the end of fiscal 
                year 2024, the Secretary shall submit to the Congress, 
                and make publicly available, a report containing the 
                following:
                            (i) A summary of the reports received under 
                        subparagraph (A).
                            (ii) An assessment of the effects, if any, 
                        of the funded programs on maternal health 
                        outcomes, with a specific focus on racial and 
                        ethnic inequities in such outcomes.
                            (iii) A description of actions the 
                        Secretary can take to ensure that pregnant and 
                        postpartum individuals eligible for medical 
                        assistance under a State plan under title XIX 
                        of the Social Security Act (42 U.S.C. 1936 et 
                        seq.) have access to free and accessible drop-
                        in child care services during prenatal and 
                        postpartum appointments, including 
                        identification of the funding necessary to 
                        carry out such actions.
            (6) Drop-in child care services defined.--In this 
        subsection, the term ``drop-in child care services'' means 
        child care and early childhood education services that are--
                    (A) delivered at a facility that meets the 
                requirements of all applicable laws and regulations of 
                the State or local government in which it is located, 
                including the licensing of the facility as a child care 
                facility; and
                    (B) provided in single encounters without requiring 
                full-time enrollment of a person in a child care 
                program.
            (7) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $5,000,000 
        for the period of fiscal years 2023 through 2025.
    (g) Grants to Local Entities Addressing Social Determinants of 
Maternal Health.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        award grants to eligible entities to--
                    (A) address social determinants of maternal health 
                for pregnant and postpartum individuals; and
                    (B) eliminate racial and ethnic inequities in 
                maternal health outcomes.
            (2) Application.--To be eligible to receive a grant under 
        this subsection an eligible entity shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may provide.
            (3) Prioritization.--In awarding grants under paragraph 
        (1), the Secretary shall give priority to an eligible entity 
        that--
                    (A) is, or will partner with, a community-based 
                organization to carrying out the activities under 
                paragraph (4);
                    (B) is operating in an area with high rates of 
                adverse maternal health outcomes or significant racial 
                or ethnic inequities in maternal health outcomes; and
                    (C) is operating in an area with a high poverty 
                rate.
            (4) Activities.--An eligible entity that receives a grant 
        under this subsection may use funds received through the grant 
        to--
                    (A) hire and retain staff;
                    (B) develop and distribute a list of available 
                resources with respect to social service programs in a 
                community;
                    (C) establish a resource center that provides 
                multiple social service programs in a single location;
                    (D) offer programs and resources in the communities 
                in which the respective eligible entities are located 
                to address social determinants of health for pregnant 
                and postpartum individuals; and
                    (E) consult with such pregnant and postpartum 
                individuals to conduct an assessment of the activities 
                under this paragraph.
            (5) Technical assistance.--The Secretary shall provide to 
        grant recipients under this subsection technical assistance to 
        plan for sustaining programs to address social determinants of 
        maternal health among pregnant and postpartum individuals after 
        the period of the grant.
            (6) Reporting.--
                    (A) Grantees.--Not later than 1 year after the date 
                on which an eligible entity first receives a grant 
                under this subsection, and annually thereafter, an 
                eligible entity shall submit to the Secretary, and make 
                publicly available, a report on the status of 
                activities conducted using the grant. Each such report 
                shall include data on the effects of such activities, 
                disaggregated by race, ethnicity, gender, and other 
                relevant factors.
                    (B) Secretary.--Not later than the end of fiscal 
                year 2026, the Secretary shall submit to Congress a 
                report that includes--
                            (i) a summary of the reports received under 
                        subparagraph (A); and
                            (ii) recommendations for--
                                    (I) improving maternal health 
                                outcomes; and
                                    (II) reducing or eliminating racial 
                                and ethnic inequities in maternal 
                                health outcomes.
            (7) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $15,000,000 for 
        each of fiscal years 2023 through 2027.
    (h) Definitions.--In this section:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care provided to 
        a health care consumer, means care that is in agreement with 
        the preferred cultural values, beliefs, worldview, language, 
        and practices of the health care consumer and other relevant 
        stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (5) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (6) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (7) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (8) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.

SEC. 5208. DATA TO SAVE MOMS.

    (a) Short Title.--This section may be cited as the ``Data to Save 
Moms Act''.
    (b) Funding for Maternal Mortality Review Committees To Promote 
Representative Community Engagement.--
            (1) In general.--Section 317K(d) of the Public Health 
        Service Act (42 U.S.C. 247b-12(d)) is amended by adding at the 
        end the following:
            ``(9) Grants to promote representative community engagement 
        in maternal mortality review committees.--
                    ``(A) In general.--The Secretary may, using funds 
                made available pursuant to subparagraph (C), provide 
                assistance to an applicable maternal mortality review 
                committee of a State, Indian tribe, tribal 
                organization, or Urban Indian organization (as such 
                term is defined in section 4 of the Indian Health Care 
                Improvement Act (25 U.S.C. 1603))--
                            ``(i) to select for inclusion in the 
                        membership of such a committee community 
                        members from the State, Indian tribe, tribal 
                        organization, or Urban Indian organization by--
                                    ``(I) prioritizing community 
                                members who can increase the diversity 
                                of the committee's membership with 
                                respect to race and ethnicity, 
                                location, and professional background, 
                                including members with non-clinical 
                                experiences; and
                                    ``(II) to the extent applicable, 
                                using funds reserved under subsection 
                                (f), to address barriers to maternal 
                                mortality review committee 
                                participation for community members, 
                                including through providing required 
                                training, reducing transportation 
                                barriers, providing compensation, and 
                                providing other supports as may be 
                                necessary;
                            ``(ii) to establish initiatives to conduct 
                        outreach and community engagement efforts 
                        within communities throughout the State or 
                        Tribe to seek input from community members on 
                        the work of such maternal mortality review 
                        committee, with a particular focus on outreach 
                        to people who are members of minority groups; 
                        and
                            ``(iii) to release public reports 
                        assessing--
                                    ``(I) the pregnancy-related death 
                                and pregnancy-associated death review 
                                processes of the maternal mortality 
                                review committee, with a particular 
                                focus on the maternal mortality review 
                                committee's sensitivity to the unique 
                                circumstances of pregnant and 
                                postpartum individuals from racial and 
                                ethnic minority groups (as such term is 
                                defined in section 1707(g)(1)) who have 
                                suffered pregnancy-related deaths; and
                                    ``(II) the impact of the use of 
                                funds made available pursuant to 
                                paragraph (C) on increasing the 
                                diversity of the maternal mortality 
                                review committee membership and 
                                promoting community engagement efforts 
                                throughout the State or Tribe.
                    ``(B) Technical assistance.--The Secretary shall 
                provide (either directly through the Department of 
                Health and Human Services or by contract) technical 
                assistance to any maternal mortality review committee 
                receiving a grant under this paragraph on best 
                practices for increasing the diversity of the maternal 
                mortality review committee's membership and for 
                conducting effective community engagement throughout 
                the State or Tribe.
                    ``(C) Authorization of appropriations.--In addition 
                to any funds made available under subsection (f), there 
                are authorized to be appropriated to carry out this 
                paragraph $10,000,000 for each of fiscal years 2023 
                through 2027.''.
            (2) Reservation of funds.--Section 317K(f) of the Public 
        Health Service Act (42 U.S.C. 247b-12(f)) is amended by adding 
        at the end the following: ``Of the amount made available under 
        the preceding sentence for a fiscal year, not less than 
        $1,500,000 shall be reserved for grants awarded under 
        subsection (d)(9) to Indian tribes, tribal organizations, or 
        Urban Indian organizations (as those terms are defined in 
        section 4 of the Indian Health Care Improvement Act (25 U.S.C. 
        1603)).''.
    (c) Data Collection and Review.--Section 317K(d)(3)(A)(i) of the 
Public Health Service Act (42 U.S.C. 247b-12(d)(3)(A)(i)) is amended--
            (1) by redesignating subclauses (II) and (III) as 
        subclauses (V) and (VI), respectively; and
            (2) by inserting after subclause (I) the following:
                                    ``(II) to the extent practicable, 
                                reviewing cases of severe maternal 
                                morbidity, according to the most up-to-
                                date indicators;
                                    ``(III) to the extent practicable, 
                                reviewing deaths during pregnancy or up 
                                to 1 year after the end of a pregnancy 
                                from suicide, overdose, or other death 
                                from a mental health condition or 
                                substance use disorder attributed to, 
                                or aggravated by, pregnancy or 
                                childbirth complications;
                                    ``(IV) to the extent practicable, 
                                consulting with local community-based 
                                organizations representing pregnant and 
                                postpartum individuals from demographic 
                                groups disproportionately impacted by 
                                poor maternal health outcomes to ensure 
                                that, in addition to clinical factors, 
                                non-clinical factors that might have 
                                contributed to a pregnancy-related 
                                death are appropriately considered;''.
    (d) Review of Maternal Health Data Collection Processes and Quality 
Measures.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the Administrator for Centers for 
        Medicare & Medicaid Serves and the Director of the Agency for 
        Healthcare Research and Quality, shall consult with relevant 
        stakeholders--
                    (A) to review existing maternal health data 
                collection processes and quality measures; and
                    (B) make recommendations to improve such processes 
                and measures, including topics described under 
                paragraph (3).
            (2) Collaboration.--In carrying out this subsection, the 
        Secretary shall consult with a diverse group of maternal health 
        stakeholders, which may include--
                    (A) pregnant and postpartum individuals and their 
                family members, and nonprofit organizations 
                representing such individuals, with a particular focus 
                on patients from racial and ethnic minority groups;
                    (B) community-based organizations that provide 
                support for pregnant and postpartum individuals, with a 
                particular focus on patients from racial and ethnic 
                minority groups;
                    (C) membership organizations for maternity care 
                providers;
                    (D) organizations representing perinatal health 
                workers;
                    (E) organizations that focus on maternal mental or 
                behavioral health;
                    (F) organizations that focus on intimate partner 
                violence;
                    (G) institutions of higher education, with a 
                particular focus on minority-serving institutions;
                    (H) licensed and accredited hospitals, birth 
                centers, midwifery practices, or other medical 
                practices that provide maternal health care services to 
                pregnant and postpartum patients;
                    (I) relevant State and local public agencies, 
                including State maternal mortality review committees; 
                and
                    (J) the National Quality Forum, or such other 
                standard-setting organizations specified by the 
                Secretary.
            (3) Topics.--The review of maternal health data collection 
        processes and recommendations to improve such processes and 
        measures required under paragraph (1) shall assess all 
        available relevant information, including information from 
        State-level sources, and shall consider at least the following:
                    (A) Current State and Tribal practices for maternal 
                health, maternal mortality, and severe maternal 
                morbidity data collection and dissemination, including 
                consideration of--
                            (i) the timeliness of processes for 
                        amending a death certificate when new 
                        information pertaining to the death becomes 
                        available to reflect whether the death was a 
                        pregnancy-related death;
                            (ii) relevant data collected with 
                        electronic health records, including data on 
                        race, ethnicity, socioeconomic status, 
                        insurance type, and other relevant demographic 
                        information;
                            (iii) maternal health data collected and 
                        publicly reported by hospitals, health systems, 
                        midwifery practices, and birth centers;
                            (iv) the barriers preventing States from 
                        correlating maternal outcome data with race and 
                        ethnicity data;
                            (v) processes for determining the cause of 
                        a pregnancy-associated death in States that do 
                        not have a maternal mortality review committee;
                            (vi) whether maternal mortality review 
                        committees include multidisciplinary and 
                        diverse membership (as described in section 
                        317K(d)(1)(A) of the Public Health Service Act 
                        (42 U.S.C. 247b-12(d)(1)(A)));
                            (vii) whether members of maternal mortality 
                        review committees participate in trainings on 
                        bias, racism, or discrimination, and the 
                        quality of such trainings;
                            (viii) the extent to which States have 
                        implemented systematic processes of listening 
                        to the stories of pregnant and postpartum 
                        individuals and their family members, with a 
                        particular focus on pregnant and postpartum 
                        individuals from racial and ethnic minority 
                        groups (as such term is defined in section 
                        1707(g)(1) of the Public Health Service Act (42 
                        U.S.C. 300u-6(g)(1))) and their family members, 
                        to fully understand the causes of, and inform 
                        potential solutions to, the maternal mortality 
                        and severe maternal morbidity crisis within 
                        their respective States;
                            (ix) the extent to which maternal mortality 
                        review committees are considering social 
                        determinants of maternal health when examining 
                        the causes of pregnancy-associated and 
                        pregnancy-related deaths;
                            (x) the extent to which maternal mortality 
                        review committees are making actionable 
                        recommendations based on their reviews of 
                        adverse maternal health outcomes and the extent 
                        to which such recommendations are being 
                        implemented by appropriate stakeholders;
                            (xi) the legal and administrative barriers 
                        preventing the collection, collation, and 
                        dissemination of State maternity care data;
                            (xii) the effectiveness of data collection 
                        and reporting processes in separating 
                        pregnancy-associated deaths from pregnancy-
                        related deaths; and
                            (xiii) the current Federal, State, local, 
                        and Tribal funding support for the activities 
                        referred to in clauses (i) through (xii).
                    (B) Whether the funding support referred to in 
                subparagraph (A)(xiii) is adequate for States to carry 
                out optimal data collection and dissemination processes 
                with respect to maternal health, maternal mortality, 
                and severe maternal morbidity.
                    (C) Current quality measures for maternity care, 
                including prenatal measures, labor and delivery 
                measures, and postpartum measures, including topics 
                such as--
                            (i) effective quality measures for 
                        maternity care used by hospitals, health 
                        systems, midwifery practices, birth centers, 
                        health plans, and other relevant entities;
                            (ii) the sufficiency of current outcome 
                        measures used to evaluate maternity care for 
                        driving improved care, experiences, and 
                        outcomes in maternity care payment and delivery 
                        system models;
                            (iii) maternal health quality measures that 
                        other countries effectively use;
                            (iv) validated measures that have been used 
                        for research purposes that could be tested, 
                        refined, and submitted for national 
                        endorsement;
                            (v) barriers preventing maternity care 
                        providers and insurers from implementing 
                        quality measures that are aligned with best 
                        practices;
                            (vi) the frequency with which maternity 
                        care quality measures are reviewed and revised;
                            (vii) the strengths and weaknesses of the 
                        Prenatal and Postpartum Care measures of the 
                        Health Plan Employer Data and Information Set 
                        measures established by the National Committee 
                        for Quality Assurance;
                            (viii) the strengths and weaknesses of 
                        maternity care quality measures under the 
                        Medicaid program under title XIX of the Social 
                        Security Act (42 U.S.C. 1396 et seq.) and the 
                        Children's Health Insurance Program under title 
                        XXI of such Act (42 U.S.C. 1397 et seq.), 
                        including the extent to which States 
                        voluntarily report relevant measures;
                            (ix) the extent to which maternity care 
                        quality measures are informed by patient 
                        experiences that include measures of patient-
                        reported experience of care;
                            (x) the current processes for collecting 
                        stratified data on the race and ethnicity of 
                        pregnant and postpartum individuals in 
                        hospitals, health systems, midwifery practices, 
                        and birth centers, and for incorporating such 
                        racially and ethnically stratified data in 
                        maternity care quality measures;
                            (xi) the extent to which maternity care 
                        quality measures account for the unique 
                        experiences of pregnant and postpartum 
                        individuals from racial and ethnic minority 
                        groups (as such term is defined in section 
                        1707(g)(1) of the Public Health Service Act (42 
                        U.S.C. 300u-6(g)(1))); and
                            (xii) the extent to which hospitals, health 
                        systems, midwifery practices, and birth centers 
                        are implementing existing maternity care 
                        quality measures.
                    (D) Recommendations on authorizing additional funds 
                and providing additional technical assistance to 
                improve maternal mortality review committees and State 
                and Tribal maternal health data collection and 
                reporting processes.
                    (E) Recommendations for new authorities that may be 
                granted to maternal mortality review committees to be 
                able to--
                            (i) access records from other Federal and 
                        State agencies and departments that may be 
                        necessary to identify causes of pregnancy-
                        associated and pregnancy-related deaths that 
                        are unique to pregnant and postpartum 
                        individuals from specific populations, such as 
                        veterans and individuals who are incarcerated; 
                        and
                            (ii) work with relevant experts who are not 
                        members of the maternal mortality review 
                        committee to assist in the review of pregnancy-
                        associated deaths of pregnant and postpartum 
                        individuals from specific populations, such as 
                        veterans and individuals who are incarcerated.
                    (F) Recommendations to improve and standardize 
                current quality measures for maternity care, with a 
                particular focus on racial and ethnic inequities in 
                maternal health outcomes.
                    (G) Recommendations to improve the coordination by 
                the Department of Health and Human Services of the 
                efforts undertaken by the agencies and organizations 
                within the Department related to maternal health data 
                and quality measures.
            (4) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Secretary shall submit to the 
        Congress, and make publicly available, a report on the results 
        of the review of maternal health data collection processes and 
        quality measures and recommendations to improve such processes 
        and measures required under paragraph (1).
            (5) Definitions.--In this subsection:
                    (A) Maternal mortality review committee.--The term 
                ``maternal mortality review committee'' means a 
                maternal mortality review committee duly authorized by 
                a State and receiving funding under section 
                317k(a)(2)(D) of the Public Health Service Act (42 
                U.S.C. 247b-12(a)(2)(D)).
                    (B) Pregnancy-associated death.--The term 
                ``pregnancy-associated'', with respect to a death, 
                means a death of a pregnant or postpartum individual, 
                by any cause, that occurs during, or within 1 year 
                following, the individual's pregnancy, regardless of 
                the outcome, duration, or site of the pregnancy.
                    (C) Pregnancy-related death.--The term ``pregnancy-
                related'', with respect to a death, means a death of a 
                pregnant or postpartum individual that occurs during, 
                or within 1 year following, the individual's pregnancy, 
                from a pregnancy complication, a chain of events 
                initiated by pregnancy, or the aggravation of an 
                unrelated condition by the physiologic effects of 
                pregnancy.
            (6) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to carry out 
        this subsection for each of fiscal years 2023 through 2027.
    (e) Indian Health Service Study on Maternal Mortality and Severe 
Maternal Morbidity.--
            (1) In general.--The Director of the Indian Health Service 
        (referred to in this subsection as the ``Director'') shall, in 
        coordination with entities described in paragraph (2)--
                    (A) not later than 90 days after the enactment of 
                this Act, enter into a contract with an independent 
                research organization or Tribal Epidemiology Center to 
                conduct a comprehensive study on maternal mortality and 
                severe maternal morbidity in the populations of 
                American Indian and Alaska Native individuals; and
                    (B) not later than 3 years after the date of the 
                enactment of this Act, submit to Congress a report on 
                such study that contains recommendations for policies 
                and practices that can be adopted to improve maternal 
                health outcomes for pregnant and postpartum American 
                Indian and Alaska Native individuals.
            (2) Participating entities.--The entities described in this 
        paragraph shall consist of 12 members, selected by the Director 
        from among individuals nominated by Indian Tribes and Tribal 
        organizations (as such terms are defined in section 4 of the 
        Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 5304)), and Urban Indian organizations (as such term is 
        defined in section 4 of the Indian Health Care Improvement Act 
        (25 U.S.C. 1603)). In selecting such members, the Director 
        shall ensure that each of the 12 service areas of the Indian 
        Health Service is represented.
            (3) Contents of study.--The study conducted pursuant to 
        paragraph (1) shall--
                    (A) examine the causes of maternal mortality and 
                severe maternal morbidity that are unique to American 
                Indian and Alaska Native individuals;
                    (B) include a systematic process of listening to 
                the stories of American Indian and Alaska Native 
                pregnant and postpartum individuals to fully understand 
                the causes of, and inform potential solutions to, the 
                maternal mortality and severe maternal morbidity crisis 
                within their respective communities;
                    (C) distinguish between the causes of, landscape of 
                maternity care at, and recommendations to improve 
                maternal health outcomes within, the different settings 
                in which American Indian and Alaska Native pregnant and 
                postpartum individuals receive maternity care, such 
                as--
                            (i) facilities operated by the Indian 
                        Health Service;
                            (ii) an Indian health program operated by 
                        an Indian Tribe or Tribal organization pursuant 
                        to a contract, grant, cooperative agreement, or 
                        compact with the Indian Health Service pursuant 
                        to the Indian Self-Determination Act; and
                            (iii) an Urban Indian health program 
                        operated by an Urban Indian organization 
                        pursuant to a grant or contract with the Indian 
                        Health Service pursuant to title V of the 
                        Indian Health Care Improvement Act;
                    (D) review processes for coordinating programs of 
                the Indian Health Service with social services provided 
                through other programs administered by the Secretary of 
                Health and Human Services (other than the Medicare 
                program under title XVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.), the Medicaid program under 
                title XIX of such Act (42 U.S.C. 1396 et seq.), and the 
                Children's Health Insurance Program under title XXI of 
                such Act (42 U.S.C. 1397aa et seq.));
                    (E) review current data collection and quality 
                measurement processes and practices;
                    (F) assess causes and frequency of maternal mental 
                health conditions and substance use disorders;
                    (G) consider social determinants of health, 
                including poverty, lack of health insurance, 
                unemployment, sexual violence, and environmental 
                conditions in Tribal areas;
                    (H) consider the role that historical mistreatment 
                of American Indian and Alaska Native people has played 
                in causing currently high rates of maternal mortality 
                and severe maternal morbidity;
                    (I) consider how current funding of the Indian 
                Health Service affects the ability of the Service to 
                deliver quality maternity care;
                    (J) consider the extent to which the delivery of 
                maternity care services is culturally appropriate for 
                American Indian and Alaska Native pregnant and 
                postpartum individuals;
                    (K) make recommendations to reduce 
                misclassification of American Indian and Alaska Native 
                pregnant and postpartum individuals, including 
                consideration of best practices in training for 
                maternal mortality review committee members to be able 
                to correctly classify American Indian and Alaska Native 
                individuals; and
                    (L) make recommendations informed by the stories 
                shared by American Indian and Alaska Native pregnant 
                and postpartum individuals pursuant to subparagraph (B) 
                to improve maternal health outcomes for such 
                individuals.
            (4) Report.--The agreement entered into under paragraph (1) 
        with an independent research organization or Tribal 
        Epidemiology Center shall require that the organization or 
        center transmit to Congress a report on the results of the 
        study conducted pursuant to that agreement not later than 36 
        months after the date of the enactment of this Act.
            (5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $2,000,000 for 
        each of fiscal years 2023 through 2025.
    (f) Grants to Minority-Serving Institutions To Study Maternal 
Mortality, Severe Maternal Morbidity, and Other Adverse Maternal Health 
Outcomes.--
            (1) In general.--The Secretary of Health and Human Services 
        shall establish a program under which the Secretary shall award 
        grants to research centers, health professions schools and 
        programs, and other entities at minority-serving institutions 
        to study specific aspects of the maternal health crisis among 
        pregnant and postpartum individuals from racial and ethnic 
        minority groups. Such research may--
                    (A) include the development and implementation of 
                systematic processes of listening to the stories of 
                pregnant and postpartum individuals from racial and 
                ethnic minority groups, and perinatal health workers 
                supporting such individuals, to fully understand the 
                causes of, and inform potential solutions to, the 
                maternal mortality and severe maternal morbidity crisis 
                within their respective communities;
                    (B) assess the potential causes of relatively low 
                rates of maternal mortality among Hispanic individuals, 
                including potential racial misclassification and other 
                data collection and reporting issues that might be 
                misrepresenting maternal mortality rates among Hispanic 
                individuals in the United States; and
                    (C) assess differences in rates of adverse maternal 
                health outcomes among subgroups identifying as 
                Hispanic.
            (2) Application.--To be eligible to receive a grant under 
        paragraph (1), an entity described in such paragraph shall 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
            (3) Technical assistance.--The Secretary may use not more 
        than 10 percent of the funds made available under paragraph 
        (7)--
                    (A) to conduct outreach to minority-serving 
                institutions to raise awareness of the availability of 
                grants under this paragraph (1);
                    (B) to provide technical assistance in the 
                application process for such a grant; and
                    (C) to promote capacity building, as needed to 
                enable entities described in such paragraph to submit 
                such an application.
            (4) Reporting requirement.--Each entity awarded a grant 
        under this subsection shall periodically submit to the 
        Secretary a report on the status of activities conducted using 
        the grant.
            (5) Evaluation.--Beginning one year after the date on which 
        the first grant is awarded under this subsection, the Secretary 
        shall submit to Congress an annual report summarizing the 
        findings of research conducted using funds made available under 
        this subsection.
            (6) Minority-serving institutions defined.--In this 
        subsection, the term ``minority-serving institution'' has the 
        meaning given the term in section 371(a) of the Higher 
        Education Act of 1965 (20 U.S.C. 1067q(a)).
            (7) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2023 through 2027.
    (g) Definitions.--In this section:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (5) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (6) Pregnancy-associated death.--The term ``pregnancy-
        associated death'' means a death of a pregnant or postpartum 
        individual, by any cause, that occurs during, or within 1 year 
        following, the individual's pregnancy, regardless of the 
        outcome, duration, or site of the pregnancy.
            (7) Pregnancy-related death.--The term ``pregnancy-related 
        death'' means a death of a pregnant or postpartum individual 
        that occurs during, or within 1 year following, the 
        individual's pregnancy, from a pregnancy complication, a chain 
        of events initiated by pregnancy, or the aggravation of an 
        unrelated condition by the physiologic effects of pregnancy.
            (8) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (9) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (10) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.

SEC. 5209. KIRA JOHNSON ACT.

    (a) Investments in Community-Based Organizations To Improve Black 
Maternal Health Outcomes.--
            (1) Awards.--Following the 1-year period described in 
        paragraph (3), the Secretary of Health and Human Services (in 
        this subsection referred to as the ``Secretary'') shall award 
        grants to eligible entities to establish or expand programs to 
        prevent maternal mortality and severe maternal morbidity among 
        Black pregnant and postpartum individuals.
            (2) Eligibility.--To be eligible to seek a grant under this 
        subsection, an entity shall be a community-based organization 
        offering programs and resources aligned with evidence-based 
        practices for improving maternal health outcomes for Black 
        pregnant and postpartum individuals.
            (3) Outreach and technical assistance period.--During the 
        1-year period beginning on the date of enactment of this Act, 
        the Secretary shall--
                    (A) conduct outreach to encourage eligible entities 
                to apply for grants under this subsection; and
                    (B) provide technical assistance to eligible 
                entities on best practices for applying for grants 
                under this subsection.
            (4) Special consideration.--
                    (A) Outreach.--In conducting outreach under 
                paragraph (3), the Secretary shall give special 
                consideration to eligible entities that--
                            (i) are based in, and provide support for, 
                        communities with high rates of adverse maternal 
                        health outcomes or significant racial and 
                        ethnic inequities in maternal health outcomes, 
                        to the extent such data are available;
                            (ii) are led by Black people; and
                            (iii) offer programs and resources that are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for Black 
                        pregnant and postpartum individuals.
                    (B) Awards.--In awarding grants under this 
                subsection, the Secretary shall give special 
                consideration to eligible entities that--
                            (i) are described in clauses (i), (ii), and 
                        (iii) of subparagraph (A);
                            (ii) offer programs and resources designed 
                        in consultation with and intended for Black 
                        pregnant and postpartum individuals; and
                            (iii) offer programs and resources in the 
                        communities in which the respective eligible 
                        entities are located that--
                                    (I) promote maternal mental health 
                                and maternal substance use disorder 
                                treatments and supports that are 
                                aligned with evidence-based practices 
                                for improving maternal mental and 
                                behavioral health outcomes for Black 
                                pregnant and postpartum individuals;
                                    (II) address social determinants of 
                                maternal health for pregnant and 
                                postpartum individuals;
                                    (III) promote evidence-based health 
                                literacy and pregnancy, childbirth, and 
                                parenting education for pregnant and 
                                postpartum individuals;
                                    (IV) provide support from perinatal 
                                health workers to pregnant and 
                                postpartum individuals;
                                    (V) provide culturally congruent 
                                training to perinatal health workers;
                                    (VI) conduct or support research on 
                                maternal health issues 
                                disproportionately impacting Black 
                                pregnant and postpartum individuals;
                                    (VII) provide support to family 
                                members of individuals who suffered a 
                                pregnancy-associated death or 
                                pregnancy-related death; or
                                    (VIII) operate midwifery practices 
                                that provide culturally congruent 
                                maternal health care and support, 
                                including for the purposes of--
                                            (aa) supporting additional 
                                        education, training, and 
                                        certification programs, 
                                        including support for distance 
                                        learning;
                                            (bb) providing financial 
                                        support to current and future 
                                        midwives to address education 
                                        costs, debts, and other needs;
                                            (cc) clinical site 
                                        investments;
                                            (dd) supporting preceptor 
                                        development trainings;
                                            (ee) expanding the 
                                        midwifery practice; or
                                            (ff) related needs 
                                        identified by the midwifery 
                                        practice and described in the 
                                        practice's application; or
                                    (IX) have developed other programs 
                                and resources that address community-
                                specific needs for pregnant and 
                                postpartum individuals and are aligned 
                                with evidence-based practices for 
                                improving maternal health outcomes for 
                                Black pregnant and postpartum 
                                individuals.
            (5) Technical assistance.--The Secretary shall provide to 
        grant recipients under this subsection technical assistance 
        on--
                    (A) capacity building to establish or expand 
                programs to prevent adverse maternal health outcomes 
                among Black pregnant and postpartum individuals;
                    (B) best practices in data collection, measurement, 
                evaluation, and reporting; and
                    (C) planning for sustaining programs to prevent 
                maternal mortality and severe maternal morbidity among 
                Black pregnant and postpartum individuals after the 
                period of the grant.
            (6) Evaluation.--Not later than the end of fiscal year 
        2026, the Secretary shall submit to the Congress an evaluation 
        of the grant program under this subsection that--
                    (A) assesses the effectiveness of outreach efforts 
                during the application process in diversifying the pool 
                of grant recipients;
                    (B) makes recommendations for future outreach 
                efforts to diversify the pool of grant recipients for 
                Department of Health and Human Services grant programs 
                and funding opportunities related to maternal health;
                    (C) assesses the effectiveness of programs funded 
                by grants under this subsection in improving maternal 
                health outcomes for Black pregnant and postpartum 
                individuals, to the extent practicable; and
                    (D) makes recommendations for future Department of 
                Health and Human Services grant programs and funding 
                opportunities that deliver funding to community-based 
                organizations that provide programs and resources that 
                are aligned with evidence-based practices for improving 
                maternal health outcomes for Black pregnant and 
                postpartum individuals.
            (7) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $10,000,000 
        for each of fiscal years 2023 through 2027.
    (b) Investments in Community-Based Organizations To Improve 
Maternal Health Outcomes in Underserved Communities.--
            (1) Awards.--Following the 1-year period described in 
        paragraph (3), the Secretary of Health and Human Services (in 
        this subsection referred to as the ``Secretary'') shall award 
        grants to eligible entities to establish or expand programs to 
        prevent maternal mortality and severe maternal morbidity among 
        underserved groups.
            (2) Eligibility.--To be eligible to seek a grant under this 
        subsection, an entity shall be a community-based organization 
        offering programs and resources aligned with evidence-based 
        practices for improving maternal health outcomes for pregnant 
        and postpartum individuals.
            (3) Outreach and technical assistance period.--During the 
        1-year period beginning on the date of enactment of this Act, 
        the Secretary shall--
                    (A) conduct outreach to encourage eligible entities 
                to apply for grants under this subsection; and
                    (B) provide technical assistance to eligible 
                entities on best practices for applying for grants 
                under this subsection.
            (4) Special consideration.--
                    (A) Outreach.--In conducting outreach under 
                paragraph (3), the Secretary shall give special 
                consideration to eligible entities that--
                            (i) are based in, and provide support for, 
                        communities with high rates of adverse maternal 
                        health outcomes or significant racial and 
                        ethnic inequities in maternal health outcomes, 
                        to the extent such data are available;
                            (ii) are led by individuals from racially, 
                        ethnically, and geographically diverse 
                        backgrounds; and
                            (iii) offer programs and resources that are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for pregnant 
                        and postpartum individuals.
                    (B) Awards.--In awarding grants under this 
                subsection, the Secretary shall give special 
                consideration to eligible entities that--
                            (i) are described in clauses (i), (ii), and 
                        (iii) of subparagraph (A);
                            (ii) offer programs and resources designed 
                        in consultation with and intended for pregnant 
                        and postpartum individuals from underserved 
                        groups; and
                            (iii) offer programs and resources in the 
                        communities in which the respective eligible 
                        entities are located that--
                                    (I) promote maternal mental health 
                                and maternal substance use disorder 
                                treatments and support that are aligned 
                                with evidence-based practices for 
                                improving maternal mental and 
                                behavioral health outcomes for pregnant 
                                and postpartum individuals;
                                    (II) address social determinants of 
                                maternal health for pregnant and 
                                postpartum individuals;
                                    (III) promote evidence-based health 
                                literacy and pregnancy, childbirth, and 
                                parenting education for pregnant and 
                                postpartum individuals;
                                    (IV) provide support from perinatal 
                                health workers to pregnant and 
                                postpartum individuals;
                                    (V) provide culturally congruent 
                                training to perinatal health workers;
                                    (VI) conduct or support research on 
                                maternal health outcomes and 
                                inequities;
                                    (VII) provide support to family 
                                members of individuals who suffered a 
                                pregnancy-associated death or 
                                pregnancy-related death; or
                                    (VIII) operate midwifery practices 
                                that provide culturally congruent 
                                maternal health care and support, 
                                including for the purposes of--
                                            (aa) supporting additional 
                                        education, training, and 
                                        certification programs, 
                                        including support for distance 
                                        learning;
                                            (bb) providing financial 
                                        support to current and future 
                                        midwives to address education 
                                        costs, debts, and other needs;
                                            (cc) clinical site 
                                        investments;
                                            (dd) supporting preceptor 
                                        development trainings;
                                            (ee) expanding the 
                                        midwifery practice; or
                                            (ff) related needs 
                                        identified by the midwifery 
                                        practice and described in the 
                                        practice's application; or
                            (iv) have developed other programs and 
                        resources that address community-specific needs 
                        for pregnant and postpartum individuals and are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for pregnant 
                        and postpartum individuals.
            (5) Technical assistance.--The Secretary shall provide to 
        grant recipients under this subsection technical assistance 
        on--
                    (A) capacity building to establish or expand 
                programs to prevent adverse maternal health outcomes 
                among pregnant and postpartum individuals from 
                underserved groups;
                    (B) best practices in data collection, measurement, 
                evaluation, and reporting; and
                    (C) planning for sustaining programs to prevent 
                maternal mortality and severe maternal morbidity among 
                pregnant and postpartum individuals from underserved 
                groups after the period of the grant.
            (6) Evaluation.--Not later than the end of fiscal year 
        2026, the Secretary shall submit to the Congress an evaluation 
        of the grant program under this subsection that--
                    (A) assesses the effectiveness of outreach efforts 
                during the application process in diversifying the pool 
                of grant recipients;
                    (B) makes recommendations for future outreach 
                efforts to diversify the pool of grant recipients for 
                Department of Health and Human Services grant programs 
                and funding opportunities related to maternal health;
                    (C) assesses the effectiveness of programs funded 
                by grants under this subsection in improving maternal 
                health outcomes for pregnant and postpartum individuals 
                from underserved groups, to the extent practicable; and
                    (D) makes recommendations for future Department of 
                Health and Human Services grant programs and funding 
                opportunities that deliver funding to community-based 
                organizations that provide programs and resources that 
                are aligned with evidence-based practices for improving 
                maternal health outcomes for pregnant and postpartum 
                individuals.
            (7) Definition.--In this subsection, the term ``underserved 
        groups'' refers to pregnant and postpartum individuals--
                    (A) from racial and ethnic minority groups (as such 
                term is defined in section 1707(g)(1) of the Public 
                Health Service Act (42 U.S.C. 300u-6(g)(1)));
                    (B) whose household income is equal to or less than 
                150 percent of the Federal poverty line;
                    (C) who live in health professional shortage areas 
                (as such term is defined in section 332 of the Public 
                Health Service Act (42 U.S.C. 254e));
                    (D) who live in counties with no hospital offering 
                obstetric care, no birth center, and no obstetric 
                provider; or
                    (E) who live in counties with a level of 
                vulnerability of moderate-to-high or higher, according 
                to the Social Vulnerability Index of the Centers for 
                Disease Control and Prevention.
            (8) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $10,000,000 
        for each of fiscal years 2023 through 2027.
    (c) Respectful Maternity Care Training for All Employees in 
Maternity Care Settings.--Part B of title VII of the Public Health 
Service Act (42 U.S.C. 293 et seq.) is amended by adding at the end the 
following new section:

``SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN 
              MATERNITY CARE SETTINGS.

    ``(a) Grants.--The Secretary shall award grants for programs to 
reduce and prevent bias, racism, and discrimination in maternity care 
settings and to advance respectful, culturally congruent, trauma-
informed care.
    ``(b) Special Consideration.--In awarding grants under subsection 
(a), the Secretary shall give special consideration to applications for 
programs that would--
            ``(1) apply to all maternity care providers and any 
        employees who interact with pregnant and postpartum individuals 
        in the provider setting, including front desk employees, 
        sonographers, schedulers, health care professionals, hospital 
        or health system administrators, security staff, and other 
        employees;
            ``(2) emphasize periodic, as opposed to one-time, trainings 
        for all birthing professionals and employees described in 
        paragraph (1);
            ``(3) address implicit bias, racism, and cultural humility;
            ``(4) be delivered in ongoing education settings for 
        providers maintaining their licenses, with a preference for 
        trainings that provide continuing education units;
            ``(5) include trauma-informed care best practices and an 
        emphasis on shared decision making between providers and 
        patients;
            ``(6) include antiracism training and programs;
            ``(7) be delivered in undergraduate programs that funnel 
        into health professions schools;
            ``(8) be delivered in settings that apply to providers of 
        the special supplemental nutrition program for women, infants, 
        and children under section 17 of the Child Nutrition Act of 
        1966;
            ``(9) integrate bias training in obstetric emergency 
        simulation trainings or related trainings;
            ``(10) include training for emergency department employees 
        and emergency medical technicians on recognizing warning signs 
        for severe pregnancy-related complications;
            ``(11) offer training to all maternity care providers on 
        the value of racially, ethnically, and professionally diverse 
        maternity care teams to provide culturally congruent care; or
            ``(12) be based on one or more programs designed by a 
        historically Black college or university or other minority-
        serving institution.
    ``(c) Application.--To seek a grant under subsection (a), an entity 
shall submit an application at such time, in such manner, and 
containing such information as the Secretary may require.
    ``(d) Reporting to Secretary.--Each recipient of a grant under this 
section shall annually submit to the Secretary a report on the status 
of activities conducted using the grant, including, as applicable, a 
description of the impact of training provided through the grant on 
patient outcomes and patient experience for pregnant and postpartum 
individuals from racial and ethnic minority groups and their families.
    ``(e) Dissemination of Findings.--Based on the annual reports 
submitted pursuant to subsection (d), the Secretary--
            ``(1) shall produce an annual report on the findings 
        resulting from programs funded through this section;
            ``(2) shall disseminate such report to all recipients of 
        grants under this section and to the public; and
            ``(3) may include in such report findings on best practices 
        for improving patient outcomes and patient experience for 
        pregnant and postpartum individuals from racial and ethnic 
        minority groups and their families in maternity care settings.
    ``(f) Definitions.--In this section:
            ``(1) The term `postpartum' means the one-year period 
        beginning on the last day of an individual's pregnancy.
            ``(2) The term `culturally congruent' means in agreement 
        with the preferred cultural values, beliefs, world view, 
        language, and practices of the health care consumer and other 
        stakeholders.
            ``(3) The term `maternity care provider' means a health 
        care provider who--
                    ``(A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    ``(B) has a focus on maternal or perinatal health.
            ``(4) The term `racial and ethnic minority group' has the 
        meaning given such term in section 1707(g)(1).
    ``(g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2023 through 2027.''.
    (d) Study on Reducing and Preventing Bias, Racism, and 
Discrimination in Maternity Care Settings.--
            (1) In general.--The Secretary of Health and Human Services 
        shall seek to enter into an agreement, not later than 90 days 
        after the date of enactment of this Act, with the National 
        Academies of Sciences, Engineering, and Medicine (referred to 
        in this subsection as the ``National Academies'') under which 
        the National Academies agree to--
                    (A) conduct a study on the design and 
                implementation of programs to reduce and prevent bias, 
                racism, and discrimination in maternity care settings 
                and to advance respectful, culturally congruent, 
                trauma-informed care; and
                    (B) not later than 24 months after the date of the 
                enactment of this Act--
                            (i) complete the study; and
                            (ii) transmit a report on the results of 
                        the study to the Congress.
            (2) Possible topics.--The agreement entered into pursuant 
        to paragraph (1) may provide for the study of any of the 
        following:
                    (A) The development of a scorecard or other 
                evaluation standards for programs designed to reduce 
                and prevent bias, racism, and discrimination in 
                maternity care settings to assess the effectiveness of 
                such programs in improving patient outcomes and patient 
                experience for pregnant and postpartum individuals from 
                racial and ethnic minority groups and their families.
                    (B) Determination of the types and frequency of 
                training to reduce and prevent bias, racism, and 
                discrimination in maternity care settings that are 
                demonstrated to improve patient outcomes or patient 
                experience for pregnant and postpartum individuals from 
                racial and ethnic minority groups and their families.
    (e) Respectful Maternity Care Compliance Program.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this subsection as the ``Secretary'') shall 
        award grants to accredited hospitals, health systems, and other 
        maternity care settings to establish as an integral part of 
        quality implementation initiatives within one or more hospitals 
        or other birth settings a respectful maternity care compliance 
        program.
            (2) Program requirements.--A respectful maternity care 
        compliance program funded through a grant under this subsection 
        shall--
                    (A) institutionalize mechanisms to allow patients 
                receiving maternity care services, the families of such 
                patients, or perinatal health workers supporting such 
                patients to report instances of racism or evidence of 
                bias on the basis of race, ethnicity, or another 
                protected class;
                    (B) institutionalize response mechanisms through 
                which representatives of the program can directly 
                follow up with the patient, if possible, and the 
                patient's family in a timely manner;
                    (C) prepare, and make publicly available, a 
                hospital- or health system-wide strategy to reduce bias 
                on the basis of race, ethnicity, or another protected 
                class in the delivery of maternity care that includes--
                            (i) information on the training programs to 
                        reduce and prevent bias, racism, and 
                        discrimination on the basis of race, ethnicity, 
                        or another protected class for all employees in 
                        maternity care settings;
                            (ii) information on the number of cases 
                        reported to the compliance program; and
                            (iii) the development of methods to 
                        routinely assess the extent to which bias, 
                        racism, or discrimination on the basis of race, 
                        ethnicity, or another protected class are 
                        present in the delivery of maternity care to 
                        patients from racial and ethnic minority 
                        groups; and
                    (D) develop mechanisms to routinely collect and 
                publicly report hospital-level data related to patient-
                reported experience of care; and
                    (E) provide annual reports to the Secretary with 
                information about each case reported to the compliance 
                program over the course of the year containing such 
                information as the Secretary may require, such as--
                            (i) de-identified demographic information 
                        on the patient in the case, such as race, 
                        ethnicity, gender identity, and primary 
                        language;
                            (ii) the content of the report from the 
                        patient or the family of the patient to the 
                        compliance program;
                            (iii) the response from the compliance 
                        program; and
                            (iv) to the extent applicable, 
                        institutional changes made as a result of the 
                        case.
            (3) Secretary requirements.--
                    (A) Processes.--Not later than 180 days after the 
                date of the enactment of this Act, the Secretary shall 
                establish processes for--
                            (i) disseminating best practices for 
                        establishing and implementing a respectful 
                        maternity care compliance program within a 
                        hospital or other birth setting;
                            (ii) promoting coordination and 
                        collaboration between hospitals, health 
                        systems, and other maternity care delivery 
                        settings on the establishment and 
                        implementation of respectful maternity care 
                        compliance programs; and
                            (iii) evaluating the effectiveness of 
                        respectful maternity care compliance programs 
                        on maternal health outcomes and patient and 
                        family experiences, especially for patients 
                        from racial and ethnic minority groups and 
                        their families.
                    (B) Study.--
                            (i) In general.--Not later than 2 years 
                        after the date of the enactment of this Act, 
                        the Secretary shall, through a contract with an 
                        independent research organization, conduct a 
                        study on strategies to address--
                                    (I) racism or bias on the basis of 
                                race, ethnicity, or another protected 
                                class in the delivery of maternity care 
                                services; and
                                    (II) successful implementation of 
                                respectful care initiatives.
                            (ii) Components of study.--The study shall 
                        include the following:
                                    (I) An assessment of the reports 
                                submitted to the Secretary from the 
                                respectful maternity care compliance 
                                programs pursuant to paragraph (2)(E).
                                    (II) Based on such assessment, 
                                recommendations for potential 
                                accountability mechanisms related to 
                                cases of racism or bias on the basis of 
                                race, ethnicity, or another protected 
                                class in the delivery of maternity care 
                                services at hospitals and other birth 
                                settings. Such recommendations shall 
                                take into consideration medical and 
                                non-medical factors that contribute to 
                                adverse patient experiences and 
                                maternal health outcomes.
                            (iii) Report.--The Secretary shall submit 
                        to the Congress, and make publicly available, a 
                        report on the results of the study under this 
                        subparagraph.
            (4) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated such sums as 
        may be necessary for fiscal years 2023 through 2028.
    (f) GAO Report.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this Act and annually thereafter, the Comptroller 
        General of the United States shall submit to the Congress, and 
        make publicly available, a report on the establishment of 
        respectful maternity care compliance programs within hospitals, 
        health systems, and other maternity care settings.
            (2) Matters included.--The report under paragraph (1) shall 
        include the following:
                    (A) Information regarding the extent to which 
                hospitals, health systems, and other maternity care 
                settings have elected to establish respectful maternity 
                care compliance programs, including--
                            (i) which hospitals and other birth 
                        settings elect to establish compliance programs 
                        and when such programs are established;
                            (ii) to the extent practicable, impacts of 
                        the establishment of such programs on maternal 
                        health outcomes and patient and family 
                        experiences in the hospitals and other birth 
                        settings that have established such programs, 
                        especially for patients from racial and ethnic 
                        minority groups and their families;
                            (iii) information on geographic areas, and 
                        types of hospitals or other birth settings, 
                        where respectful maternity care compliance 
                        programs are not being established and 
                        information on factors contributing to 
                        decisions to not establish such programs; and
                            (iv) recommendations for establishing 
                        respectful maternity care compliance programs 
                        in geographic areas, and types of hospitals or 
                        other birth settings, where such programs are 
                        not being established.
                    (B) Whether the funding made available to carry out 
                this subsection has been sufficient and, if applicable, 
                recommendations for additional appropriations to carry 
                out this subsection.
                    (C) Such other information as the Comptroller 
                General determines appropriate.
    (g) Definitions.--In this section:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (5) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (6) Pregnancy-associated death.--The term ``pregnancy-
        associated death'' means a death of a pregnant or postpartum 
        individual, by any cause, that occurs during, or within 1 year 
        following, the individual's pregnancy, regardless of the 
        outcome, duration, or site of the pregnancy.
            (7) Pregnancy-related death.--The term ``pregnancy-related 
        death'' means a death of a pregnant or postpartum individual 
        that occurs during, or within 1 year following, the 
        individual's pregnancy, from a pregnancy complication, a chain 
        of events initiated by pregnancy, or the aggravation of an 
        unrelated condition by the physiologic effects of pregnancy.
            (8) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (9) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (10) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.

SEC. 5210. MOMS MATTER.

    (a) Maternal Mental Health Equity Grant Program.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the Assistant Secretary for Mental 
        Health and Substance Use, shall establish a program to award 
        grants to eligible entities to address maternal mental health 
        conditions and substance use disorders with respect to pregnant 
        and postpartum individuals, with a focus on racial and ethnic 
        minority groups.
            (2) Application.--To be eligible to receive a grant under 
        this subsection, an eligible entity shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may provide, 
        including how such entity will use funds for activities 
        described in paragraph (4) that are culturally congruent.
            (3) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to an eligible entity that--
                    (A) is, or will partner with, a community-based 
                organization to address maternal mental health 
                conditions and substance use disorders described in 
                paragraph (1);
                    (B) is operating in an area with high rates of--
                            (i) adverse maternal health outcomes; or
                            (ii) significant racial or ethnic 
                        inequities in maternal health outcomes; and
                    (C) is operating in a health professional shortage 
                area designated under section 332 of the Public Health 
                Service Act (42 U.S.C. 254e).
            (4) Use of funds.--An eligible entity that receives a grant 
        under this subsection shall use funds for the following:
                    (A) Establishing or expanding maternity care 
                programs to improve the integration of maternal health 
                and behavioral health care services into primary care 
                settings where pregnant individuals regularly receive 
                health care services.
                    (B) Establishing or expanding group prenatal care 
                programs or postpartum care programs.
                    (C) Expanding existing programs that improve 
                maternal mental and behavioral health during the 
                prenatal and postpartum periods, with a focus on 
                individuals from racial and ethnic minority groups.
                    (D) Providing services and support for pregnant and 
                postpartum individuals with maternal mental health 
                conditions and substance use disorders, including 
                referrals to addiction treatment centers that offer 
                evidence-based treatment options.
                    (E) Addressing stigma associated with maternal 
                mental health conditions and substance use disorders, 
                with a focus on racial and ethnic minority groups.
                    (F) Raising awareness of warning signs of maternal 
                mental health conditions and substance use disorders, 
                with a focus on pregnant and postpartum individuals 
                from racial and ethnic minority groups.
                    (G) Establishing or expanding programs to prevent 
                suicide or self-harm among pregnant and postpartum 
                individuals.
                    (H) Offering evidence-aligned programs at 
                freestanding birth centers that provide maternal mental 
                and behavioral health care education, treatments, and 
                services, and other services for individuals throughout 
                the prenatal and postpartum period.
                    (I) Establishing or expanding programs to provide 
                education and training to maternity care providers with 
                respect to--
                            (i) identifying potential warning signs for 
                        maternal mental health conditions or substance 
                        use disorders in pregnant and postpartum 
                        individuals, with a focus on individuals from 
                        racial and ethnic minority groups; and
                            (ii) in the case where such providers 
                        identify such warning signs, offering referrals 
                        to mental and behavioral health care 
                        professionals.
                    (J) Developing a website, or other source, that 
                includes information on health care providers who treat 
                maternal mental health conditions and substance use 
                disorders.
                    (K) Establishing or expanding programs in 
                communities to improve coordination between maternity 
                care providers and mental and behavioral health care 
                providers who treat maternal mental health conditions 
                and substance use disorders, including through the use 
                of toll-free hotlines.
                    (L) Carrying out other programs aligned with 
                evidence-based practices for addressing maternal mental 
                health conditions and substance use disorders for 
                pregnant and postpartum individuals from racial and 
                ethnic minority groups.
            (5) Reporting.--
                    (A) Eligible entities.--An eligible entity that 
                receives a grant under paragraph (1) shall submit 
                annually to the Secretary, and make publicly available, 
                a report on the activities conducted using funds 
                received through a grant under this subsection. Such 
                reports shall include quantitative and qualitative 
                evaluations of such activities, including the 
                experience of individuals who received health care 
                through such grant.
                    (B) Secretary.--Not later than the end of fiscal 
                year 2024, the Secretary shall submit to Congress a 
                report that includes--
                            (i) a summary of the reports received under 
                        subparagraph (A);
                            (ii) an evaluation of the effectiveness of 
                        grants awarded under this subsection;
                            (iii) recommendations with respect to 
                        expanding coverage of evidence-based screenings 
                        and treatments for maternal mental health 
                        conditions and substance use disorders; and
                            (iv) recommendations with respect to 
                        ensuring activities described under paragraph 
                        (4) continue after the end of a grant period.
            (6) Definitions.--In this subsection:
                    (A) Eligible entity.--The term ``eligible entity'' 
                means--
                            (i) a community-based organization serving 
                        pregnant and postpartum individuals, including 
                        such organizations serving individuals from 
                        racial and ethnic minority groups and other 
                        underserved populations;
                            (ii) a nonprofit or patient advocacy 
                        organization with expertise in maternal mental 
                        and behavioral health;
                            (iii) a maternity care provider;
                            (iv) a mental or behavioral health care 
                        provider who treats maternal mental health 
                        conditions or substance use disorders;
                            (v) a State or local governmental entity, 
                        including a State or local public health 
                        department;
                            (vi) an Indian Tribe or Tribal organization 
                        (as such terms are defined in section 4 of the 
                        Indian Self-Determination and Education 
                        Assistance Act (25 U.S.C. 5304)); and
                            (vii) an Urban Indian organization (as such 
                        term is defined in section 4 of the Indian 
                        Health Care Improvement Act (25 U.S.C. 1603)).
                    (B) Culturally congruent.--The term ``culturally 
                congruent'', with respect to care or maternity care, 
                means care that is in agreement with the preferred 
                cultural values, beliefs, worldview, language, and 
                practices of the health care consumer and other 
                stakeholders.
                    (C) Freestanding birth center.--The term 
                ``freestanding birth center'' has the meaning given 
                that term under section 1905(l) of the Social Security 
                Act (42 U.S.C. 1396d(1)).
                    (D) Maternity care provider.--The term ``maternity 
                care provider'' means a health care provider who--
                            (i) is a physician, physician assistant, 
                        midwife who meets at a minimum the 
                        international definition of the midwife and 
                        global standards for midwifery education as 
                        established by the International Confederation 
                        of Midwives, nurse practitioner, or clinical 
                        nurse specialist; and
                            (ii) has a focus on maternal or perinatal 
                        health.
                    (E) Secretary.--The term ``Secretary'' means the 
                Secretary of Health and Human Services.
            (7) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $25,000,000 
        for each of fiscal years 2023 through 2026.
    (b) Grants To Grow and Diversify the Maternal Mental and Behavioral 
Health Care Workforce.--Title VII of the Public Health Service Act is 
amended by inserting after section 757 of such Act (42 U.S.C. 294f) the 
following new section:

``SEC. 758. MATERNAL MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE 
              GRANTS.

    ``(a) In General.--The Secretary may award grants to entities to 
establish or expand programs described in subsection (b) to grow and 
diversify the maternal mental and behavioral health care workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the maternal mental and behavioral 
health care workforce by--
            ``(1) establishing schools or programs that provide 
        education and training to individuals seeking appropriate 
        licensing or certification as mental or behavioral health care 
        providers who will specialize in maternal mental health 
        conditions or substance use disorders; or
            ``(2) expanding the capacity of existing schools or 
        programs described in paragraph (1), for the purposes of 
        increasing the number of students enrolled in such schools or 
        programs, including by awarding scholarships for students.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any entity that--
            ``(1) has demonstrated a commitment to recruiting and 
        retaining students and faculty from racial and ethnic minority 
        groups;
            ``(2) has developed a strategy to recruit and retain a 
        diverse pool of students into the maternal mental or behavioral 
        health care workforce program or school supported by funds 
        received through the grant, particularly from racial and ethnic 
        minority groups and other underserved populations;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in a health professional shortage 
        area designated under section 332;
            ``(4) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic inequities in maternal health outcomes, to 
        the extent practicable; and
            ``(5) includes in the standard curriculum for all students 
        within the maternal mental or behavioral health care workforce 
        program or school a bias, racism, or discrimination training 
        program that includes training on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section for a maternal mental or behavioral health care workforce 
program or school, an entity shall agree to submit to the Secretary an 
annual report on the activities conducted through the grant, 
including--
            ``(1) the number and demographics of students participating 
        in the program or school;
            ``(2) the extent to which students in the program or school 
        are entering careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                inequities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the program or school has included in the 
        standard curriculum for all students a bias, racism, or 
        discrimination training program that includes training on 
        implicit bias and racism, and if so the effectiveness of such 
        training program.
    ``(e) Period of Grants.--The period of a grant under this section 
shall be up to 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to entities seeking or receiving a 
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the maternal mental or behavioral health 
care workforce programs or schools proposed to be, or being, 
established or expanded through the grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups and other underserved populations;
            ``(2) increasing the number of mental or behavioral health 
        care providers specializing in maternal mental health 
        conditions or substance use disorders from racial and ethnic 
        minority groups and other underserved populations;
            ``(3) increasing the number of mental or behavioral health 
        care providers specializing in maternal mental health 
        conditions or substance use disorders working in health 
        professional shortage areas designated under section 332; and
            ``(4) increasing the number of mental or behavioral health 
        care providers specializing in maternal mental health 
        conditions or substance use disorders working in areas with 
        significant racial and ethnic inequities in maternal health 
        outcomes, to the extent such data are available.
    ``(i) Definitions.--In this section:
            ``(1) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' has the meaning given such term in 
        section 1707(g)(1).
            ``(2) Mental or behavioral health care provider.--The term 
        `mental or behavioral health care provider' refers to a health 
        care provider in the field of mental and behavioral health, 
        including substance use disorders, acting in accordance with 
        State law.
    ``(j) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2023 through 2027.''.

SEC. 5211. TASKFORCE RECOMMENDING IMPROVEMENTS FOR UNADDRESSED MENTAL 
              PERINATAL & POSTPARTUM HEALTH (TRIUMPH) FOR NEW MOMS.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 317L-1 (42 U.S.C. 247b-
13a) the following:

``SEC. 317L-2. TASK FORCE ON MATERNAL MENTAL HEALTH.

    ``(a) Establishment.--Not later than 90 days after the date of 
enactment of this section, the Secretary shall establish a task force, 
to be known as the Task Force on Maternal Mental Health (in this 
section referred to as the `Task Force') to identify, evaluate, and 
make recommendations to coordinate and improve, Federal responses to 
maternal mental health conditions.
    ``(b) Membership.--
            ``(1) Composition.--The Task Force shall be composed of--
                    ``(A) the Assistant Secretary for Health of the 
                Department of Health and Human Services (or the 
                Assistant Secretary's designee) who shall serve as the 
                Chair of the Task Force;
                    ``(B) the Federal members under paragraph (2); and
                    ``(C) the non-Federal members under paragraph (3).
            ``(2) Federal members.--In addition to the Assistant 
        Secretary for Health, the Federal members of the Task Force 
        shall consist of the heads of the following Federal departments 
        and agencies (or their designees):
                    ``(A) The Administration for Children and Families.
                    ``(B) The Agency for Healthcare Research and 
                Quality.
                    ``(C) The Centers for Disease Control and 
                Prevention.
                    ``(D) The Centers for Medicare & Medicaid Services.
                    ``(E) The Health Resources and Services 
                Administration.
                    ``(F) The Food and Drug Administration.
                    ``(G) The Indian Health Service.
                    ``(H) The Office of the Assistant Secretary for 
                Planning and Evaluation of the Department of Health and 
                Human Services.
                    ``(I) The Office of Minority Health of the 
                Department of Health and Human Services.
                    ``(J) The Office of the Surgeon General of the 
                Department of Health and Human Services.
                    ``(K) The Office of Women's Health of the 
                Department of Health and Human Services.
                    ``(L) The National Institutes of Health.
                    ``(M) The Substance Abuse and Mental Health 
                Services Administration.
                    ``(N) Such other Federal departments and agencies 
                as the Secretary determines that serve individuals with 
                maternal mental health conditions, such as the 
                Department of Veterans Affairs, the Department of 
                Justice, the Department of Labor, the Department of 
                Housing and Urban Development, and the Department of 
                Defense.
            ``(3) Non-federal members.--The non-Federal members of the 
        Task Force shall--
                    ``(A) compose not more than one-half, and not less 
                than one-third, of the total membership of the Task 
                Force;
                    ``(B) be appointed by the Secretary; and
                    ``(C) include--
                            ``(i) representatives of medical societies 
                        with expertise in maternal or mental health;
                            ``(ii) representatives of nonprofit 
                        organizations with expertise in maternal or 
                        mental health;
                            ``(iii) relevant industry representatives; 
                        and
                            ``(iv) other representatives, as 
                        appropriate.
            ``(4) Deadline for designating designees.--If the Assistant 
        Secretary for Health, or the head of a Federal department or 
        agency serving as a member of the Task Force under paragraph 
        (2), chooses to be represented on the Task Force by a designee, 
        the Assistant Secretary or head shall designate such designee 
        not later than 90 days after the date of the enactment of this 
        section.
    ``(c) Duties.--The Task Force shall--
            ``(1) create and regularly update a report that identifies, 
        analyzes, and evaluates the state of national maternal mental 
        health policy and programs at the Federal, State, and local 
        levels, and identifies best practices including--
                    ``(A) a set of evidence-based, evidence-informed, 
                and promising practices with respect to--
                            ``(i) prevention strategies for individuals 
                        at risk of experiencing a maternal mental 
                        health condition, including strategies and 
                        recommendations to address social determinants 
                        of health;
                            ``(ii) the identification, screening, 
                        diagnosis, intervention, and treatment of 
                        individuals and families affected by a maternal 
                        mental health condition;
                            ``(iii) the expeditious referral to, and 
                        implementation of, practices and supports that 
                        prevent and mitigate the effects of a maternal 
                        mental health condition, including strategies 
                        and recommendations to eliminate the racial and 
                        ethnic inequities that exist in maternal mental 
                        health; and
                            ``(iv) community-based or multigenerational 
                        practices that support individuals and families 
                        affected by a maternal mental health condition; 
                        and
                    ``(B) Federal and State programs and activities to 
                prevent, screen, diagnose, intervene, and treat 
                maternal mental health conditions;
            ``(2) develop and regularly update a national strategy for 
        maternal mental health, taking into consideration the findings 
        of the reports under paragraph (1), on how the Task Force and 
        Federal departments and agencies represented on the Task Force 
        will prioritize options for, and implement a coordinated 
        approach to, addressing maternal mental health conditions, 
        including by--
                    ``(A) increasing prevention, screening, diagnosis, 
                intervention, treatment, and access to care, including 
                clinical and nonclinical care such as peer-support and 
                community health workers, through the public and 
                private sectors;
                    ``(B) providing support for pregnant or postpartum 
                individuals who are at risk for or experiencing a 
                maternal mental health condition, and their families as 
                appropriate;
                    ``(C) reducing racial, ethnic, geographic, and 
                other health inequities for prevention, diagnosis, 
                intervention, treatment, and access to care;
                    ``(D) identifying opportunities for local- and 
                State-level partnerships;
                    ``(E) identifying options for modifying, 
                strengthening, and coordinating Federal programs and 
                activities, including existing infant and maternity 
                programs, such as the Medicaid program under title XIX 
                of the Social Security Act and the State Children's 
                Health Insurance Program under title XXI of such Act, 
                in order to increase research, prevention, 
                identification, intervention, and treatment with 
                respect to maternal mental health;
                    ``(F) providing recommendations to ensure research, 
                services, supports, and prevention activities are not 
                unnecessarily duplicative; and
                    ``(G) planning, data sharing, and communication 
                within and across Federal departments, agencies, 
                offices, and programs;
            ``(3) solicit public comments from stakeholders for the 
        report under paragraph (1) and the national strategy under 
        paragraph (2), including comments from frontline service 
        providers, mental health professionals, researchers, experts in 
        maternal mental health, institutions of higher education, 
        public health agencies (including maternal and child health 
        programs), and industry representatives, in order to inform the 
        activities and reports of the Task Force; and
            ``(4) disaggregate any data collected under this section by 
        race, ethnicity, geographical location, age, marital status, 
        socioeconomic level, and other factors as determined 
        appropriate by the Secretary.
    ``(d) Meetings.--The Task Force shall--
            ``(1) meet not less than two times each year; and
            ``(2) convene public meetings, as appropriate, to fulfill 
        its duties under this section.
    ``(e) Reports to Public and Federal Leaders.--The Task Force shall 
make publicly available and submit to the heads of relevant Federal 
departments and agencies, the Committee on Energy and Commerce of the 
House of Representatives, the Committee on Health, Education, Labor, 
and Pensions of the Senate, and other relevant congressional 
committees, the following:
            ``(1) Not later than 1 year after the first meeting of the 
        Task Force, an initial report under subsection (c)(1).
            ``(2) Not later than 2 years after the first meeting of the 
        Task Force, an initial national strategy under subsection 
        (c)(2).
            ``(3) Each year thereafter--
                    ``(A) an updated report under subsection (c)(1);
                    ``(B) an updated national strategy under subsection 
                (c)(2); or
                    ``(C) if no such update is made, a report 
                summarizing the activities of the Task Force.
    ``(f) Reports to Governors.--Upon finalizing the initial national 
strategy under subsection (c)(2), and upon making relevant updates to 
such strategy, the Task Force shall submit a report to the Governors of 
all States describing opportunities for local- and State-level 
partnerships identified under subsection (c)(2)(D).
    ``(g) Sunset.--The Task Force shall terminate on the date that is 6 
years after the date on which the Task Force is established under 
subsection (a).''.

SEC. 5212. PROTECT MOMS FROM DOMESTIC VIOLENCE.

    (a) Study by Department of Health and Human Services.--
            (1) Study.--The Secretary, in collaboration with the Health 
        Resources and Services Administration, the Substance Abuse and 
        Mental Health Services Administration, and the Administration 
        for Children and Families, and in consultation with the 
        Attorney General of the United States, the Director of the 
        Indian Health Service, and stakeholders (including community-
        based organizations, culturally specific organizations, and 
        Tribal public health authorities), shall conduct a study on the 
        extent to which individuals are more at risk of maternal 
        mortality or severe maternal morbidity as a result of being a 
        victim of domestic violence, dating violence, sexual assault, 
        stalking, human trafficking, sex trafficking, child sexual 
        abuse, or forced marriage.
            (2) Reports.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary shall complete the study 
        under paragraph (1) and submit a report to the Congress on the 
        results of such study. Such report shall include--
                    (A) an analysis of the extent to which domestic 
                violence, dating violence, sexual assault, stalking, 
                human trafficking, sex trafficking, child sexual abuse, 
                and forced marriage contribute to, or result in, 
                maternal mortality;
                    (B) an analysis of the impact of domestic violence, 
                dating violence, sexual assault, stalking, human 
                trafficking, sex trafficking, child sexual abuse, and 
                forced marriage on access to health care (including 
                mental health care) and substance use disorder 
                treatment and recovery support;
                    (C) a breakdown (including by race and ethnicity) 
                of categories of individuals who are disproportionately 
                victims of domestic violence, dating violence, sexual 
                assault, stalking, human trafficking, sex trafficking, 
                child sexual abuse, or forced marriage that contributes 
                to, or results in, pregnancy-related death;
                    (D) an analysis of the impact on health, mental 
                health, and substance use resulting from domestic 
                violence, dating violence, sexual assault, stalking, 
                human trafficking, sex trafficking, child sexual abuse, 
                and forced marriage among Alaskan Natives, Native 
                Hawaiians, and American Indians during the prenatal and 
                postpartum period;
                    (E) an assessment of the factors that increase or 
                decrease risks for maternal mortality or severe 
                maternal morbidity among victims of domestic violence, 
                dating violence, sexual assault, stalking, human 
                trafficking, sex trafficking, child sexual abuse, or 
                forced marriage;
                    (F) an assessment of increased risk of maternal 
                mortality or severe maternal morbidity stemming from 
                suicide, substance use disorders, or drug overdose due 
                to domestic violence, dating violence, sexual assault, 
                stalking, human trafficking, sex trafficking, child 
                sexual abuse, or forced marriage;
                    (G) recommendations for legislative or policy 
                changes--
                            (i) to reduce maternal mortality rates; and
                            (ii) to address health inequities that 
                        contribute to inequities in such rates and 
                        deaths;
                    (H) best practices to reduce maternal mortality and 
                severe maternal morbidity among victims of domestic 
                violence, dating violence, sexual assault, stalking, 
                human trafficking, sex trafficking, child sexual abuse, 
                and forced marriage, including--
                            (i) reducing reproductive coercion, mental 
                        health conditions, and substance use coercion; 
                        and
                            (ii) routinely assessing pregnant people 
                        for domestic violence and other forms of 
                        reproductive violence; and
                    (I) any other information on maternal mortality or 
                severe maternal morbidity the Secretary determines 
                appropriate to include in the report.
    (b) Study by National Academy of Medicine.--
            (1) In general.--The Secretary shall seek to enter into an 
        arrangement with the National Academy of Medicine (or, if the 
        Academy declines to enter into such arrangement, another 
        appropriate entity) to study--
                    (A) the impact of domestic violence, dating 
                violence, sexual assault, stalking, human trafficking, 
                sex trafficking, child sexual abuse, and forced 
                marriage on an individual's health; relative to
                    (B) maternal mortality and severe maternal 
                morbidity.
            (2) Topics.--The study under paragraph (1) shall--
                    (A) examine--
                            (i) whether domestic violence, dating 
                        violence, sexual assault, stalking, human 
                        trafficking, sex trafficking, child sexual 
                        abuse, or forced marriage, or generational 
                        intimate partner violence, trauma, and 
                        psychiatric disorders, increase the risk of 
                        suicide, substance use, and drug overdose among 
                        pregnant and postpartum persons; and
                            (ii) the intersection of domestic violence, 
                        dating violence, sexual assault, stalking, 
                        human trafficking, sex trafficking, child 
                        sexual abuse, and forced marriage as a social 
                        determinant of health; and
                    (B) give particular focus to impacts among African 
                American, American Indian, Native Hawaiian, Alaskan 
                Native, and LGBTQ birthing persons.
    (c) Grants for Innovative Approaches.--
            (1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, and in collaboration with the Administration 
        for Children and Families, the Indian Health Service, and the 
        Substance Abuse and Mental Health Services Administration, 
        shall award grants to eligible entities for developing and 
        implementing innovative approaches to improve maternal and 
        child health outcomes of victims of domestic violence, dating 
        violence, sexual assault, stalking, human trafficking, sex 
        trafficking, child sexual abuse, or forced marriage.
            (2) Eligible entity.--To seek a grant under this 
        subsection, an entity shall be--
                    (A) a State, local, or federally recognized Tribal 
                government;
                    (B) a nonprofit organization or community-based 
                organization that provides prevention or intervention 
                services related to domestic violence, dating violence, 
                sexual assault, stalking, human trafficking, sex 
                trafficking, child sexual abuse, or forced marriage;
                    (C) a tribal organization or Urban Indian 
                organization (as such terms are defined in section 4 of 
                the Indian Health Care Improvement Act (25 U.S.C. 
                1603));
                    (D) an entity, the principal purpose of which is to 
                provide health care, such as a hospital, clinic, health 
                department, freestanding birthing center, perinatal 
                health worker, or maternity care provider;
                    (E) an institution of higher education; or
                    (F) a comprehensive substance use disorder 
                parenting program.
            (3) Priority.--In awarding grants under this subsection, 
        the Secretary of Health and Human Services shall give priority 
        to applicants proposing to address--
                    (A) mental health and substance use disorders among 
                pregnant persons; or
                    (B) pregnant and postpartum persons experiencing 
                intimate partner violence.
            (4) Freestanding birth center defined.--In this subsection, 
        the term ``freestanding birth center'' has the meaning given 
        that term in section 1905(l) of the Social Security Act (42 
        U.S.C. 1396d(1)).
            (5) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $25,000,000 
        for the period of fiscal years 2023 through 2025.
    (d) Guidance.--Not later than 2 years after the date of enactment 
of this Act, the Secretary shall issue and disseminate guidance to 
States, Tribes, Territories, maternity care providers, and managed care 
entities on--
            (1) providing universal education on healthy relationships 
        and intimate partner violence;
            (2) developing protocols on--
                    (A) routine assessment of intimate partner 
                violence; and
                    (B) health promotion and strategies for trauma-
                informed care plans; and
            (3) creating sustainable partnerships with community-based 
        organizations that address domestic violence, dating violence, 
        sexual assault, stalking, human trafficking, sex trafficking, 
        child sexual abuse, or forced marriage.
    (e) Definitions.--In this section:
            (1) The term ``maternal mortality''--
                    (A) means death that--
                            (i) occurs during, or within the 1-year 
                        period after, pregnancy; and
                            (ii) is attributed to or aggravated by 
                        pregnancy-related or childbirth complications; 
                        and
                    (B) includes a suicide, drug overdose death, 
                homicide (including a domestic violence-related 
                homicide), or other death resulting from a mental 
                health or substance use disorder attributed to or 
                aggravated by pregnancy-related or childbirth 
                complications.
            (2) The term ``maternity care provider'' means a health 
        care provider who--
                    (A) is a physician, physician assistant, nurse, 
                midwife who meets at a minimum the international 
                definition of the midwife and global standards for 
                midwifery education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) The term ``perinatal health worker'' means a worker 
        who--
                    (A) is a doula, community health worker, peer 
                supporter, breastfeeding and lactation educator or 
                counselor, nutritionist or dietitian, childbirth 
                educator, social worker, home visitor, language 
                interpreter, or navigator; and
                    (B) provides assistance with perinatal health.
            (4) The term ``postpartum'' refers to the 12-month period 
        following childbirth.
            (5) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (6) The term ``severe maternal morbidity'' means a health 
        condition, including a mental health condition or substance use 
        disorder, that--
                    (A) is attributed to or aggravated by pregnancy or 
                childbirth; and
                    (B) results in significant short-term or long-term 
                consequences to the health of the individual who was 
                pregnant.

SEC. 5213. PERINATAL WORKFORCE.

    (a) HHS Agency Directives.--
            (1) Guidance to states.--
                    (A) In general.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary of Health 
                and Human Services shall issue and disseminate guidance 
                to States to educate providers, managed care entities, 
                and other insurers about the value and process of 
                delivering respectful maternal health care through 
                diverse and multidisciplinary care provider models.
                    (B) Contents.--The guidance required by 
                subparagraph (A) shall address how States can encourage 
                and incentivize hospitals, health systems, midwifery 
                practices, freestanding birth centers, other maternity 
                care provider groups, managed care entities, and other 
                insurers--
                            (i) to recruit and retain maternity care 
                        providers, mental and behavioral health care 
                        providers acting in accordance with State law, 
                        registered dietitians or nutrition 
                        professionals (as such term is defined in 
                        section 1861(vv)(2) of the Social Security Act 
                        (42 U.S.C. 1395x(vv)(2))), and lactation 
                        consultants certified by the International 
                        Board of Lactation Consultants Examiners--
                                    (I) from racially, ethnically, and 
                                linguistically diverse backgrounds;
                                    (II) with experience practicing in 
                                racially and ethnically diverse 
                                communities; and
                                    (III) who have undergone training 
                                on implicit bias and racism;
                            (ii) to incorporate into maternity care 
                        teams--
                                    (I) midwives who meet, at a 
                                minimum, the international definition 
                                of the midwife and global standards for 
                                midwifery education, as established by 
                                the International Confederation of 
                                Midwives; and
                                    (II) perinatal health workers;
                            (iii) to provide collaborative, culturally 
                        congruent care; and
                            (iv) to provide opportunities for 
                        individuals enrolled in accredited midwifery 
                        education programs to participate in job 
                        shadowing with maternity care teams in 
                        hospitals, health systems, midwifery practices, 
                        and freestanding birth centers.
            (2) Study on respectful and culturally congruent maternity 
        care.--
                    (A) Study.--The Secretary of Health and Human 
                Services, acting through the Director of the National 
                Institutes of Health (in this paragraph referred to as 
                the ``Secretary''), shall conduct a study on best 
                practices in respectful and culturally congruent 
                maternity care.
                    (B) Report.--Not later than 2 years after the date 
                of enactment of this Act, the Secretary shall--
                            (i) complete the study required by 
                        subparagraph (A);
                            (ii) submit to the Congress, and make 
                        publicly available, a report on the results of 
                        such study; and
                            (iii) include in such report--
                                    (I) a compendium of examples of 
                                hospitals, health systems, midwifery 
                                practices, freestanding birth centers, 
                                other maternity care provider groups, 
                                managed care entities, and other 
                                insurers that are delivering respectful 
                                and culturally congruent maternal 
                                health care;
                                    (II) a compendium of examples of 
                                hospitals, health systems, midwifery 
                                practices, freestanding birth centers, 
                                other maternity care provider groups, 
                                managed care entities, and other 
                                insurers that have made progress in 
                                reducing inequities in maternal health 
                                outcomes and improving birthing 
                                experiences for pregnant and postpartum 
                                individuals from racial and ethnic 
                                minority groups; and
                                    (III) recommendations to hospitals, 
                                health systems, midwifery practices, 
                                freestanding birth centers, other 
                                maternity care provider groups, managed 
                                care entities, and other insurers, for 
                                best practices in respectful and 
                                culturally congruent maternity care.
    (b) Grants To Grow and Diversify the Perinatal Workforce.--Title 
VII of the Public Health Service Act is amended by inserting after 
section 758, as added by section 5210(b), the following new section:

``SEC. 758A. PERINATAL WORKFORCE GRANTS.

    ``(a) In General.--The Secretary shall award grants to entities to 
establish or expand programs described in subsection (b) to grow and 
diversify the perinatal workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the perinatal workforce by--
            ``(1) establishing schools or programs that provide 
        education and training to individuals seeking appropriate 
        licensing or certification as--
                    ``(A) physician assistants who will complete 
                clinical training in the field of maternal and 
                perinatal health; or
                    ``(B) perinatal health workers; and
            ``(2) expanding the capacity of existing schools or 
        programs described in paragraph (1), for the purposes of 
        increasing the number of students enrolled in such schools or 
        programs, including by awarding scholarships for students.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any entity that--
            ``(1) has demonstrated a commitment to recruiting and 
        retaining students and faculty from racial and ethnic minority 
        groups;
            ``(2) has developed a strategy to recruit and retain a 
        diverse pool of students into the perinatal workforce program 
        or school supported by funds received through the grant, 
        particularly from racial and ethnic minority groups and other 
        underserved populations;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in a health professional shortage 
        area designated under section 332;
            ``(4) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic inequities in maternal health outcomes, to 
        the extent practicable; and
            ``(5) includes in the standard curriculum for all students 
        within the perinatal workforce program or school a bias, 
        racism, or discrimination training program that includes 
        training on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section for a perinatal workforce program or school, an entity shall 
agree to submit to the Secretary an annual report on the activities 
conducted through the grant, including--
            ``(1) the number and demographics of students participating 
        in the program or school;
            ``(2) the extent to which students in the program or school 
        are entering careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                inequities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the program or school has included in the 
        standard curriculum for all students a bias, racism, or 
        discrimination training program that includes explicit and 
        implicit bias, and if so the effectiveness of such training 
        program.
    ``(e) Period of Grants.--The period of a grant under this section 
shall not exceed 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to entities seeking or receiving a 
grant under this section on the development, use, evaluation, and post-
grant period sustainability of the perinatal workforce programs or 
schools proposed to be, or being, established or expanded through the 
grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups;
            ``(2) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, from racial and 
        ethnic minority groups and other underserved populations;
            ``(3) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, working in 
        health professional shortage areas designated under section 
        332; and
            ``(4) increasing the number of physician assistants who 
        will complete clinical training in the field of maternal and 
        perinatal health, and perinatal health workers, working in 
        areas with significant racial and ethnic inequities in maternal 
        health outcomes, to the extent such data are available.
    ``(i) Definition.--In this section, the term `racial and ethnic 
minority group' has the meaning given such term in section 1707(g).
    ``(j) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2023 through 2027.''.
    (c) Grants To Grow and Diversify the Nursing Workforce in Maternal 
and Perinatal Health.--Title VIII of the Public Health Service Act is 
amended by inserting after section 811 of that Act (42 U.S.C. 296j) the 
following:

``SEC. 812. PERINATAL NURSING WORKFORCE GRANTS.

    ``(a) In General.--The Secretary shall award grants to schools of 
nursing to grow and diversify the perinatal nursing workforce.
    ``(b) Use of Funds.--Recipients of grants under this section shall 
use the grants to grow and diversify the perinatal nursing workforce by 
providing scholarships to students seeking to become--
            ``(1) nurse practitioners whose education includes a focus 
        on maternal and perinatal health; or
            ``(2) clinical nurse specialists whose education includes a 
        focus on maternal and perinatal health.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to any school of nursing that--
            ``(1) has developed a strategy to recruit and retain a 
        diverse pool of students seeking to enter careers focused on 
        maternal and perinatal health, particularly students from 
        racial and ethnic minority groups and other underserved 
        populations;
            ``(2) has developed a partnership with a practice setting 
        in a health professional shortage area designated under section 
        332 for the clinical placements of the school's students;
            ``(3) has developed a strategy to recruit and retain 
        students who plan to practice in an area with significant 
        racial and ethnic inequities in maternal health outcomes, to 
        the extent practicable; and
            ``(4) includes in the standard curriculum for all students 
        seeking to enter careers focused on maternal and perinatal 
        health a bias, racism, or discrimination training program that 
        includes education on implicit bias and racism.
    ``(d) Reporting.--As a condition on receipt of a grant under this 
section, a school of nursing shall agree to submit to the Secretary an 
annual report on the activities conducted through the grant, including, 
to the extent practicable--
            ``(1) the number and demographics of students in the school 
        of nursing seeking to enter careers focused on maternal and 
        perinatal health;
            ``(2) the extent to which such students are preparing to 
        enter careers in--
                    ``(A) health professional shortage areas designated 
                under section 332; and
                    ``(B) areas with significant racial and ethnic 
                inequities in maternal health outcomes, to the extent 
                such data are available; and
            ``(3) whether the standard curriculum for all students 
        seeking to enter careers focused on maternal and perinatal 
        health includes a bias, racism, or discrimination training 
        program that includes education on implicit bias and racism.
    ``(e) Period of Grants.--The period of a grant under this section 
shall be up to 5 years.
    ``(f) Application.--To seek a grant under this section, an entity 
shall submit to the Secretary an application, at such time, in such 
manner, and containing such information as the Secretary may require, 
including any information necessary for prioritization under subsection 
(c).
    ``(g) Technical Assistance.--The Secretary shall provide, directly 
or by contract, technical assistance to schools of nursing seeking or 
receiving a grant under this section on the processes of awarding and 
evaluating scholarships through the grant.
    ``(h) Report by the Secretary.--Not later than 4 years after the 
date of enactment of this section, the Secretary shall prepare and 
submit to the Congress, and post on the internet website of the 
Department of Health and Human Services, a report on the effectiveness 
of the grant program under this section at--
            ``(1) recruiting students from racial and ethnic minority 
        groups and other underserved populations;
            ``(2) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health from racial and ethnic minority groups and 
        other underserved populations;
            ``(3) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health working in health professional shortage 
        areas designated under section 332; and
            ``(4) increasing the number of nurse practitioners and 
        clinical nurse specialists entering careers focused on maternal 
        and perinatal health working in areas with significant racial 
        and ethnic inequities in maternal health outcomes, to the 
        extent such data are available.
    ``(i) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2023 through 2027.''.
    (d) GAO Report.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this Act, and every 5 years thereafter, the 
        Comptroller General of the United States shall submit to 
        Congress a report on barriers to maternal health education and 
        access to care in the United States. Such report shall include 
        the information and recommendations described in paragraph (2).
            (2) Content of report.--The report under paragraph (1) 
        shall include--
                    (A) an assessment of current barriers to entering 
                accredited midwifery education programs, and 
                recommendations for addressing such barriers, 
                particularly for low-income people and people from 
                racial and ethnic minority groups;
                    (B) an assessment of current barriers to entering 
                and successfully completing accredited education 
                programs for other health professional careers related 
                to maternity care, including maternity care providers, 
                mental and behavioral health care providers acting in 
                accordance with State law, registered dietitians or 
                nutrition professionals (as such term is defined in 
                section 1861(vv)(2) of the Social Security Act (42 
                U.S.C. 1395x(vv)(2))), and lactation consultants 
                certified by the International Board of Lactation 
                Consultants Examiners, particularly for low-income 
                people and people from racial and ethnic minority 
                groups;
                    (C) an assessment of current barriers that prevent 
                midwives from meeting the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, and recommendations for 
                addressing such barriers, particularly for low-income 
                people and people from racial and ethnic minority 
                groups;
                    (D) an assessment of inequities in access to 
                maternity care providers, mental or behavioral health 
                care providers acting in accordance with State law, 
                registered dietitians or nutrition professionals (as 
                such term is defined in section 1861(vv)(2) of the 
                Social Security Act (42 U.S.C. 1395x(vv)(2))), 
                lactation consultants certified by the International 
                Board of Lactation Consultants Examiners, and perinatal 
                health workers, stratified by race, ethnicity, gender 
                identity, geographic location, and insurance type and 
                recommendations to promote greater access equity; and
                    (E) recommendations to promote greater equity in 
                compensation for perinatal health workers under public 
                and private insurers, particularly for such individuals 
                from racially and ethnically diverse backgrounds.
    (e) Definitions.--In this section:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (4) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (5) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).

SEC. 5214. MIDWIVES SCHOOLS AND PROGRAMS EXPANSION.

    (a) Midwifery Schools and Programs.--
            (1) In general.--Title VII of the Public Health Service Act 
        is amended by inserting after section 760 of such Act (42 
        U.S.C. 294k) the following:

``SEC. 760A. MIDWIFERY SCHOOLS AND PROGRAMS.

    ``(a) In General.--The Secretary may award grants to institutions 
of higher education (as defined in subsections (a) and (b) of section 
101 of the Higher Education Act of 1965) for the following:
            ``(1) Direct support of students in an accredited midwifery 
        school or program.
            ``(2) Establishment or expansion of an accredited midwifery 
        school or program.
            ``(3) Securing, preparing, or providing support for 
        increasing the number of, qualified preceptors for training the 
        students of an accredited midwifery school or program.
    ``(b) Special Considerations.--In awarding grants under subsection 
(a), the Secretary shall give special consideration to any institution 
of higher education that--
            ``(1) agrees to prioritize students who plan to practice in 
        a health professional shortage area designated under section 
        332; and
            ``(2) demonstrates a focus on increasing racial and ethnic 
        minority representation in midwifery education.
    ``(c) Restriction.--The Secretary shall not provide any assistance 
under this section to be used with respect to a midwifery school or 
program within a school of nursing (as defined in section 801).
    ``(d) Authorization of Appropriations.--
            ``(1) In general.--There is authorized to be appropriated 
        to carry out this section $15,000,000 for the period of fiscal 
        years 2023 through 2027.
            ``(2) Allocation.--Of the amounts made available to carry 
        out this section for any fiscal year, the Secretary shall use--
                    ``(A) 50 percent to award grants for purposes 
                specified in subsection (a)(1);
                    ``(B) 25 percent to award grants for purposes 
                specified in subsection (a)(2); and
                    ``(C) 25 percent to award grants for purposes 
                specified in subsection (a)(3).''.
            (2) Definitions.--
                    (A) Midwifery school or program.--Section 
                799B(1)(A) of the Public Health Service Act (42 U.S.C. 
                295p(1)(A)) is amended--
                            (i) by inserting ```midwifery school or 
                        program','' before ``and `school of 
                        chiropractic''';
                            (ii) by inserting ``a degree or certificate 
                        in midwifery or an equivalent degree or 
                        certificate,'' before ``and a degree of doctor 
                        of chiropractic or an equivalent degree''; and
                            (iii) by striking ``any such school'' and 
                        inserting ``any such school or program''.
                    (B) Accredited.--Section 799B(1)(E) of the Public 
                Health Service Act (42 U.S.C. 295p(1)(E)) is amended by 
                inserting ``or a midwifery school or program,'' before 
                ``or a graduate program in health administration''.
    (b) Nurse-Midwives.--Title VIII of the Public Health Service Act, 
as amended by section 5213, is further amended by inserting after 
section 812 of that Act, as added by section 5213, the following:

``SEC. 812A. MIDWIFERY EXPANSION PROGRAM.

    ``(a) In General.--The Secretary may award grants to schools of 
nursing for the following:
            ``(1) Direct support of students in an accredited nurse-
        midwifery school or program.
            ``(2) Establishment or expansion of an accredited nurse-
        midwifery school or program.
            ``(3) Securing, preparing, or providing support for 
        increasing the numbers of, preceptors at clinical training 
        sites to precept students training to become certified nurse-
        midwives.
    ``(b) Special Considerations.--In awarding grants under subsection 
(a), the Secretary shall give special consideration to any school of 
nursing that--
            ``(1) agrees to prioritize students who choose to pursue an 
        advanced education degree in nurse-midwifery to practice in a 
        health professional shortage area designated under section 332; 
        and
            ``(2) demonstrates a focus on increasing racial and ethnic 
        minority representation in nurse-midwifery education.
    ``(c) Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there is 
        authorized to be appropriated $20,000,000 for the period of 
        fiscal years 2023 through 2027.
            ``(2) Allocation.--Of the amounts made available to carry 
        out this section for any fiscal year, the Secretary shall use--
                    ``(A) 50 percent to award grants for purposes 
                specified in subsection (a)(1);
                    ``(B) 25 percent to award grants for purposes 
                specified in subsection (a)(2); and
                    ``(C) 25 percent to award grants for purposes 
                specified in subsection (a)(3).''.

SEC. 5215. GESTATIONAL DIABETES.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by adding after section 317H the following:

``SEC. 317H-1. GESTATIONAL DIABETES.

    ``(a) Understanding and Monitoring Gestational Diabetes.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, in 
        consultation with the Diabetes Mellitus Interagency 
        Coordinating Committee established under section 429 and 
        representatives of appropriate national health organizations, 
        shall develop a multisite gestational diabetes research project 
        within the diabetes program of the Centers for Disease Control 
        and Prevention to expand and enhance surveillance data and 
        public health research on gestational diabetes.
            ``(2) Areas to be addressed.--The research project 
        developed under paragraph (1) shall address--
                    ``(A) procedures to establish accurate and 
                efficient systems for the collection of gestational 
                diabetes data within each State and commonwealth, 
                territory, or possession of the United States;
                    ``(B) the progress of collaborative activities with 
                the National Vital Statistics System, the National 
                Center for Health Statistics, and State health 
                departments with respect to the standard birth 
                certificate, in order to improve surveillance of 
                gestational diabetes;
                    ``(C) postpartum methods of tracking individuals 
                with gestational diabetes after delivery as well as 
                targeted interventions proven to lower the incidence of 
                type 2 diabetes in that population;
                    ``(D) variations in the distribution of diagnosed 
                and undiagnosed gestational diabetes, and of impaired 
                fasting glucose tolerance and impaired fasting glucose, 
                within and among groups of pregnant individuals; and
                    ``(E) factors and culturally sensitive 
                interventions that influence risks and reduce the 
                incidence of gestational diabetes and related 
                complications during childbirth, including cultural, 
                behavioral, racial, ethnic, geographic, demographic, 
                socioeconomic, and genetic factors.
            ``(3) Report.--Not later than 2 years after the date of the 
        enactment of this section, and annually thereafter, the 
        Secretary shall generate a report on the findings and 
        recommendations of the research project including prevalence of 
        gestational diabetes in the multisite area and disseminate the 
        report to the appropriate Federal and non-Federal agencies.
    ``(b) Expansion of Gestational Diabetes Research.--
            ``(1) In general.--The Secretary shall expand and intensify 
        public health research regarding gestational diabetes. Such 
        research may include--
                    ``(A) developing and testing novel approaches for 
                improving postpartum diabetes testing or screening and 
                for preventing type 2 diabetes in individuals who can 
                become pregnant with a history of gestational diabetes; 
                and
                    ``(B) conducting public health research to further 
                understanding of the epidemiologic, socioenvironmental, 
                behavioral, translation, and biomedical factors and 
                health systems that influence the risk of gestational 
                diabetes and the development of type 2 diabetes in 
                individuals who can become pregnant with a history of 
                gestational diabetes.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        each of fiscal years 2023 through 2027.
    ``(c) Demonstration Grants To Lower the Rate of Gestational 
Diabetes.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall award grants, on a competitive basis, to eligible 
        entities for demonstration projects that implement evidence-
        based interventions to reduce the incidence of gestational 
        diabetes, the recurrence of gestational diabetes in subsequent 
        pregnancies, and the development of type 2 diabetes in 
        individuals who can become pregnant with a history of 
        gestational diabetes.
            ``(2) Priority.--In making grants under this subsection, 
        the Secretary shall give priority to projects focusing on--
                    ``(A) helping individuals who can become pregnant 
                who have 1 or more risk factors for developing 
                gestational diabetes;
                    ``(B) working with individuals who can become 
                pregnant with a history of gestational diabetes during 
                a previous pregnancy;
                    ``(C) providing postpartum care for individuals who 
                can become pregnant with gestational diabetes;
                    ``(D) tracking cases where individuals who can 
                become pregnant with a history of gestational diabetes 
                developed type 2 diabetes;
                    ``(E) educating mothers with a history of 
                gestational diabetes about the increased risk of their 
                child developing diabetes;
                    ``(F) working to prevent gestational diabetes and 
                prevent or delay the development of type 2 diabetes in 
                individuals who can become pregnant with a history of 
                gestational diabetes; and
                    ``(G) achieving outcomes designed to assess the 
                efficacy and cost-effectiveness of interventions that 
                can inform decisions on long-term sustainability, 
                including third-party reimbursement.
            ``(3) Application.--An eligible entity desiring to receive 
        a grant under this subsection shall submit to the Secretary--
                    ``(A) an application at such time, in such manner, 
                and containing such information as the Secretary may 
                require; and
                    ``(B) a plan to--
                            ``(i) lower the rate of gestational 
                        diabetes during pregnancy; or
                            ``(ii) develop methods of tracking 
                        individuals who can become pregnant with a 
                        history of gestational diabetes and develop 
                        effective interventions to lower the incidence 
                        of the recurrence of gestational diabetes in 
                        subsequent pregnancies and the development of 
                        type 2 diabetes.
            ``(4) Uses of funds.--An eligible entity receiving a grant 
        under this subsection shall use the grant funds to carry out 
        demonstration projects described in paragraph (1), including--
                    ``(A) expanding community-based health promotion 
                education, activities, and incentives focused on the 
                prevention of gestational diabetes and development of 
                type 2 diabetes in individuals who can become pregnant 
                with a history of gestational diabetes;
                    ``(B) aiding State- and Tribal-based diabetes 
                prevention and control programs to collect, analyze, 
                disseminate, and report surveillance data on 
                individuals who can become pregnant with, and at risk 
                for, gestational diabetes, the recurrence of 
                gestational diabetes in subsequent pregnancies, and, 
                for individuals who can become pregnant with a history 
                of gestational diabetes, the development of type 2 
                diabetes; and
                    ``(C) training and encouraging health care 
                providers--
                            ``(i) to promote risk assessment, high-
                        quality care, and self-management for 
                        gestational diabetes and the recurrence of 
                        gestational diabetes in subsequent pregnancies; 
                        and
                            ``(ii) to prevent the development of type 2 
                        diabetes in individuals who can become pregnant 
                        with a history of gestational diabetes, and its 
                        complications in the practice settings of the 
                        health care providers.
            ``(5) Report.--Not later than 4 years after the date of the 
        enactment of this section, the Secretary shall prepare and 
        submit to the Congress a report concerning the results of the 
        demonstration projects conducted through the grants awarded 
        under this subsection.
            ``(6) Definition of eligible entity.--In this subsection, 
        the term `eligible entity' means a nonprofit organization (such 
        as a nonprofit academic center or community health center) or a 
        State, Tribal, or local health agency.
            ``(7) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $5,000,000 for 
        each of fiscal years 2023 through 2027.
    ``(d) Postpartum Followup Regarding Gestational Diabetes.--The 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, shall work with the State- and Tribal-based 
diabetes prevention and control programs assisted by the Centers to 
encourage postpartum followup after gestational diabetes, as medically 
appropriate, for the purpose of reducing the incidence of gestational 
diabetes, the recurrence of gestational diabetes in subsequent 
pregnancies, the development of type 2 diabetes in individuals with a 
history of gestational diabetes, and related complications.''.

SEC. 5216. CONSUMER EDUCATION CAMPAIGN.

    Section 229(b) of the Public Health Service Act (42 U.S.C. 
237a(b)), as amended--
            (1) in paragraph (6), at the end, by striking ``and'';
            (2) in paragraph (7), at the end, by striking the period 
        and inserting a semicolon; and
            (3) by adding at the end the following:
            ``(8) not later than one year after the date of the 
        enactment of this paragraph, develop and implement a 4-year 
        culturally and linguistically appropriate multimedia consumer 
        education campaign that is designed to promote understanding 
        and acceptance of evidence-based maternity practices and models 
        of care for optimal maternity outcomes among individuals of 
        childbearing ages and families of such individuals and that--
                    ``(A) highlights the importance of protecting, 
                promoting, and supporting the innate capacities of 
                childbearing individuals and their newborns for 
                childbirth, breastfeeding, and attachment;
                    ``(B) promotes understanding of the importance of 
                using obstetric interventions when medically necessary 
                and when supported by strong, high-quality evidence;
                    ``(C) highlights the widespread overuse of 
                maternity practices that have been shown to have 
                benefit when used appropriately in situations of 
                medical necessity, but which can expose pregnant 
                individuals, infants, or both to risk of harm if used 
                routinely and indiscriminately;
                    ``(D) emphasizes the noninvasive maternity 
                practices that have proven correlation or may be 
                associated with improvement in outcomes with no 
                detrimental side effects, and are significantly 
                underused in the United States, including smoking 
                cessation programs in pregnancy, group model prenatal 
                care, continuous labor support, nonsupine positions for 
                birth, and external version to turn breech babies at 
                term;
                    ``(E) educates consumers about--
                            ``(i) the qualifications of licensed 
                        providers of maternity care, including 
                        obstetrician-gynecologists, family physicians, 
                        certified nurse-midwives, certified midwives, 
                        and certified professional midwives; and
                            ``(ii) the best evidence about the safety, 
                        satisfaction, outcomes, and costs of such 
                        providers;
                    ``(F) informs consumers about the best available 
                research comparing birth center births, planned home 
                births, and hospital births, including information 
                about each setting's safety, satisfaction, outcomes, 
                and costs;
                    ``(G) fosters participation in high-quality, 
                evidence-based childbirth education that promotes a 
                healthy and safe approach to pregnancy, childbirth, and 
                early parenting; is taught by certified educators, peer 
                counselors, and health professionals; and promotes 
                informed decision making by childbearing individuals;
                    ``(H) informs consumers about--
                            ``(i) the effects of systemic, 
                        institutional, and interpersonal racism on the 
                        health, well-being, and outcomes of birthing 
                        people;
                            ``(ii) the importance of respectful, 
                        culturally and linguistically appropriate, and 
                        culturally congruent care; and
                            ``(iii) the value of community-based and 
                        community-led maternal care and support; and
                    ``(I) is pilot tested for consumer comprehension, 
                cultural sensitivity, and acceptance of the messages 
                across geographically, racially, ethnically, and 
                linguistically diverse populations;''.

SEC. 5217. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC REVIEWS FOR CARE OF 
              CHILDBEARING INDIVIDUALS AND NEWBORNS.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services, 
acting through the Director of the Agency for Healthcare Research and 
Quality, shall--
            (1) make publicly available an online bibliographic 
        database identifying systematic reviews, including an 
        explanation of the level and quality of evidence, for care of 
        childbearing individuals and newborns; and
            (2) initiate regular updates that incorporate newly issued 
        and updated systematic reviews.
    (b) Sources.--To aim for a comprehensive inventory of systematic 
reviews relevant to maternal and newborn care, the database shall 
identify reviews from diverse sources, including--
            (1) scientific peer-reviewed journals;
            (2) databases, including the Cochrane Database of 
        Systematic Reviews; and
            (3) internet websites of agencies and organizations 
        throughout the world that produce such systematic reviews.
    (c) Features.--The database shall--
            (1) provide bibliographic citations for each record within 
        the database, and for each such citation include an explanation 
        of the level and quality of evidence;
            (2) include abstracts, as available;
            (3) provide reference to companion documents as may exist 
        for each review, such as evidence tables and guidelines or 
        consumer educational materials developed from the review;
            (4) provide links to the source of the full review and to 
        any companion documents;
            (5) provide links to the source of a previous version or 
        update of the review;
            (6) be searchable by intervention or other topic of the 
        review, reported outcomes, author, title, and source; and
            (7) offer to users periodic electronic notification of 
        database updates relating to users' topics of interest.
    (d) Outreach.--Not later than the first date the database is made 
publicly available and periodically thereafter, the Secretary of Health 
and Human Services shall publicize the availability, features, and uses 
of the database under this section to the stakeholders described in 
subsection (e).
    (e) Consultation.--For purposes of developing the database under 
this section and maintaining and updating such database, the Secretary 
of Health and Human Services shall convene and consult with an advisory 
committee composed of relevant stakeholders, including--
            (1) Federal Medicaid administrators and State agencies 
        administrating State plans under title XIX of the Social 
        Security Act pursuant to section 1902(a)(5) of such Act (42 
        U.S.C. 1396a(a)(5));
            (2) providers of maternity and newborn care from both 
        academic and community-based settings, including obstetrician-
        gynecologists, family physicians, certified nurse midwives, 
        certified midwives, certified professional midwives, physician 
        assistants, perinatal nurses, pediatricians, and nurse 
        practitioners;
            (3) maternal-fetal medicine specialists;
            (4) neonatologists;
            (5) childbearing individuals and advocates for such 
        individuals, including childbirth educators certified by a 
        nationally accredited program, representing communities that 
        are diverse in terms of race, ethnicity, indigenous status, and 
        geographic area;
            (6) employers and purchasers;
            (7) health facility and system leaders, including both 
        hospital and birth center facilities;
            (8) journalists; and
            (9) bibliographic informatics specialists.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated $2,500,000 for each of the fiscal years 2023 through 2025 
for the purpose of developing the database and such sums as may be 
necessary for each subsequent fiscal year for updating the database and 
providing outreach and notification to users, as described in this 
section.

SEC. 5218. DEVELOPMENT OF INTERPROFESSIONAL MATERNITY CARE EDUCATIONAL 
              MODELS AND TOOLS.

    (a) In General.--Not later than 6 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services, 
acting in conjunction with the Administrator of Health Resources and 
Services Administration, shall convene, for a 1-year period, an 
Interprofessional Maternity Provider Education Commission (referred to 
in this section as the ``Commission'') to discuss and make 
recommendations for--
            (1) a consensus standard physiologic maternity care 
        curriculum that takes into account the core competencies for 
        basic midwifery practice such as those developed by the 
        American College of Nurse Midwives and the North American 
        Registry of Midwives, and the educational objectives for 
        physicians practicing in obstetrics and gynecology as 
        determined by the Council on Resident Education in Obstetrics 
        and Gynecology;
            (2) suggestions for multidisciplinary use of the consensus 
        physiologic curriculum;
            (3) strategies to integrate and coordinate education across 
        maternity care disciplines, including recommendations to 
        increase medical and midwifery student exposure to out-of-
        hospital birth;
            (4) curriculum and strategies for continuing education of 
        practicing perinatal professionals who have completed their 
        undergraduate and graduate education; and
            (5) pilot demonstrations of interprofessional educational 
        models.
    (b) Participants.--
            (1) Professions.--The Commission shall include maternity 
        care educators, curriculum developers, service leaders, 
        certification leaders, and accreditation leaders from the 
        various professions that provide or support maternity care in 
        the United States. Such professions shall include obstetrician 
        gynecologists, certified nurse midwives or certified midwives, 
        family practice physicians, nurse practitioners, physician 
        assistants, certified professional midwives, perinatal nurses, 
        doulas, lactation personnel, and community health workers.
            (2) Consumer advocates.--The Commission shall also include 
        representation from maternity care consumer advocates.
    (c) Curriculum.--The consensus standard physiologic maternity care 
curriculum described in subsection (a)(1) shall--
            (1) have a public health focus with a foundation in health 
        promotion and disease prevention;
            (2) foster physiologic childbearing and person and family 
        centered care;
            (3) reflect the extensive, growing research evidence 
        about--
                    (A) the innate abilities and processes of the 
                birthing person and the fetus or newborn for labor, 
                birth, postpartum transition, breastfeeding, and 
                attachment, when promoted, supported, and protected; 
                and
                    (B) the effects of factors that disturb and disrupt 
                these processes;
            (4) integrate strategies to reduce maternal and infant 
        morbidity and mortality;
            (5) incorporate recommendations to ensure respectful, safe, 
        and seamless consultation, referral, transport, and transfer of 
        care when necessary;
            (6) include cultural sensitivity and strategies to decrease 
        inequities in maternity outcomes; and
            (7) include implicit bias training.
    (d) Report.--Not later than 6 months after the final meeting of the 
Commission, the Secretary of Health and Human Services shall--
            (1) submit to Congress a report containing the 
        recommendations made by the Commission under this section; and
            (2) make such report publicly available.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,000,000 for each of the 
fiscal years 2023 and 2024, and such sums as are necessary for each of 
the fiscal years 2025 through 2027.

SEC. 5219. DISSEMINATION OF THE QUALITY FAMILY PLANNING GUIDELINES.

    (a) In General.--Not later than 180 days after the date of 
enactment of this Act, the Secretary of Health and Human Services and 
the Director of the Centers for Disease Control and Prevention shall--
            (1) develop a plan for outreach to publicly funded health 
        care providers, including federally qualified health centers 
        (as defined in section 1861(aa)(4) of the Social Security Act 
        (42 U.S.C. 1395x(aa)(4))) and branches of the Indian Health 
        Service, about the quality family planning guidelines referred 
        to in section 5304; and
            (2) award grants to eligible entities to implement such 
        guidelines for all patients seeking family planning services.
    (b) Definition.--In this section, the term ``eligible entity'' 
means a publicly funded health care provider that serves persons of 
reproductive age.

       Subtitle D--Federal Agency Coordination on Maternal Health

SEC. 5301. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF 
              OPTIMAL MATERNITY OUTCOMES.

    (a) In General.--Part A of title II of the Public Health Service 
Act (42 U.S.C. 202 et seq.) is amended by adding at the end the 
following:

``SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF 
              OPTIMAL MATERNITY OUTCOMES.

    ``(a) In General.--The Secretary, acting through the Deputy 
Assistant Secretary for Women's Health under section 229 and in 
collaboration with the Federal officials specified in subsection (b), 
shall establish the Interagency Coordinating Committee on the Promotion 
of Optimal Maternity Outcomes (referred to in this section as the 
`ICCPOM').
    ``(b) Other Agencies.--The officials specified in this subsection 
are the Secretary of Labor, the Secretary of Defense, the Secretary of 
Veterans Affairs, the Surgeon General, the Director of the Centers for 
Disease Control and Prevention, the Administrator of the Health 
Resources and Services Administration, the Administrator of the Centers 
for Medicare & Medicaid Services, the Director of the Indian Health 
Service, the Administrator of the Substance Abuse and Mental Health 
Services Administration, the Director of the National Institute of 
Child Health and Human Development, the Director of the Agency for 
Healthcare Research and Quality, the Assistant Secretary for Children 
and Families, the Deputy Assistant Secretary for Minority Health, the 
Director of the Office of Personnel Management, and such other Federal 
officials as the Secretary of Health and Human Services determines to 
be appropriate.
    ``(c) Chair.--The Deputy Assistant Secretary for Women's Health 
shall serve as the chair of the ICCPOM.
    ``(d) Duties.--The ICCPOM shall guide policy and program 
development across the Federal Government with respect to promotion of 
optimal maternity care, provided, however, that nothing in this section 
shall be construed as transferring regulatory or program authority from 
an agency to the ICCPOM.
    ``(e) Consultations.--The ICCPOM shall actively seek the input of, 
and shall consult with, all appropriate and interested stakeholders, 
including State health departments, public health research and interest 
groups, foundations, childbearing individuals and their advocates, and 
maternity care professional associations and organizations, reflecting 
racially, ethnically, demographically, and geographically diverse 
communities.
    ``(f) Annual Report.--
            ``(1) In general.--The Secretary, on behalf of the ICCPOM, 
        shall annually submit to Congress a report that summarizes--
                    ``(A) all programs and policies of Federal agencies 
                (including the Medicare Program under title XVIII of 
                the Social Security Act and the Medicaid program under 
                title XIX of such Act) designed to promote optimal 
                maternity care, focusing particularly on programs and 
                policies that support the adoption of evidence-based 
                maternity care, as defined by timely, scientifically 
                sound systematic reviews;
                    ``(B) all programs and policies of Federal agencies 
                (including the Medicare Program under title XVIII of 
                the Social Security Act and the Medicaid program under 
                title XIX of such Act) designed to address the problems 
                of maternal mortality and morbidity, infant mortality, 
                prematurity, and low birth weight, including such 
                programs and policies designed to address racial and 
                ethnic inequities with respect to each of such 
                problems;
                    ``(C) the extent of progress in reducing maternal 
                mortality and infant mortality, low birth weight, and 
                prematurity at State and national levels; and
                    ``(D) such other information regarding optimal 
                maternity care (such as quality and performance 
                measures) as the Secretary determines to be 
                appropriate.
            ``(2) Reducing inequities with respect to indigenous 
        status.--The information specified in paragraph (1)(C) shall be 
        included in each such report in a manner that disaggregates 
        such information by race, ethnicity, and indigenous status in 
        order to determine the extent of progress in reducing racial 
        and ethnic inequities and inequities related to indigenous 
        status.
            ``(3) Certain information.--Each report under paragraph (1) 
        shall include information (disaggregated by race, ethnicity, 
        and indigenous status, as applicable) on the following rates, 
        trends, and costs by State:
                    ``(A) The rate and trend of primary cesarean 
                deliveries and repeat cesarean deliveries.
                    ``(B) The rate and trend of vaginal births after 
                cesarean.
                    ``(C) The rate and trend of vaginal breech births.
                    ``(D) The rate and trend of induction of labor.
                    ``(E) The rate and trend of freestanding birth 
                center births.
                    ``(F) The rate and trend of planned and unplanned 
                home birth.
                    ``(G) The rate and trends of attended births by 
                different types of maternity care providers, including 
                by an obstetrician-gynecologist, family practice 
                physician, obstetrician-gynecologist physician 
                assistant, certified nurse-midwife, certified midwife, 
                and certified professional midwife.
                    ``(H) The rate and trend of severe maternal 
                morbidity.
                    ``(I) The rates and trends of prenatal and 
                postpartum anxiety and depression.
                    ``(J) The rate and trend of pre-term birth.
                    ``(K) The rate and trend of low birth weight.
                    ``(L) The cost of maternity care disaggregated by 
                place of birth and provider of care, including--
                            ``(i) uncomplicated vaginal birth;
                            ``(ii) complicated vaginal birth;
                            ``(iii) uncomplicated cesarean birth; and
                            ``(iv) complicated cesarean birth.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated, in addition to amounts authorized to be appropriated 
under section 229(e), to carry out this section $1,000,000 for each of 
the fiscal years 2023 through 2027.''.
    (b) Conforming Amendments.--
            (1) Inclusion as duty of hhs office on women's health.--
        Section 229(b) of such Act (42 U.S.C. 237a(b)), as amended by 
        section 5216, is further amended by adding at the end the 
        following new paragraph:
            ``(9) establish the Interagency Coordinating Committee on 
        the Promotion of Optimal Maternity Outcomes in accordance with 
        section 229A; and''.
            (2) Treatment of biennial reports.--Section 229(d) of such 
        Act (42 U.S.C. 237a(d)) is amended by inserting ``(other than 
        under subsection (b)(9))'' after ``under this section''.

SEC. 5302. EXPANSION OF CDC PREVENTION RESEARCH CENTERS PROGRAM TO 
              INCLUDE CENTERS ON OPTIMAL MATERNITY OUTCOMES.

    (a) In General.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
support the establishment of additional Prevention Research Centers 
under the Prevention Research Center Program administered by the 
Centers for Disease Control and Prevention. Such additional centers 
shall each be known as a Center for Excellence on Optimal Maternity 
Outcomes.
    (b) Research.--Each Center for Excellence on Optimal Maternity 
Outcomes shall--
            (1) conduct at least one focused program of research to 
        improve maternity outcomes, including the reduction of cesarean 
        birth rates, early elective inductions, prematurity rates, and 
        low birth weight rates within an underserved population that 
        has a disproportionately large burden of suboptimal maternity 
        outcomes, including maternal mortality and morbidity, infant 
        mortality, prematurity, or low birth weight, which such program 
        shall include developing performance and quality measures for 
        accountability;
            (2) work with partners on special interest projects, as 
        specified by the Centers for Disease Control and Prevention and 
        other relevant agencies within the Department of Health and 
        Human Services, and on projects funded by other sources; and
            (3) involve a minimum of two distinct birth setting models, 
        such as--
                    (A) a hospital labor and delivery model and 
                freestanding birth center model; or
                    (B) a hospital labor and delivery model and planned 
                home birth model.
    (c) Interdisciplinary Providers.--Each Center for Excellence on 
Optimal Maternity Outcomes shall include the following 
interdisciplinary providers of maternity care:
            (1) Obstetrician-gynecologists.
            (2) At least two of the following providers:
                    (A) Family practice physicians.
                    (B) Nurse practitioners.
                    (C) Physician assistants.
                    (D) Certified professional midwives, certified 
                nurse-midwives, or certified midwives.
    (d) Services.--Research conducted by each Center for Excellence on 
Optimal Maternity Outcomes shall include at least 2 (and preferably 
more) of the following supportive provider services:
            (1) Mental health.
            (2) Doula labor support.
            (3) Nutrition education.
            (4) Childbirth education.
            (5) Social work.
            (6) Physical therapy or occupation therapy.
            (7) Substance use disorder services.
            (8) Home visiting.
    (e) Coordination.--The programs of research at each of the Centers 
of Excellence on Optimal Maternity Outcomes shall complement and not 
replicate the work of the other.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,000,000 for each of the 
fiscal years 2023 through 2027.

SEC. 5303. EXPANDING MODELS TO BE TESTED BY CENTER FOR MEDICARE AND 
              MEDICAID INNOVATION TO EXPLICITLY INCLUDE MATERNITY CARE 
              AND CHILDREN'S HEALTH MODELS.

    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended--
            (1) in subparagraph (B), by adding at the end the 
        following:
                            ``(xxviii) Promoting evidence-based models 
                        of care that have been associated with 
                        reductions in pregnancy-related and infant 
                        health inequities, including incorporating the 
                        use of and payment for doulas, particularly 
                        community-based doulas, and promoting support 
                        for people during pregnancy and for the one-
                        year period after the last day of such person's 
                        pregnancy, through evidence-based models of 
                        antepartum, birth, postpartum care, and two-
                        generation birthing person and newborn care 
                        models, and supporting the risk-appropriate use 
                        of out-of-hospital birth models, including 
                        births at home and in freestanding birth 
                        centers. Such models shall be selected and 
                        evaluated based on their impact on quality, 
                        equity, and developmental outcomes, 
                        notwithstanding any other provision of this 
                        section.'';
            (2) in subparagraph (C), by adding at the end the 
        following:
                            ``(ix) Whether the model includes a regular 
                        process for ensuring the provision of 
                        culturally and linguistically appropriate 
                        services.
                            ``(x) Whether health care services and 
                        supportive services included in the model are 
                        tailored to community health and health-related 
                        social needs and provided by community-based 
                        and community-led providers.
                            ``(xi) Whether the model is designed to 
                        mitigate harmful effects of discrimination on 
                        the basis of race, sex, disability, ethnicity, 
                        language, and age.''; and
            (3) by adding at the end the following:
                    ``(D) Mandatory health equity models to be 
                tested.--The Secretary shall select--
                            ``(i) Medicaid global and episode-based 
                        payment models for culturally and 
                        linguistically appropriate antepartum, labor 
                        and delivery, and postpartum doula services, 
                        including community-based doula services, that 
                        are--
                                    ``(I) structured to provide payment 
                                to doulas as individuals, health care 
                                entity staff, or members of a doula 
                                group or collective, or through a 
                                third-party administrator;
                                    ``(II) designed to reduce racial 
                                and intersecting health inequities;
                                    ``(III) designed to provide doulas 
                                providing support with an equitable and 
                                sustainable reimbursement rate;
                                    ``(IV) designed to reduce barriers 
                                to workforce entry for culturally and 
                                linguistically competent and racially 
                                congruent doulas to provide services to 
                                Medicaid enrollees; and
                                    ``(V) designed with input from 
                                community-based doulas, maternal health 
                                advocates, reproductive justice 
                                advocates, and Medicaid beneficiaries;
                            ``(ii) a Medicaid episode-based payment 
                        model for pregnancy-related services, including 
                        health care services and supportive services to 
                        address health-related socials needs, during 
                        the prenatal, intrapartum, and postpartum 
                        periods, to improve health outcomes and reduce 
                        racial health inequities, and to be designed 
                        with input from maternity care providers, 
                        maternal health advocates, reproductive justice 
                        advocates, and Medicaid beneficiaries;
                            ``(iii) a Medicaid alternative payment 
                        model for a pregnancy-related health home to 
                        improve health outcomes during and for one year 
                        after pregnancy and during the newborn period, 
                        and to reduce racial health inequities, 
                        designed with input from maternity care 
                        providers, maternal health advocates, 
                        reproductive justice advocates, and Medicaid 
                        beneficiaries;
                            ``(iv) a Medicaid perinatal health worker 
                        service delivery model for culturally and 
                        linguistically appropriate and respectful 
                        health care and supportive services that are 
                        tailored to community health and health-related 
                        social needs, designed to improve health 
                        outcomes and mitigate harmful effects of racism 
                        and other forms of discrimination, and provided 
                        by community-based and community-led providers; 
                        and
                            ``(v) one or more models exclusively 
                        focused on early intervention and prevention 
                        for children enrolled in a State plan (or 
                        waiver of such plan) under title XIX or a State 
                        child health plan under title XXI using 
                        evidence-based interventions including 
                        parenting support programs, home-visiting 
                        services, and dyadic therapy treatment for 
                        children and adolescents at-risk.
                Such models shall be selected and evaluated based on 
                their impact on quality, equity, and developmental 
                outcomes, notwithstanding any other provision of this 
                section.''.

SEC. 5304. INTERAGENCY UPDATE TO THE QUALITY FAMILY PLANNING 
              GUIDELINES.

    (a) In General.--Not later than six months after the date of 
enactment of this Act, the Director of the Centers for Disease Control 
and Prevention and the Office of Population Affairs shall review and 
expand the 2014 Quality Family Planning Guidelines to address--
            (1) health inequities; and
            (2) the importance of patient-directed contraceptive 
        decision making.
    (b) Consultation.--In carrying out subsection (a), the Director of 
the Centers for Disease Control and Prevention and the Office of 
Population Affairs shall convene a meeting, and solicit the views of, 
stakeholders including experts on health inequities, experts on 
reproductive coercion, representatives of provider organizations, 
patient advocates, reproductive justice organizations, organizations 
that represent racial and ethnic minority communities, organizations 
that represent people with disabilities, organizations that represent 
LGBTQ persons, and organizations that represent people with limited 
English proficiency.

               Subtitle E--Reproductive and Sexual Health

SEC. 5401. FINDINGS; SENSE OF CONGRESS ON URGENT BARRIERS TO ABORTION 
              ACCESS AND VITAL SOLUTIONS.

    (a) Findings.--Congress finds the following:
            (1) Affordable, comprehensive health insurance that 
        includes coverage for a full range of pregnancy-related care, 
        including abortion, is critical to the health of every person 
        regardless of actual or perceived race, color, national origin, 
        immigration status, sex (including sexual orientation, gender 
        identity, pregnancy, childbirth, a medical condition relating 
        to pregnancy or childbirth, or sex stereotyping), age, or 
        disability status.
            (2) Abortion services are essential to health care and 
        access to those services is central to people's ability to 
        participate equally in the economic and social life of the 
        United States. Abortion access allows people who are pregnant 
        to make their own decisions about their pregnancies, their 
        families, and their lives.
            (3) Reproductive justice seeks to address restrictions on 
        reproductive health, including abortion, that perpetuate 
        systems of oppression, lack of bodily autonomy, White 
        supremacy, and anti-Black racism. The violent legacy of these 
        systems of oppression has manifested in policies including 
        enslavement, rape, and experimentation on Black people, forced 
        sterilizations, medical experimentation on low-income people's 
        reproductive systems, and the forcible removal of Indigenous 
        children. Access to equitable reproductive health care, 
        including abortion services, has always been deficient in the 
        United States for Black, Indigenous, and other People of Color 
        (BIPOC) and their families. Transgender, nonbinary, and gender-
        expansive individuals, and specifically those who are Black, 
        disabled, and at the intersections of multiple forms of 
        oppression, also experience inequitable access to abortion 
        services due to systemic violence. Centering abortion rights 
        and access as a ``women's health'' issue restricts access to 
        those with reproductive needs who do not identify as cisgender 
        women. In order to work towards reproductive justice for all 
        communities, transgender, nonbinary, and gender expansive must 
        be centered in conversations of abortion access. Improving 
        abortion access for this community requires a gender-neutral 
        approach to abortion care, rights, and justice policy.
            (4) The legacy of restrictions on reproductive health, 
        rights, and justice is not a dated vestige of a dark history. 
        Access to abortion services is obstructed across the United 
        States in various ways, including blockades of health care 
        facilities and associated violence, prohibitions of, and 
        restrictions on, insurance coverage, parental involvement laws 
        (notification and consent), restrictions that shame and 
        stigmatize people seeking abortion services, and medically 
        unnecessary regulations that neither confer any health benefit 
        nor further the safety of abortion services, but which harm 
        people by delaying, complicating access to, and reducing the 
        availability of, abortion services. As of December 2, 2021, 19 
        States have enacted 106 restrictions, including 12 new abortion 
        bans, making 2021 the year with the highest number of 
        restrictions passed since Roe v. Wade was decided in 1973. 
        Additionally, 21 States are poised to immediately ban or 
        significantly restrict access to abortion services if the 
        Supreme Court chooses to overturn or weaken Roe v. Wade. These 
        unprecedented attacks on abortion rights and access fall 
        especially heavily on people with low incomes, BIPOC, 
        immigrants, young people, people with disabilities, those 
        living in rural and other medically underserved areas, and 
        transgender, nonbinary, and gender expansive individuals.
            (5) Since 1976, the Federal Government has withheld funds 
        for abortion coverage in most circumstances through the Hyde 
        amendment and similar coverage restrictions, affecting 
        individuals of reproductive age in the United States who are 
        insured through the Medicaid program, as well as individuals 
        who receive insurance or care through other Federal health 
        plans and programs. Of women aged 15 to 44 enrolled in Medicaid 
        in 2017, 55 percent lived in the 35 States and the District of 
        Columbia that do not cover abortion, except in limited 
        circumstances. This amounts to roughly 7,300,000 women of 
        reproductive age, including 3,100,000 women living below the 
        Federal poverty level. Women of color are disproportionately 
        likely to be insured by the Medicaid program, and nationwide, 
        32 percent of Black women and 27 percent of Hispanic women aged 
        15 to 44 were enrolled in Medicaid in 2017, compared with 16 
        percent of White women.
            (6) Abortion-specific restrictions are even more compounded 
        by the ongoing criminalization of people who are pregnant, 
        including those who are incarcerated, living with HIV, or with 
        substance-use disorders. These communities already experience 
        health inequities due to social, political, and environmental 
        inequities, and restrictions on abortion services exacerbate 
        these harms. Removing medically unjustified restrictions on 
        abortion services would constitute one important step on the 
        path toward realizing reproductive justice by ensuring that the 
        full range of reproductive health care is accessible to all who 
        need it.
            (7) Abortion-specific restrictions are a tool of gender 
        oppression, as they target health care services that are used 
        primarily by individuals with reproductive needs. These 
        paternalistic restrictions rely on and reinforce harmful 
        stereotypes about gender roles, people's decision making, and 
        people's need for protection instead of support, undermining 
        their ability to control their own lives and well-being. These 
        restrictions harm the basic autonomy, dignity, and equality of 
        individuals with reproductive health needs, and their ability 
        to participate in the social and economic life of the Nation.
            (8) Many abortion-specific restrictions do not confer any 
        health or safety benefits on the patient. Instead, these 
        restrictions have the purpose and effect of unduly burdening 
        people's personal and private medical decisions to end their 
        pregnancies by making access to abortion services more 
        difficult, invasive, and costly, often forcing people to travel 
        significant distances and make multiple unnecessary visits to 
        the provider, and in some cases, foreclosing the option 
        altogether.
            (9) Congress has used its authority in the past to protect 
        access to abortion services and health care providers' ability 
        to provide abortion services. In the early 1990s, protests and 
        blockades at health care facilities where abortion services 
        were provided, and associated violence, increased dramatically 
        and reached crisis level, requiring congressional action. 
        Congress passed the Freedom of Access to Clinic Entrances Act 
        (Public Law 103-259; 108 Stat. 694) to address that situation 
        and protect physical access to abortion services.
            (10) Congressional action is necessary to put an end to 
        harmful restrictions, to federally protect access to abortion 
        services for everyone regardless of where they live, and to 
        protect the ability of health care providers to provide these 
        services in a safe and accessible manner.
            (11) The Equal Access to Abortion Coverage in Health 
        Insurance Act of 2021 or the EACH Act of 2021 (H.R. 2234, S. 
        1021) introduced in the 117th Congress, would reverse the Hyde 
        amendment and related abortion coverage restrictions. It would 
        create an enforceable statutory right for people who receive 
        health coverage or care through enumerated Federal programs 
        (including Medicaid, the Children's Health Insurance Program, 
        Medicare, the Indian Health Service, among others) and plans 
        (including government-sponsored health insurance due to a 
        current or former employment relationship) to receive abortion 
        coverage. It would require the Federal government to facilitate 
        abortion access for individuals eligible to receive health care 
        in Federal facilities or in facilitates with which it contracts 
        to provide health care, such as immigration detention centers. 
        It also prohibits the Federal Government from prohibiting, 
        restricting, or otherwise inhibiting State or local governments 
        or private health insurance issuers from providing abortion 
        coverage.
            (12) The Women's Health Protection Act of 2021 (H.R. 3755, 
        S. 1975) introduced in the 117th Congress, would establish an 
        enforceable statutory right for health care providers to 
        provide, and abortion patients to receive, abortions free from 
        medically unnecessary restrictions, limitations, and bans that 
        delay, and at times, completely obstruct, access to abortion.
    (b) Sense of Congress.--It is the sense of Congress that 
eliminating the Hyde amendment, enacting the Equal Access to Abortion 
Coverage in Health Insurance Act of 2021, and enacting the Women's 
Health Protection Act of 2021, are critical to--
            (1) promoting equitable abortion access, including 
        coverage, for all who seek care;
            (2) creating enforceable rights to receive, and receive 
        coverage for, such care;
            (3) advancing equitable access to comprehensive health 
        coverage, which cannot be achieved without abortion coverage; 
        and
            (4) alleviating urgent racial, gender, and other inequities 
        in health and health care and corresponding reproductive 
        injustices.

SEC. 5402. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.

    (a) Emergency Contraception Public Education Program.--
            (1) In general.--The Secretary, acting through the Director 
        of the Centers for Disease Control and Prevention, shall 
        develop and disseminate to the public medically accurate and 
        complete information on emergency contraceptives.
            (2) Dissemination.--The Secretary may disseminate medically 
        accurate and complete information under paragraph (1) directly 
        or through arrangements with nonprofit organizations, community 
        health workers, including promotores, consumer groups, 
        institutions of higher education, clinics, the media, and 
        Federal, State, and local agencies.
            (3) Information.--The information disseminated under 
        paragraph (1) shall--
                    (A) include, at a minimum, a description of 
                emergency contraceptives and an explanation of the use, 
                safety, efficacy, affordability, and availability, 
                including over-the-counter access, of such 
                contraceptives and options for access to such 
                contraceptives without cost-sharing through insurance 
                and other programs; and
                    (B) be pilot tested for consumer comprehension, 
                cultural and linguistic appropriateness, and acceptance 
                of the messages across geographically, racially, 
                ethnically, and linguistically diverse populations.
    (b) Emergency Contraception Information Program for Health Care 
Providers.--
            (1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and in consultation with major medical and 
        public health organizations, shall develop and disseminate to 
        health care providers, including pharmacists, information on 
        emergency contraceptives.
            (2) Information.--The information disseminated under 
        paragraph (1) shall include, at a minimum--
                    (A) information describing the use, safety, 
                efficacy, and availability of emergency contraceptives, 
                and options for access without cost-sharing through 
                insurance and other programs;
                    (B) a recommendation regarding the use of such 
                contraceptives; and
                    (C) information explaining how to obtain copies of 
                the information developed under subsection (a) for 
                distribution to the patients of the providers.
    (c) Definitions.--In this section:
            (1) Health care provider.--The term ``health care 
        provider'' means an individual who is licensed or certified 
        under State law to provide health care services and who is 
        operating within the scope of such license. Such term shall 
        include a pharmacist.
            (2) Institution of higher education.--The term 
        ``institution of higher education'' has the same meaning given 
        such term in section 101(a) of the Higher Education Act of 1965 
        (20 U.S.C. 1001(a)).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of the fiscal years 2023 through 2027.

SEC. 5403. ACCESS TO BIRTH CONTROL DUTIES OF PHARMACIES TO ENSURE 
              PROVISION OF FDA-APPROVED CONTRACEPTION.

    Part B of title II of the Public Health Service Act (42 U.S.C. 238 
et seq.) is amended by adding at the end the following:

``SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION OF FDA-APPROVED 
              CONTRACEPTION.

    ``(a) In General.--Subject to subsection (c), a pharmacy that 
receives Food and Drug Administration-approved drugs or devices in 
interstate commerce shall maintain compliance with the following:
            ``(1) If a customer requests a contraceptive or a 
        medication related to a contraceptive, including emergency 
        contraception, that is in stock, the pharmacy shall ensure that 
        the contraceptive is provided to the customer without delay.
            ``(2) If a customer requests a contraceptive or a 
        medication related to a contraceptive that is not in stock and 
        the pharmacy in the normal course of business stocks 
        contraception, the pharmacy shall immediately inform the 
        customer that the contraceptive is not in stock and without 
        delay offer the customer the following options:
                    ``(A) If the customer prefers to obtain the 
                contraceptive or a medication related to a 
                contraceptive through a referral or transfer, the 
                pharmacy shall--
                            ``(i) locate a pharmacy of the customer's 
                        choice or the closest pharmacy confirmed to 
                        have the contraceptive or a medication related 
                        to a contraceptive in stock; and
                            ``(ii) refer the customer or transfer the 
                        prescription to that pharmacy.
                    ``(B) If the customer prefers for the pharmacy to 
                order the contraceptive or a medication related to a 
                contraceptive, the pharmacy shall obtain the 
                contraceptive or medication under the pharmacy's 
                standard procedure for expedited ordering of medication 
                and notify the customer when the contraceptive or 
                medication arrives.
            ``(3) The pharmacy shall ensure that--
                    ``(A) the pharmacy does not operate an environment 
                in which customers are intimidated, threatened, or 
                harassed in the delivery of services relating to a 
                request for contraception or a medication related to a 
                contraceptive;
                    ``(B) the pharmacy's employees do not interfere 
                with or obstruct the delivery of services relating to a 
                request for contraception or a medication related to a 
                contraceptive;
                    ``(C) the pharmacy's employees do not intentionally 
                misrepresent or deceive customers about the 
                availability of a contraceptive or a medication related 
                to a contraceptive, or the mechanism of action of such 
                contraceptive or medication;
                    ``(D) the pharmacy's employees do not breach 
                medical confidentiality with respect to a request for a 
                contraceptive or a medication related to a 
                contraceptive or threaten to breach such 
                confidentiality; or
                    ``(E) the pharmacy's employees do not refuse to 
                return a valid, lawful prescription for a contraceptive 
                or a medication related to a contraceptive upon 
                customer request.
    ``(b) Contraceptives Not Ordinarily Stocked.--Nothing in subsection 
(a)(2) shall be construed to require any pharmacy to comply with such 
subsection if the pharmacy does not ordinarily stock contraceptives or 
a medication related to a contraceptive in the normal course of 
business.
    ``(c) Refusals Pursuant to Standard Pharmacy Practice.--This 
section does not prohibit a pharmacy from refusing to provide a 
contraceptive or a medication related to a contraceptive to a customer 
in accordance with any of the following:
            ``(1) If it is unlawful to dispense the contraceptive or a 
        medication related to a contraceptive to the customer without a 
        valid, lawful prescription and no such prescription is 
        presented.
            ``(2) If the customer is unable to pay for the 
        contraceptive or the medication related to a contraceptive.
            ``(3) If the employee of the pharmacy refuses to provide 
        the contraceptive or a medication related to a contraceptive on 
        the basis of a professional clinical judgment.
    ``(d) Relation to Other Law.--
            ``(1) Rule of construction.--Nothing in this section shall 
        be construed to invalidate or limit rights, remedies, 
        procedures, or legal standards under title VII of the Civil 
        Rights Act of 1964.
            ``(2) Certain claims.--The Religious Freedom Restoration 
        Act of 1993 shall not provide a basis for a claim concerning, 
        or a defense to a claim under, this section, or provide a basis 
        for challenging the application or enforcement of this section.
    ``(e) Preemption.--This section does not preempt any provision of 
State law or any professional obligation made applicable by a State 
board or other entity responsible for licensing or discipline of 
pharmacies or pharmacists, to the extent that such State law or 
professional obligation provides protections for customers that are 
greater than the protections provided by this section.
    ``(f) Enforcement.--
            ``(1) Civil penalty.--A pharmacy that violates a 
        requirement of subsection (a) is liable to the United States 
        for a civil penalty in an amount not exceeding $1,000 per day 
        of violation, not to exceed $100,000 for all violations 
        adjudicated in a single proceeding.
            ``(2) Private cause of action.--Any person aggrieved as a 
        result of a violation of a requirement of subsection (a) may, 
        in any court of competent jurisdiction, commence a civil action 
        against the pharmacy involved to obtain appropriate relief, 
        including actual and punitive damages, injunctive relief, and a 
        reasonable attorney's fee and cost.
            ``(3) Limitations.--A civil action under paragraph (1) or 
        (2) may not be commenced against a pharmacy after the 
        expiration of the 5-year period beginning on the date on which 
        the pharmacy allegedly engaged in the violation involved.
    ``(g) Definitions.--In this section:
            ``(1) Contraception.--The term `contraception' or 
        `contraceptive' means any drug or device approved by the Food 
        and Drug Administration to prevent pregnancy.
            ``(2) Employee.--The term `employee' means a person hired, 
        by contract or any other form of an agreement, by a pharmacy.
            ``(3) Medication related to a contraceptive.--The term 
        `medication related to a contraceptive' means any drug or 
        device approved by the Food and Drug Administration that a 
        medical professional determines necessary to use before or in 
        conjunction with a contraceptive.
            ``(4) Pharmacy.--The term `pharmacy' means an entity that--
                    ``(A) is authorized by a State to engage in the 
                business of selling prescription drugs at retail; and
                    ``(B) employs one or more employees.
            ``(5) Product.--The term `product' means a Food and Drug 
        Administration-approved drug or device.
            ``(6) Professional clinical judgment.--The term 
        `professional clinical judgment' means the use of professional 
        knowledge and skills to form a clinical judgment, in accordance 
        with prevailing medical standards.
            ``(7) Without delay.--The term `without delay', with 
        respect to a pharmacy providing, providing a referral for, or 
        ordering contraception, or transferring the prescription for 
        contraception, means within the usual and customary timeframe 
        at the pharmacy for providing, providing a referral for, or 
        ordering other products, or transferring the prescription for 
        other products, respectively.
    ``(h) Effective Date.--This section shall take effect on the 31st 
day after the date of the enactment of this section, without regard to 
whether the Secretary has issued any guidance or final rule regarding 
this section.''.

SEC. 5404. REAL EDUCATION AND ACCESS FOR HEALTHY YOUTH.

    (a) Purpose.--The purpose of this section is to provide young 
people with sex education and sexual health services that--
            (1) promote and uphold the rights of young people to 
        information and services that empower them to make decisions 
        about their bodies, health, sexuality, families, and 
        communities in all areas of life;
            (2) are evidence-informed, comprehensive in scope, 
        confidential, equitable, accessible, medically accurate and 
        complete, age and developmentally appropriate, culturally 
        responsive, and trauma-informed and resilience-oriented;
            (3) provide information about the prevention, treatment, 
        and care of pregnancy, sexually transmitted infections, and 
        interpersonal violence;
            (4) provide information about the importance of consent as 
        a basis for healthy relationships and for autonomy in health 
        care;
            (5) provide information on gender roles and gender 
        discrimination;
            (6) provide information on the historical and current 
        condition in which education and health systems, policies, 
        programs, services, and practices have uniquely and adversely 
        impacted Black, Indigenous, Latinx, Asian, Asian American and 
        Pacific Islander, and other People of Color; and
            (7) redress inequities in the delivery of sex education and 
        sexual health services to marginalized young people.
    (b) Definitions.--In this section:
            (1) Age and developmentally appropriate.--The term ``age 
        and developmentally appropriate'' means topics, messages, and 
        teaching methods suitable to particular ages, age groups, or 
        developmental levels, based on cognitive, emotional, social, 
        and behavioral capacity of most young people at that age level.
            (2) Characteristics of effective programs.--The term 
        ``characteristics of effective programs'' means the aspects of 
        evidence-informed programs, including development, content, and 
        implementation of such programs, that--
                    (A) have been shown to be effective in terms of 
                increasing knowledge, clarifying values and attitudes, 
                increasing skills, and impacting behavior; and
                    (B) are widely recognized by leading medical and 
                public health agencies to be effective in changing 
                sexual behaviors that lead to sexually transmitted 
                infections, unintended pregnancy, and interpersonal 
                violence among young people.
            (3) Consent.--The term ``consent'' means affirmative, 
        conscious, and voluntary agreement to engage in interpersonal, 
        physical, or sexual activity.
            (4) Culturally responsive.--The term ``culturally 
        responsive'' means education and services that--
                    (A) embrace and actively engage and adjust to young 
                people and their various cultural identities;
                    (B) recognize the ways in which many marginalized 
                young people face unique barriers in our society that 
                result in increased adverse health outcomes and 
                associated stereotypes; and
                    (C) may address the ways in which racism has shaped 
                national health care policy, the lasting historical 
                trauma associated with reproductive health experiments 
                and forced sterilizations of Black, Latinx, and 
                Indigenous communities, or sexual stereotypes assigned 
                to young People of Color or LGBTQ+ people.
            (5) Evidence-informed.--The term ``evidence-informed'' 
        means incorporates characteristics, content, or skills that 
        have been proven to be effective through evaluation in changing 
        sexual behavior.
            (6) Gender expression.--The term ``gender expression'' 
        means the expression of one's gender, such as through behavior, 
        clothing, haircut, or voice, and which may or may not conform 
        to socially defined behaviors and characteristics typically 
        associated with being either masculine or feminine.
            (7) Gender identity.--The term ``gender identity'' means 
        the gender-related identity, appearance, mannerisms, or other 
        gender-related characteristics of an individual, regardless of 
        the individual's designated sex at birth.
            (8) Inclusive.--The term ``inclusive'' means content and 
        skills that ensure marginalized young people are valued, 
        respected, centered, and supported in sex education instruction 
        and materials.
            (9) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given the 
        term in section 101 of the Higher Education Act of 1965 (20 
        U.S.C. 1001).
            (10) Interpersonal violence.--The term ``interpersonal 
        violence'' means abuse, assault, bullying, dating violence, 
        domestic violence, harassment, intimate partner violence, or 
        stalking.
            (11) Marginalized young people.--The term ``marginalized 
        young people'' means young people who are disadvantaged by 
        underlying structural barriers and social inequities, including 
        young people who are--
                    (A) Black, Indigenous, and other People of Color;
                    (B) immigrants;
                    (C) in contact with the foster care system;
                    (D) in contact with the juvenile justice system;
                    (E) experiencing homelessness;
                    (F) pregnant or parenting;
                    (G) lesbian, gay, bisexual, transgender, or queer;
                    (H) living with HIV;
                    (I) living with disabilities;
                    (J) from families with low-incomes; or
                    (K) living in rural areas.
            (12) Medically accurate and complete.--The term ``medically 
        accurate and complete'' means that--
                    (A) the information provided through the education 
                is verified or supported by the weight of research 
                conducted in compliance with accepted scientific 
                methods and is published in peer-reviewed journals, 
                where applicable; or
                    (B) the education contains information that leading 
                professional organizations and agencies with relevant 
                expertise in the field recognize as accurate, 
                objective, and complete.
            (13) Resilience.--The term ``resilience'' means the ability 
        to adapt to trauma and tragedy.
            (14) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (15) Sex education.--The term ``sex education'' means high 
        quality teaching and learning that--
                    (A) is delivered, to the maximum extent 
                practicable, following the National Sexuality Education 
                Standards of the Future of Sex Ed Initiative;
                    (B) is about a broad variety of topics related to 
                sex and sexuality, including--
                            (i) puberty and adolescent development;
                            (ii) sexual and reproductive anatomy and 
                        physiology;
                            (iii) sexual orientation, gender identity, 
                        and gender expression;
                            (iv) contraception, pregnancy, and 
                        reproduction;
                            (v) HIV and other STIs;
                            (vi) consent and healthy relationships; and
                            (vii) interpersonal violence;
                    (C) explores values and beliefs about such topics; 
                and
                    (D) helps young people in gaining the skills that 
                are needed to navigate relationships and manage one's 
                own sexual health.
            (16) Sexual development.--The term ``sexual development'' 
        means the lifelong process of physical, behavioral, cognitive, 
        and emotional growth and change as it relates to an 
        individual's sexuality and sexual maturation, including 
        puberty, identity development, socio-cultural influences, and 
        sexual behaviors.
            (17) Sexual health services.--The term ``sexual health 
        services'' includes--
                    (A) sexual health information, education, and 
                counseling;
                    (B) all methods of contraception approved by the 
                Food and Drug Administration;
                    (C) routine gynecological care, including human 
                papillomavirus (HPV) vaccines and cancer screenings;
                    (D) pre-exposure prophylaxis or post-exposure 
                prophylaxis;
                    (E) substance use and mental health services;
                    (F) interpersonal violence survivor services; and
                    (G) other prevention, care, or treatment services.
            (18) Sexual orientation.--The term ``sexual orientation'' 
        means an individual's romantic, emotional, or sexual attraction 
        to other people.
            (19) Trauma.--The term ``trauma'' means a response to an 
        event, series of events, or set of circumstances that is 
        experienced or witnessed by an individual or group of people as 
        physically or emotionally harmful or life-threatening with 
        lasting adverse effects on their functioning and mental, 
        physical, social, emotional, or spiritual well-being.
            (20) Trauma-informed and resilience-oriented.--The term 
        ``trauma-informed and resilience-oriented'' means an approach 
        that realizes the prevalence of trauma, recognizes the various 
        ways individuals, organizations, and communities may respond to 
        trauma differently, recognizes that resilience can be built, 
        and responds by putting this knowledge into practice.
            (21) Young people.--The term ``young people'' means 
        individuals who are ages 10 through 29 at the time of 
        commencement of participation in a project supported under this 
        section.
            (22) Youth-friendly sexual health services.--The term 
        ``youth-friendly sexual health services'' means sexual health 
        services that are provided in a confidential, equitable, and 
        accessible manner that makes it easy and comfortable for young 
        people to seek out and receive services.
    (c) Grants for Sex Education at Elementary and Secondary Schools 
and Youth-Serving Organizations.--
            (1) Program authorized.--The Secretary, in coordination 
        with the Secretary of Education, shall award grants, on a 
        competitive basis, to eligible entities to enable such eligible 
        entities to carry out projects that provide young people with 
        sex education.
            (2) Duration.--Grants awarded under this subsection shall 
        be for a period of 5 years.
            (3) Eligible entity.--In this subsection, the term 
        ``eligible entity'' means a public or private entity that 
        delivers health education to young people.
            (4) Applications.--An eligible entity desiring a grant 
        under this subsection shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may require.
            (5) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to eligible entities that 
        are--
                    (A) State educational agencies or local educational 
                agencies; or
                    (B) Indian Tribes or Tribal organizations, as 
                defined in section 4 of the Indian Self-Determination 
                and Education Assistance Act (25 U.S.C. 5304).
            (6) Use of funds.--Each eligible entity that receives a 
        grant under this subsection shall use the grant funds to carry 
        out a project that provides young people with sex education.
    (d) Grants for Sex Education at Institutions of Higher Education.--
            (1) Program authorized.--The Secretary, in coordination 
        with the Secretary of Education, shall award grants, on a 
        competitive basis, to institutions of higher education or 
        consortia of such institutions to enable such institutions to 
        provide students with age and developmentally appropriate sex 
        education.
            (2) Duration.--Grants awarded under this subsection shall 
        be for a period of 5 years.
            (3) Applications.--An institution of higher education or 
        consortium of such institutions desiring a grant under this 
        subsection shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require.
            (4) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to an institution of higher 
        education that--
                    (A) has an enrollment of needy students, as defined 
                in section 318(b) of the Higher Education Act of 1965 
                (20 U.S.C. 1059e(b));
                    (B) is a Hispanic-serving institution, as defined 
                in section 502(a) of such Act (20 U.S.C. 1101a(a));
                    (C) is a Tribal College or University, as defined 
                in section 316(b) of such Act (20 U.S.C. 1059c(b));
                    (D) is an Alaska Native-serving institution, as 
                defined in section 317(b) of such Act (20 U.S.C. 
                1059d(b));
                    (E) is a Native Hawaiian-serving institution, as 
                defined in section 317(b) of such Act (20 U.S.C. 
                1059d(b));
                    (F) is a Predominantly Black Institution, as 
                defined in section 318(b) of such Act (20 U.S.C. 
                1059e(b));
                    (G) is a Native American-serving, nontribal 
                institution, as defined in section 319(b) of such Act 
                (20 U.S.C. 1059f(b));
                    (H) is an Asian American and Native American 
                Pacific Islander-serving institution, as defined in 
                section 320(b) of such Act (20 U.S.C. 1059g(b)); or
                    (I) is a minority institution, as defined in 
                section 365 of such Act (20 U.S.C. 1067k), with an 
                enrollment of needy students, as defined in section 312 
                of such Act (20 U.S.C. 1058).
            (5) Uses of funds.--An institution of higher education or 
        consortium of such institutions receiving a grant under this 
        subsection shall use grant funds to develop and implement a 
        project to integrate sex education into the institution of 
        higher education in order to reach a large number of students, 
        by carrying out 1 or more of the following activities:
                    (A) Adopting and incorporating age and 
                developmentally appropriate sex education into student 
                orientation, general education, or courses.
                    (B) Developing or adopting and implementing 
                educational programming outside of class that delivers 
                age and developmentally appropriate sex education to 
                students.
                    (C) Developing or adopting and implementing 
                innovative technology-based approaches to deliver age 
                and developmentally appropriate sex education to 
                students.
                    (D) Developing or adopting and implementing peer-
                led activities to generate discussion, educate, and 
                raise awareness among students about age and 
                developmentally appropriate sex education.
                    (E) Developing or adopting and implementing 
                policies and practices to link students to sexual 
                health services.
    (e) Grants for Educator Training.--
            (1) Program authorized.--The Secretary, in coordination 
        with the Secretary of Education, shall award grants, on a 
        competitive basis, to eligible entities to enable such eligible 
        entities to carry out the activities described in paragraph 
        (5).
            (2) Duration.--Grants awarded under this subsection shall 
        be for a period of 5 years.
            (3) Eligible entity.--In this subsection, the term 
        ``eligible entity'' means--
                    (A) a State educational agency or local educational 
                agency;
                    (B) an Indian Tribe or Tribal organization, as 
                defined in section 4 of the Indian Self-Determination 
                and Education Assistance Act (25 U.S.C. 5304);
                    (C) a State or local department of health;
                    (D) an educational service agency;
                    (E) a nonprofit institution of higher education or 
                a consortium of such institutions; or
                    (F) a national or statewide nonprofit organization 
                or consortium of nonprofit organizations that has as 
                its primary purpose the improvement of provision of sex 
                education through training and effective teaching of 
                sex education.
            (4) Application.--An eligible entity desiring a grant under 
        this subsection shall submit an application to the Secretary at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
            (5) Authorized activities.--
                    (A) Required activity.--Each eligible entity 
                receiving a grant under this subsection shall use grant 
                funds for professional development and training of 
                relevant teachers, health educators, faculty, 
                administrators, and staff, in order to increase 
                effective teaching of sex education to young people.
                    (B) Permissible activities.--Each eligible entity 
                receiving a grant under this subsection may use grant 
                funds to--
                            (i) provide training and support for 
                        educators about the content, skills, and 
                        professional disposition needed to implement 
                        sex education effectively;
                            (ii) develop and provide training and 
                        support to educators on incorporating anti-
                        racist and gender inclusive policies and 
                        practices in sex education;
                            (iii) support the dissemination of 
                        information on effective practices and research 
                        findings concerning the teaching of sex 
                        education;
                            (iv) support research on--
                                    (I) effective sex education 
                                teaching practices; and
                                    (II) the development of assessment 
                                instruments and strategies to 
                                document--
                                            (aa) young people's 
                                        understanding of sex education; 
                                        and
                                            (bb) the effects of sex 
                                        education;
                            (v) convene conferences on sex education, 
                        in order to effectively train educators in the 
                        provision of sex education; and
                            (vi) develop and disseminate appropriate 
                        research-based materials to foster sex 
                        education.
                    (C) Subgrants.--Each eligible entity receiving a 
                grant under this subsection may award subgrants to 
                nonprofit organizations that possess a demonstrated 
                record of providing training to teachers, health 
                educators, faculty, administrators, and staff on sex 
                education to--
                            (i) train educators in sex education;
                            (ii) support internet or distance learning 
                        related to sex education;
                            (iii) promote rigorous academic standards 
                        and assessment techniques to guide and measure 
                        student performance in sex education;
                            (iv) encourage replication of best 
                        practices and model programs to promote sex 
                        education;
                            (v) develop and disseminate effective, 
                        research-based sex education learning 
                        materials; or
                            (vi) develop academic courses on the 
                        pedagogy of sex education at institutions of 
                        higher education.
    (f) Authorization of Grants To Support the Delivery of Sexual 
Health Services to Marginalized Young People.--
            (1) Program authorized.--The Secretary shall award grants, 
        on a competitive basis, to eligible entities to enable such 
        entities to provide youth-friendly sexual health services to 
        marginalized young people.
            (2) Duration.--Grants awarded under this subsection shall 
        be for a period of 5 years.
            (3) Eligible entity.--In this subsection, the term 
        ``eligible entity'' means--
                    (A) a public or private youth-serving organization; 
                or
                    (B) a covered entity, as defined in section 340B of 
                the Public Health Service Act (42 U.S.C. 256b).
            (4) Applications.--An eligible entity desiring a grant 
        under this subsection shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may require.
            (5) Uses of funds.--Each eligible entity that receives a 
        grant under this subsection may use the grant funds to--
                    (A) develop and implement an evidence-informed 
                project to deliver sexual health services to 
                marginalized young people;
                    (B) establish, alter, or modify staff positions, 
                service delivery policies and practices, service 
                delivery locations, service delivery environments, 
                service delivery schedules, or other services 
                components in order to increase youth-friendly sexual 
                health services to marginalized young people;
                    (C) conduct outreach to marginalized young people 
                to invite them to participate in the eligible entity's 
                sexual health services and to provide feedback to 
                inform improvements in the delivery of such services;
                    (D) establish and refine systems of referral to 
                connect marginalized young people to other sexual 
                health services and supportive services;
                    (E) establish partnerships and collaborations with 
                entities providing services to marginalized young 
                people to link such young people to sexual health 
                services, such as by delivering health services at 
                locations where they congregate, providing 
                transportation to locations where sexual health 
                services are provided, or other linkages to services 
                approaches;
                    (F) provide evidence-informed, comprehensive in 
                scope, confidential, equitable, accessible, medically 
                accurate and complete, age and developmentally 
                appropriate, culturally responsive, and trauma-informed 
                and resilience-oriented sexual health information to 
                marginalized young people in the languages and cultural 
                contexts that are most appropriate for the marginalized 
                young people to be served by the eligible entity;
                    (G) promote effective communication regarding 
                sexual health among marginalized young people; and
                    (H) provide training and support for eligible 
                entity personnel and community members who work with 
                marginalized young people about the content, skills, 
                and professional disposition needed to provide youth-
                friendly sex education and youth-friendly sexual health 
                services.
    (g) Reporting and Impact Evaluation.--
            (1) Grantee report to secretary.--For each year an eligible 
        entity receives grant funds under subsection (d), (e), (f), or 
        (g), the eligible entity shall submit to the Secretary a report 
        that includes--
                    (A) the use of grant funds by the eligible entity;
                    (B) how the use of grant funds has increased the 
                access of young people to sex education or sexual 
                health services; and
                    (C) such other information as the Secretary may 
                require.
            (2) Secretary's report to congress.--Not later than 1 year 
        after the date of the enactment of this Act, and annually 
        thereafter for a period of 5 years, the Secretary shall prepare 
        and submit to Congress a report on the activities funded under 
        this section. The Secretary's report to Congress shall 
        include--
                    (A) a statement of how grants awarded by the 
                Secretary meet the purposes described in subsection 
                (b)(1); and
                    (B) information about--
                            (i) the number of eligible entities that 
                        are receiving grant funds under subsections 
                        (d), (e), (f), and (g);
                            (ii) the specific activities supported by 
                        grant funds awarded under subsections (d), (e), 
                        (f), and (g);
                            (iii) the number of young people served by 
                        projects funded under subsections (d), (e), 
                        (f), and (g), in the aggregate and 
                        disaggregated and cross-tabulated by grant 
                        program, race and ethnicity, sex, sexual 
                        orientation, gender identity, and other 
                        characteristics determined by the Secretary 
                        (except that such disaggregation or cross-
                        tabulation shall not be required in a case in 
                        which the results would reveal personally 
                        identifiable information about an individual 
                        young person);
                            (iv) the number of teachers, health 
                        educators, faculty, school administrators, and 
                        staff trained under subsection (f); and
                            (v) the status of the evaluation required 
                        under paragraph (3).
            (3) Multi-year evaluation.--
                    (A) In general.--Not later than 6 months after the 
                date of the enactment of this Act, the Secretary shall 
                enter into a contract with a nonprofit organization 
                with experience in conducting impact evaluations to 
                conduct a multi-year evaluation on the impact of the 
                projects funded under subsections (d), (e), (f), and 
                (g) and to report to Congress and the Secretary on the 
                findings of such evaluation.
                    (B) Evaluation.--The evaluation conducted under 
                this paragraph shall--
                            (i) be conducted in a manner consistent 
                        with relevant, nationally recognized 
                        professional and technical evaluation 
                        standards;
                            (ii) use sound statistical methods and 
                        techniques relating to the behavioral sciences, 
                        including quasi-experimental designs, 
                        inferential statistics, and other methodologies 
                        and techniques that allow for conclusions to be 
                        reached;
                            (iii) be carried out by an independent 
                        organization that has not received a grant 
                        under subsection (d), (e), (f), or (g); and
                            (iv) be designed to provide information on 
                        output measures and outcome measures to be 
                        determined by the Secretary.
                    (C) Report.--Not later than 6 years after the date 
                of enactment of this Act, the organization conducting 
                the evaluation under this paragraph shall prepare and 
                submit to the appropriate committees of Congress and 
                the Secretary a report on such evaluation. Such report 
                shall be made publicly available, including on the 
                website of the Department of Health and Human Services.
    (h) Nondiscrimination.--Activities funded under this section shall 
not discriminate on the basis of actual or perceived sex (including 
sexual orientation and gender identity), age, parental status, race, 
color, ethnicity, national origin, disability, or religion. Nothing in 
this section shall be construed to invalidate or limit rights, 
remedies, procedures, or legal standards available under any other 
Federal law or any law of a State or a political subdivision of a 
State, including the Civil Rights Act of 1964 (42 U.S.C. 2000a et 
seq.), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et 
seq.), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), 
the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.), 
and section 1557 of the Patient Protection and Affordable Care Act (42 
U.S.C. 18116).
    (i) Limitation.--No Federal funds provided under this section may 
be used for sex education or sexual health services that--
            (1) withhold health-promoting or life-saving information 
        about sexuality-related topics, including HIV;
            (2) are medically inaccurate or incomplete;
            (3) promote gender or racial stereotypes or are 
        unresponsive to gender or racial inequities;
            (4) fail to address the needs of sexually active young 
        people;
            (5) fail to address the needs of pregnant or parenting 
        young people;
            (6) fail to address the needs of survivors of interpersonal 
        violence;
            (7) fail to address the needs of young people of all 
        physical, developmental, or mental abilities;
            (8) fail to be inclusive of individuals with varying gender 
        identities, gender expressions, and sexual orientations; or
            (9) are inconsistent with the ethical imperatives of 
        medicine and public health.
    (j) Amendments to Other Laws.--
            (1) Amendment to the public health service act.--Section 
        2500 of the Public Health Service Act (42 U.S.C. 300ee) is 
        amended by striking subsections (b) through (d) and inserting 
        the following:
    ``(b) Contents of Programs.--All programs of education and 
information receiving funds under this subchapter shall include 
information about the potential effects of intravenous substance 
use.''.
            (2) Amendments to the elementary and secondary education 
        act of 1965.--Section 8526 of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 7906) is amended--
                    (A) by striking paragraphs (3), (5), and (6);
                    (B) in paragraph (2), by inserting ``or'' after the 
                semicolon;
                    (C) by redesignating paragraph (4) as paragraph 
                (3); and
                    (D) in paragraph (3), as redesignated by 
                subparagraph (C), by striking the semicolon and 
                inserting a period.
    (k) Funding.--
            (1) Authorization.--For the purpose of carrying out this 
        section, there is authorized to be appropriated $100,000,000 
        for each of fiscal years 2022 through 2027. Amounts 
        appropriated under this paragraph shall remain available until 
        expended.
            (2) Reservations of funds.--
                    (A) In general.--Of the amount authorized under 
                paragraph (1), the Secretary shall reserve--
                            (i) not more than 30 percent for the 
                        purposes of awarding grants for sex education 
                        at elementary and secondary schools and youth-
                        serving organizations under subsection (d);
                            (ii) not more than 10 percent for the 
                        purpose of awarding grants for sex education at 
                        institutions of higher education under 
                        subsection (e);
                            (iii) not more than 15 percent for the 
                        purpose of awarding grants for educator 
                        training under subsection (f);
                            (iv) not more than 30 percent for the 
                        purpose of awarding grants for sexual health 
                        services for marginalized youth under 
                        subsection (g); and
                            (v) not less than 5 percent for the purpose 
                        of carrying out the reporting and impact 
                        evaluation required under subsection (h).
                    (B) Research, training and technical assistance.--
                The Secretary shall reserve not less than 10 percent of 
                the amount authorized under paragraph (1) for 
                expenditures by the Secretary to provide, directly or 
                through a competitive grant process, research, 
                training, and technical assistance, including 
                dissemination of research and information regarding 
                effective and promising practices, providing 
                consultation and resources, and developing resources 
                and materials to support the activities of recipients 
                of grants. In carrying out such functions, the 
                Secretary shall collaborate with a variety of entities 
                that have expertise in sex education and sexual health 
                services standards setting, design, development, 
                delivery, research, monitoring, and evaluation.
            (3) Reprogramming of abstinence only until marriage program 
        funding.--The unobligated balance of funds made available to 
        carry out section 510 of the Social Security Act (42 U.S.C. 
        710) (as in effect on the day before the date of enactment of 
        this Act) are hereby transferred and shall be used by the 
        Secretary to carry out this section. The amounts transferred 
        and made available to carry out this section shall remain 
        available until expended.
            (4) Repeal of abstinence only until marriage program.--
        Section 510 of the Social Security Act (42 U.S.C. 710 et seq.) 
        is repealed.

SEC. 5405. COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES.

    (a) Medicare.--
            (1) Limitation on payment.--Section 1866(a)(1) of the 
        Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
                    (A) by moving the indentation of subparagraph (W) 2 
                ems to the left;
                    (B) in subparagraph (X)--
                            (i) by moving the indentation 2 ems to the 
                        left; and
                            (ii) by striking ``and'' at the end;
                    (C) in subparagraph (Y)--
                            (i) by striking ``and'' at the end of item 
                        (bb); and
                            (ii) by striking the period at the end and 
                        inserting ``; and''; and
                    (D) by inserting after subparagraph (Y) the 
                following new subparagraph:
            ``(Z) in the case of a hospital or critical access 
        hospital, to adopt and enforce a policy to ensure compliance 
        with the requirements of subsection (l) and to meet the 
        requirements of such subsection.''.
            (2) Assistance to victims.--Section 1866 of the Social 
        Security Act (42 U.S.C. 1395cc) is amended by adding at the end 
        the following new subsection:
    ``(l) Compassionate Assistance for Rape Emergencies.--
            ``(1) In general.--For purposes of subsection (a)(1)(Z), a 
        hospital meets the requirements of this subsection if the 
        hospital provides each of the services described in paragraph 
        (2) to each individual, whether or not eligible for benefits 
        under this title or under any other form of health insurance, 
        who comes to the hospital on or after January 1, 2021, and--
                    ``(A) who states to hospital personnel that they 
                are victims of sexual assault;
                    ``(B) who is accompanied by an individual who 
                states to hospital personnel that the individual is a 
                victim of sexual assault; or
                    ``(C) whom hospital personnel, during the course of 
                treatment and care for the individual, have reason to 
                believe is a victim of sexual assault.
            ``(2) Required services described.--For purposes of 
        paragraph (1), the services described in this subparagraph are 
        the following:
                    ``(A) Provision of medically and factually accurate 
                and unbiased written and oral information about 
                emergency contraception that--
                            ``(i) is written in clear and concise 
                        language;
                            ``(ii) is readily comprehensible;
                            ``(iii) includes an explanation that 
                        emergency contraceptives--
                                    ``(I) have been approved by the 
                                Food and Drug Administration for 
                                individuals and are a safe and 
                                effective way to prevent pregnancy 
                                after unprotected intercourse or 
                                contraceptive failure if taken in a 
                                timely manner;
                                    ``(II) are more effective the 
                                sooner it is taken; and
                                    ``(III) do not cause an abortion 
                                and cannot interrupt an established 
                                pregnancy;
                            ``(iv) meet such conditions regarding the 
                        provision of such information in languages 
                        other than English as the Secretary may 
                        establish; and
                            ``(v) are provided without regard to the 
                        ability of the individual or their family to 
                        pay costs associated with the provision of such 
                        information to the individual.
                    ``(B) Immediate offer to provide emergency 
                contraception to the individual at the hospital and, in 
                the case that such individual accepts such offer, 
                immediate provision to such individual of such 
                contraception on the same day it is requested without 
                regard to the inability of the individual or their 
                family to pay costs associated with the offer and 
                provision of such contraception.
                    ``(C) Development and implementation of a written 
                policy to ensure that an individual is present at the 
                hospital, or on-call, who--
                            ``(i) has authority to dispense or 
                        prescribe emergency contraception, 
                        independently, or under a protocol prepared by 
                        a physician for the administration of emergency 
                        contraception at the hospital to a victim of 
                        sexual assault; and
                            ``(ii) is trained to comply with the 
                        requirements of this section.
                    ``(D) Provision of medically and factually accurate 
                and unbiased written and oral information and 
                counseling about post-exposure prophylaxis (PEP) 
                protocol for the prevention of HIV.
                    ``(E) Immediate offer to begin PEP to the 
                individual at the hospital except in cases where the 
                medical professional's best judgement is that further 
                evaluation is required or that such a regimen will be 
                substantially detrimental to the health of such 
                individual. Such provision shall be offered regardless 
                of the individual's ability to pay. Hospitals shall be 
                responsible for ensuring adequate supply of PEP 
                medications to provide to patients.
            ``(3) Hospital defined.--For purposes of this paragraph, 
        the term `hospital' includes a critical access hospital, as 
        defined in section 1861(mm)(1).''.
    (b) Limitation on Payment Under Medicaid.--Section 1903(i) of the 
Social Security Act (42 U.S.C. 1396b(i)) is amended by inserting after 
paragraph (8) the following new paragraph:
            ``(9) with respect to any amount expended for care or 
        services furnished under the plan by a hospital on or after 
        January 1, 2021, unless such hospital meets the requirements 
        specified in section 1866(l) for purposes of title XVIII;''.

SEC. 5406. MENSTRUAL EQUITY FOR ALL ACT OF 2021.

    (a) Short Title.--This section may be cited as the ``Menstrual 
Equity For All Act of 2021''.
    (b) Menstrual Products for Students at Elementary and Secondary 
Schools.--
            (1) In general.--Section 4108(5)(C) of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7118(5)(C)) is 
        amended--
                    (A) in clause (vi), by striking ``or'' after the 
                semicolon;
                    (B) in clause (vii), by inserting ``or'' after the 
                semicolon; and
                    (C) by adding at the end the following:
                            ``(viii) provide free menstrual products to 
                        students who use menstrual products;''.
            (2) Definitions.--Section 4102 of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7112) is amended--
                    (A) by redesignating paragraphs (6) through (8) as 
                paragraphs (7) through (9), respectively; and
                    (B) by inserting after paragraph (5) the following:
            ``(6) Menstrual products.--The term `menstrual products' 
        means sanitary napkins and tampons that conform to applicable 
        industry standards.''.
            (3) Rulemaking.--Not later than 1 year after the date of 
        enactment of this section, the Secretary of Education, in 
        consultation with the Secretary of Health and Human Services, 
        shall promulgate rules with respect to the definition of 
        ``menstrual products'' in paragraph (6) of section 4102 of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 
        7112), as amended by section 3(b).
    (c) Menstrual Products for Students at Institutions of Higher 
Education.--
            (1) Purpose.--The purpose of this section is to alleviate--
                    (A) the barriers to academic success faced by many 
                college and graduate students due to the inability of 
                such students to afford to purchase menstrual products; 
                and
                    (B) the unique set of burdens that college and 
                graduate students experiencing period poverty face that 
                can be compounded by lack of access to basic needs such 
                as housing, food, transportation, and access to 
                physical and mental health services.
            (2) In general.--The Secretary of Education shall establish 
        a program to award grants, on a competitive basis, to at least 
        4 institutions of higher education, to--
                    (A) support programs that provide free menstrual 
                products to students; and
                    (B) report on best practices of such programs.
            (3) Application.--To apply for a grant under this 
        subsection, an institution of higher education shall submit to 
        the Secretary an application in such form, at such time, and 
        containing such information as the Secretary determines 
        appropriate, including an assurance that such grant will be 
        used to carry out the activities described in paragraph (5).
            (4) Community colleges.--At least 50 percent of the grants 
        awarded under this subsection shall be awarded to community 
        colleges.
            (5) Grant uses.--A grant awarded under this subsection may 
        only be used to--
                    (A) carry out or expand activities that fund 
                programs that support direct provision of free 
                menstrual products to students in appropriate campus 
                locations, including--
                            (i) campus restroom facilities;
                            (ii) wellness centers; and
                            (iii) on-campus residential buildings;
                    (B) report on best practices of such programs;
                    (C) conduct outreach to students to encourage 
                participation in menstrual equity programs and 
                services;
                    (D) help eligible students apply for and enroll in 
                local, State, and Federal public assistance programs; 
                and
                    (E) coordinate and collaborate with government or 
                community-based organizations to carry out the 
                activities described in subparagraphs (A) through (D).
            (6) Priority.--In awarding grants under this subsection, 
        the Secretary shall prioritize--
                    (A) institutions with Federal Pell Grant enrollment 
                that is at least 25 percent of the total enrollment of 
                such institution; and
                    (B) historically Black colleges and universities, 
                Hispanic-serving institutions, Asian American and 
                Native American Pacific Islander-serving institutions, 
                and other minority serving institutions.
            (7) Menstrual product defined.--In this subsection, the 
        term ``menstrual product'' means a sanitary napkin or tampon 
        that conforms to industry standards.
            (8) Authorization of appropriations.--There are authorized 
        to be appropriated, out of funds appropriated for a fiscal year 
        to the Fund for the Improvement of Postsecondary Education 
        under section 741 of the Higher Education Act of 1965 (20 
        U.S.C. 1138), $5,000,000 to carry out the grant program under 
        this subsection.
    (d) Menstrual Products for Incarcerated Individuals and 
Detainees.--
            (1) Requirement for states.--Beginning on the date that is 
        180 days after the date of the enactment of this section, and 
        annually thereafter, the chief executive officer of each State 
        that receives a grant under subpart 1 of part E of title I of 
        the Omnibus Crime Control and Safe Streets Act of 1968 (42 
        U.S.C. 3750 et seq.) (commonly referred to as the ``Edward 
        Byrne Memorial Justice Assistance Grant Program'') shall submit 
        to the Attorney General a certification, in such form and 
        containing such information as the Attorney General may 
        require, that--
                    (A) all incarcerated individuals and detainees in 
                that State have access to menstrual products--
                            (i) on demand; and
                            (ii) at no cost to such individuals and 
                        detainees; and
                    (B) no visitor is prohibited from visiting an 
                incarcerated individual due to the visitor's use of 
                menstrual products.
            (2) Reduction in grant funding.--In the case of a State 
        whose chief executive officer fails to submit a certification 
        required under paragraph (1) in a fiscal year, the Attorney 
        General shall reduce the amount that the State would have 
        otherwise received under section 505 of title I of the Omnibus 
        Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3755) by 
        20 percent for the following fiscal year.
            (3) Reallocation.--Amounts not allocated to a State under 
        section 505 of title I of the Omnibus Crime Control and Safe 
        Streets Act of 1968 (42 U.S.C. 3755) for a fiscal year pursuant 
        to paragraph (2) shall be reallocated under such section to 
        States that submit such certifications.
            (4) Menstrual products.--For the purposes of paragraph (1), 
        the term ``menstrual products'' means sanitary napkins and 
        tampons that conform to applicable industry standards.
            (5) Availability for federal prisoners.--The Attorney 
        General shall make rules requiring, and the Director of the 
        Bureau of Prisons shall take such actions as may be necessary 
        to ensure, the distribution and accessibility (without charge) 
        of menstrual products to prisoners in the custody of the Bureau 
        of Prisons, including any prisoner in a Federal penal or 
        correctional institution, any Federal prisoner in a State penal 
        or correctional institution, and any Federal prisoner in a 
        facility administered by a private detention entity, and that 
        each prisoner who requires these products may receive them in 
        sufficient quantity.
            (6) Availability for detainees.--The Secretary of Homeland 
        Security shall take such actions as may be necessary to ensure 
        that menstrual products are distributed and made accessible to 
        each alien detained by the Secretary of Homeland Security, 
        including any alien in a facility administered by a private 
        detention entity, at no expense to the alien.
    (e) Menstrual Products Availability for Homeless Individuals Under 
Emergency Food and Shelter Grant Program.--Subsection (a) of section 
316 of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11346(a)) 
is amended--
            (1) in paragraph (5), by striking ``and'' at the end;
            (2) in paragraph (6), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following new paragraph:
            ``(7) guidelines that ensure that amounts provided under 
        the program to private nonprofit organizations and local 
        governments may be used to provide sanitary napkins and tampons 
        that conform to applicable industry standards.''.
    (f) Menstrual Products Covered by Medicaid.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)--
                            (i) by redesignating paragraphs (30) and 
                        (31) as paragraphs (31) and (32), respectively; 
                        and
                            (ii) by inserting after paragraph (29) the 
                        following new paragraph:
            ``(30) menstrual products (as defined in subsection 
        (hh));''; and
                    (B) by adding at the end the following:
    ``(jj) Menstrual Products.--For purposes of subsection (a)(30), the 
term `menstrual products' means sanitary napkins, tampons, liners, 
cups, and similar items used by individuals with respect to 
menstruation and that conform to industry standards.''.
            (2) Effective date.--
                    (A) In general.--Subject to subparagraph (B), the 
                amendments made by this subsection shall apply with 
                respect to medical assistance furnished during or after 
                the first calendar quarter beginning on or after the 
                date that is 1 year after the date of the enactment of 
                this section.
                    (B) Exception for state legislation.--In the case 
                of a State plan under title XIX of the Social Security 
                Act (42 U.S.C. 1396 et seq.) that the Secretary of 
                Health and Human Services determines requires State 
                legislation in order for the respective plan to meet 
                any requirement imposed by amendments made by this 
                section, the respective plan shall not be regarded as 
                failing to comply with the requirements of such title 
                solely on the basis of its failure to meet such an 
                additional requirement before the first day of the 
                first calendar quarter beginning after the close of the 
                first regular session of the State legislature that 
                begins after the date of the enactment of this section. 
                For purposes of the previous sentence, in the case of a 
                State that has a 2-year legislative session, each year 
                of the session shall be considered to be a separate 
                regular session of the State legislature.
    (g) Menstrual Products for Employees.--Section 6 of the 
Occupational Safety and Health Act of 1970 (29 U.S.C. 655) is amended 
by adding at the end the following:
    ``(h) The Secretary shall by rule promulgate a requirement that 
each employer with not less than 100 employees provide menstrual 
products free of charge for employees of the employer. For purposes of 
the preceding sentence, `menstrual products' means sanitary napkins and 
tampons that conform to applicable industry standards.''.
    (h) Menstrual Products in Federal Buildings.--
            (1) Requirement.--Each appropriate authority shall ensure 
        that menstrual products are stocked in, and available free of 
        charge in, each covered restroom in each covered public 
        building under the jurisdiction of such authority.
            (2) Definitions.--In this section:
                    (A) Appropriate authority.--The term ``appropriate 
                authority'' means the head of a Federal agency, the 
                Architect of the Capitol, or other official authority 
                responsible for the operation of a covered public 
                building.
                    (B) Covered public building.--The term ``covered 
                public building'' means a public building, as defined 
                in section 3301 of title 40, United States Code, that 
                is open to the public and contains a public restroom, 
                and includes a building listed in section 6301 or 5101 
                of such title.
                    (C) Covered restroom.--The term ``covered 
                restroom'' means a restroom in a covered public 
                building.
                    (D) Menstrual products.--The term ``menstrual 
                products'' means sanitary napkins and tampons that 
                conform to applicable industry standards.

SEC. 5407. ADDITIONAL FOCUS AREA FOR THE OFFICE ON WOMEN'S HEALTH.

    Section 229(b) of the Public Health Service Act (42 U.S.C. 
237a(b)), as amended by sections 5217 and 5301, is further amended by 
adding at the end the following:
            ``(10) facilitate policymakers, health system leaders and 
        providers, consumers, and other stakeholders in understanding 
        optimal maternity care and support for the provision of such 
        care, including the priorities of--
                    ``(A) protecting, promoting, and supporting the 
                innate capacities of childbearing individuals and their 
                newborns for childbirth, breastfeeding, and attachment;
                    ``(B) using obstetric interventions only when such 
                interventions are supported by strong, high-quality 
                evidence, and minimizing overuse of maternity practices 
                that have been shown to have benefit in limited 
                situations and that can expose people, infants, or both 
                to risk of harm if used routinely and indiscriminately, 
                including continuous electronic fetal monitoring, labor 
                induction, epidural analgesia, primary cesarean 
                section, and routine repeat cesarean birth;
                    ``(C) reliably incorporating noninvasive, evidence-
                based practices that have a documented correlation with 
                considerable improvement in outcomes with no 
                detrimental side effects, such as smoking cessation 
                programs in pregnancy, maternal immunizations, and 
                proven models (including group prenatal care, midwifery 
                care, and doula support) that integrate health 
                assessment, education, and support into a unified 
                program and supporting evidence-based breastfeeding 
                promotion efforts with respect for a breastfeeding 
                individual's personal decision making;
                    ``(D) a shared understanding of the qualifications 
                of licensed providers of maternity care and the best 
                evidence about the safety, satisfaction, outcomes, and 
                costs of maternity care, and appropriate deployment of 
                such caregivers within the maternity care workforce to 
                address the needs of childbearing individuals and 
                newborns and the growing shortage of maternity 
                caregivers;
                    ``(E) a shared understanding of the results of the 
                best available research comparing hospital, birth 
                center, and planned home births, including information 
                about each setting's safety, satisfaction, outcomes, 
                and costs;
                    ``(F) a shared understanding of the importance for 
                the safety and choices of birthing families of an 
                integrated maternity care system with seamless 
                processes for consultation, shared care, transfer and 
                transport across maternity care settings, and providers 
                when birthing people and their newborns require a 
                higher level of care;
                    ``(G) high-quality, evidence-based childbirth 
                education that--
                            ``(i) promotes a healthy and safe approach 
                        to pregnancy, childbirth, and early parenting;
                            ``(ii) is taught by certified educators, 
                        peer counselors, and health professionals; and
                            ``(iii) promotes informed decision making 
                        by childbearing individuals; and
                    ``(H) developing measures that enable a more 
                robust, balanced set of standardized maternity care 
                measures, including performance and quality 
                measures.''.

SEC. 5408. INCLUDING SERVICES FURNISHED BY CERTAIN STUDENTS, INTERNS, 
              AND RESIDENTS SUPERVISED BY CERTIFIED NURSE MIDWIVES OR 
              CERTIFIED MIDWIVES WITHIN INPATIENT HOSPITAL SERVICES 
              UNDER MEDICARE.

    (a) In General.--Section 1861(b) of the Social Security Act (42 
U.S.C. 1395x(b)) is amended--
            (1) in paragraph (6), by striking ``; or'' at the end and 
        inserting ``, or in the case of services in a hospital or 
        osteopathic hospital by a student midwife or an intern or 
        resident-in-training under a teaching program previously 
        described in this paragraph who is in the field of obstetrics 
        and gynecology, if such student midwife, intern, or resident-
        in-training is supervised by a certified nurse-midwife or 
        certified midwife to the extent permitted under applicable 
        State law and as may be authorized by the hospital;'';
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``; or''; and
            (3) by adding at the end the following new paragraph:
            ``(8) a certified nurse-midwife or certified midwife where 
        the hospital has a teaching program approved as specified in 
        paragraph (6), if--
                    ``(A) the hospital elects to receive any payment 
                due under this title for reasonable costs of such 
                services; and
                    ``(B) all certified nurse-midwives or certified 
                midwives in such hospital agree not to bill charges for 
                professional services rendered in such hospital to 
                individuals covered under the insurance program 
                established by this title.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to services furnished on or after the date of the enactment of 
this Act.

SEC. 5409. GRANTS TO PROFESSIONAL ORGANIZATIONS AND MINORITY-SERVING 
              INSTITUTIONS TO INCREASE DIVERSITY IN MATERNAL, 
              REPRODUCTIVE, AND SEXUAL HEALTH PROFESSIONALS.

    (a) Grants to Health Professional Organizations.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the Administrator of the Health 
        Resources and Services Administration, shall carry out a grant 
        program under which the Secretary may make to eligible 
        organizations--
                    (A) for fiscal year 2023, planning grants described 
                in paragraph (2); and
                    (B) for the subsequent 4-year period, 
                implementation grants described in paragraph (3).
            (2) Planning grants.--
                    (A) In general.--Planning grants described in this 
                paragraph are grants for the following purposes:
                            (i) To collect data and identify any 
                        workforce inequalities, with respect to a 
                        health profession, at each of the following 
                        areas along the health professional continuum:
                                    (I) Pipeline availability, with 
                                respect to students at the high school 
                                and college or university levels 
                                considering, and working toward, 
                                entrance in the profession, including 
                                barriers triggered by criminal records.
                                    (II) Entrance into the training 
                                program for the profession.
                                    (III) Graduation from such training 
                                program.
                                    (IV) Entrance into practice, 
                                including barriers triggered by 
                                criminal records.
                                    (V) Retention in practice for more 
                                than a 5-year period.
                            (ii) To develop one or more strategies to 
                        address the workforce inequalities within the 
                        health profession, as identified under (and in 
                        response to the findings pursuant to) clause 
                        (i).
                    (B) Application.--To be eligible to receive a grant 
                under this paragraph, an eligible health professional 
                organization shall submit to the Secretary an 
                application in such form and manner and containing such 
                information as specified by the Secretary.
                    (C) Amount.--Each grant awarded under this 
                paragraph shall be for an amount not to exceed 
                $300,000.
                    (D) Report.--Each recipient of a grant under this 
                paragraph shall submit to the Secretary a report 
                containing--
                            (i) information on the extent and 
                        distribution of workforce inequities identified 
                        through the grant; and
                            (ii) reasonable objectives and strategies 
                        developed to address such inequalities within a 
                        5-, 10-, and 25-year period.
            (3) Implementation grants.--
                    (A) In general.--Implementation grants described in 
                this paragraph are grants to implement one or more of 
                the strategies developed pursuant to a planning grant 
                awarded under paragraph (2).
                    (B) Application.--To be eligible to receive a grant 
                under this paragraph, an eligible health professional 
                organization shall submit to the Secretary an 
                application in such form and manner as specified by the 
                Secretary. Each such application shall contain 
                information on--
                            (i) the capability of the organization to 
                        carry out a strategy described in subparagraph 
                        (A);
                            (ii) the involvement of partners or 
                        coalitions;
                            (iii) the organization's plans for 
                        developing sustainability of the efforts after 
                        the culmination of the grant cycle, and any 
                        other information specified by the Secretary.
                    (C) Amount; duration.--Each grant awarded under 
                this paragraph shall be for an amount not to exceed 
                $500,000 each year of the grant. The term of a grant 
                under this subsection shall not exceed 4 years.
                    (D) Reports.--For each of the first 3 years for 
                which an eligible health professional organization is 
                awarded a grant under this paragraph, the organization 
                shall submit to the Secretary of Health and Human 
                Services a report on the activities carried out by such 
                organization through the grant during such year and 
                objectives for the subsequent year. For the fourth year 
                for which an eligible health professional organization 
                is awarded a grant under this paragraph, the 
                organization shall submit to the Secretary a report 
                that includes an analysis of all the activities carried 
                out by the organization through the grant and a 
                detailed plan for the continuation of the 
                organization's outreach efforts.
            (4) Eligible health professional organization defined.--For 
        purposes of this subsection, the term ``eligible health 
        professional organization'' means a professional organization 
        representing obstetrician-gynecologists, certified nurse 
        midwives, certified midwives, family practice physicians, nurse 
        practitioners whose scope of practice includes maternity or 
        sexual and reproductive health care, physician assistants whose 
        scope of practice includes obstetrical or sexual and 
        reproductive health care, or certified professional midwives, 
        adolescent medicine specialists, and pediatricians who provide 
        sexual and reproductive health care.
    (b) Grants to Minority-Serving Institutions.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the Administrator of the Health 
        Resources and Services Administration (referred to in this 
        section as the ``Secretary''), shall carry out a grant program 
        under which the Secretary may make to eligible organizations--
                    (A) for fiscal years 2023 and 2024, planning grants 
                described in paragraph (2); and
                    (B) for the subsequent ten-year period, 
                implementation grants described in paragraph (3).
            (2) Planning grants.--
                    (A) In general.--Planning grants described in this 
                paragraph are grants for plans the following purposes:
                            (i) To develop or expand academic programs 
                        to educate maternity care clinicians and 
                        maternity care support personnel, including--
                                    (I) nurses with the intention of 
                                providing maternity, newborn, or sexual 
                                and reproductive health care;
                                    (II) nurse-practitioners whose 
                                scope of practice includes maternity, 
                                newborn, or sexual and reproductive 
                                health care; and
                                    (III) maternity care support 
                                personnel, such as doulas and lactation 
                                counselors.
                            (ii) To develop or expand academic programs 
                        to educate obstetrician-gynecologists.
                    (B) Application.--To be eligible to receive a grant 
                under this paragraph, an eligible minority serving 
                institution shall submit to the Secretary an 
                application in such form and manner and containing such 
                information as specified by the Secretary.
                    (C) Amount.--Each grant awarded under this 
                paragraph shall be for an amount not to exceed $400,000 
                for each of two years.
                    (D) Report.--Each recipient of a grant under this 
                paragraph shall submit to the Secretary an annual 
                report describing the planned development or expansion 
                of educational programs, including--
                            (i) the types of clinical or support 
                        personnel and the degrees or certificates to be 
                        conferred;
                            (ii) the associated curricula;
                            (iii) the faculty and their capabilities 
                        and commitments, including any plans for 
                        recruitment;
                            (iv) the anticipated number of students to 
                        be enrolled and plans for their recruitment and 
                        social, emotional, and financial support; and
                            (v) the objectives and strategies for 
                        addressing inequities and preparing students to 
                        provide high-quality culturally congruent care.
            (3) Implementation grants.--
                    (A) In general.--Implementation grants described in 
                this paragraph are grants to implement the strategies 
                developed under paragraph (2).
                    (B) Application.--To be eligible to receive a grant 
                under this paragraph, an eligible minority serving 
                institution shall submit to the Secretary of Health and 
                Human Services an application in such form and manner 
                as specified by the Secretary. Each such application 
                shall contain information on the capability of the 
                institution to carry out a strategy described in 
                paragraph (2), plans for sustainability of the program 
                after the culmination of the grant cycle, and any other 
                information specified by the Secretary.
                    (C) Amount.--Each grant under this paragraph shall 
                be for an amount not to exceed $1,000,000 each year 
                during the 10-year period of the grant.
                    (D) Reports.--
                            (i) Initial period.--For each of the first 
                        9 years for which an eligible minority-serving 
                        institution is awarded a grant under this 
                        paragraph, the institution shall submit a 
                        report to the Secretary on the activities 
                        carried out by such institution through the 
                        grant during such year and objectives for the 
                        subsequent year.
                            (ii) Final year.--For the tenth year for 
                        which an eligible minority-serving institution 
                        is awarded a grant under this paragraph, the 
                        organization shall submit to the Secretary a 
                        report that includes an analysis of all the 
                        activities carried out by the institution 
                        through the grant and a detailed plan for 
                        continuation of the educational program.
            (4) Eligible minority-serving institutions defined.--For 
        the purposes of this subsection, the term ``minority-serving 
        institution'' means a historically Black college or university, 
        Tribal college or university, Latino-serving institution, Asian 
        American and Pacific Islander serving institution, or other 
        minority serving institution of higher education.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out--
            (1) subsection (a), $2,000,000 for fiscal year 2023 and 
        $3,000,000 for each of the fiscal years 2024 through 2027; and
            (2) subsection (b), $4,000,000 for each of fiscal years 
        2023 and 2024 and $10,000,000 for each of fiscal years 2025 
        through 2034.

                     Subtitle F--Children's Health

SEC. 5501. CARING FOR KIDS ACT.

    (a) Permanent Extension of Children's Health Insurance Program.--
            (1) In general.--Section 2104(a)(28) of the Social Security 
        Act (42 U.S.C. 1397dd(a)(28)) is amended to read as follows:
            ``(28) for fiscal year 2027 and each subsequent year, such 
        sums as are necessary to fund allotments to States under 
        subsections (c) and (m).''.
            (2) Allotments.--
                    (A) In general.--Section 2104(m) of the Social 
                Security Act (42 U.S.C. 1397dd(m)) is amended--
                            (i) in paragraph (2)(B)(i), by striking 
                        ``,, 2023, and 2027'' and inserting ``and 
                        2023'';
                            (ii) in paragraph (7)--
                                    (I) in subparagraph (A), by 
                                striking ``and ending with fiscal year 
                                2027,''; and
                                    (II) in the flush left matter at 
                                the end, by striking ``or fiscal year 
                                2026'' and inserting ``fiscal year 
                                2026, or a subsequent even-numbered 
                                fiscal year'';
                            (iii) in paragraph (9)--
                                    (I) by striking ``(10), or (11)'' 
                                and inserting ``or (10)''; and
                                    (II) by striking ``2023, or 2027,'' 
                                and inserting ``or 2023''; and
                            (iv) by striking paragraph (11).
                    (B) Conforming amendment.--Section 50101(b)(2) of 
                the Bipartisan Budget Act of 2018 (Public Law 115-123) 
                is repealed.
    (b) Permanent Extensions of Other Programs and Demonstration 
Projects.--
            (1) Pediatric quality measures program.--Section 
        1139A(i)(1) of the Social Security Act (42 U.S.C. 1320b-
        9a(i)(1)) is amended--
                    (A) in subparagraph (C), by striking at the end 
                ``and'';
                    (B) in subparagraph (D), by striking the period at 
                the end and insert a semicolon; and
                    (C) by adding at the end the following new 
                subparagraphs:
                    ``(E) for fiscal year 2028, $15,000,000 for the 
                purpose of carrying out this section (other than 
                subsections (e), (f), and (g)); and
                    ``(F) for a subsequent fiscal year, the amount 
                appropriated under this paragraph for the previous 
                fiscal year, increased by the percentage increase in 
                the consumer price index for all urban consumers (all 
                items; United States city average) over such previous 
                fiscal year, for the purpose of carrying out this 
                section (other than subsections (e), (f), and (g)).''.
            (2) Express lane eligibility option.--Section 1902(e)(13) 
        of the Social Security Act (42 U.S.C. 1396a(e)(13)) is amended 
        by striking subparagraph (I).
            (3) Assurance of affordability standard for children and 
        families.--
                    (A) In general.--Section 2105(d)(3) of the Social 
                Security Act (42 U.S.C. 1397ee(d)(3)) is amended--
                            (i) in the paragraph heading, by striking 
                        ``through september 30, 2027''; and
                            (ii) in subparagraph (A), in the matter 
                        preceding clause (i)--
                                    (I) by striking ``During the period 
                                that begins on the date of enactment of 
                                the Patient Protection and Affordable 
                                Care Act and ends on September 30, 
                                2027'' and inserting ``Beginning on the 
                                date of the enactment of the Patient 
                                Protection and Affordable Care Act'';
                                    (II) by striking ``During the 
                                period that begins on October 1, 2019, 
                                and ends on September 30, 2027'' and 
                                inserting ``Beginning on October 1, 
                                2019''; and
                                    (III) by striking ``The preceding 
                                sentences shall not be construed as 
                                preventing a State during any such 
                                periods from'' and inserting ``The 
                                preceding sentences shall not be 
                                construed as preventing a State from''.
                    (B) Conforming amendments.--Section 1902(gg)(2) of 
                the Social Security Act (42 U.S.C. 1396a(gg)(2)) is 
                amended--
                            (i) in the paragraph heading, by striking 
                        ``through september 30, 2027''; and
                            (ii) by striking ``through September 30'' 
                        and all that follows through ``ends on 
                        September 30, 2027'' and inserting ``(but 
                        beginning on October 1, 2019,''.
            (4) Qualifying states option.--Section 2105(g)(4) of the 
        Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
                    (A) in the paragraph heading, by striking ``for 
                fiscal years 2009 through 2027'' and inserting ``after 
                fiscal year 2008''; and
                    (B) in subparagraph (A), by striking ``for any of 
                fiscal years 2009 through 2027'' and inserting ``for 
                any fiscal year after fiscal year 2008''.
            (5) Outreach and enrollment program.--Section 2113 of the 
        Social Security Act (42 U.S.C. 1397mm) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by striking ``during 
                        the period of fiscal years 2009 through 2027'' 
                        and inserting ``, beginning with fiscal year 
                        2009,'';
                            (ii) in paragraph (2)--
                                    (I) by striking ``10 percent of 
                                such amounts'' and inserting ``10 
                                percent of such amounts for the period 
                                or the fiscal year for which such 
                                amounts are appropriated''; and
                                    (II) by striking ``during such 
                                period'' and inserting ``, during such 
                                period or such fiscal year,''; and
                            (iii) in paragraph (3), by striking ``For 
                        the period of fiscal years 2024 through 2027, 
                        an amount equal to 10 percent of such amounts'' 
                        and inserting ``Beginning with fiscal year 
                        2024, an amount equal to 10 percent of such 
                        amounts for the period or the fiscal year for 
                        which such amounts are appropriated''; and
                    (B) in subsection (g)--
                            (i) by striking ``2017,,'' and inserting 
                        ``2017,'';
                            (ii) by striking ``and $48,000,000'' and 
                        inserting ``$48,000,000''; and
                            (iii) by inserting after ``through 2027'' 
                        the following: ``, $12,000,000 for fiscal year 
                        2028, and, for each fiscal year after fiscal 
                        year 2028, the amount appropriated under this 
                        subsection for the previous fiscal year, 
                        increased by the percentage increase in the 
                        consumer price index for all urban consumers 
                        (all items; United States city average) over 
                        such previous fiscal year''.
            (6) Child enrollment contingency fund.--Section 2104(n) of 
        the Social Security Act (42 U.S.C. 1397dd(n)) is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A)(ii)--
                                    (I) by striking ``and 2024 through 
                                2026'' and inserting ``beginning with 
                                fiscal year 2024''; and
                                    (II) by striking ``2023, and 2027'' 
                                and inserting ``, and 2023''; and
                            (ii) in subparagraph (B)--
                                    (I) by striking ``2024 through 
                                2026'' and inserting ``beginning with 
                                fiscal year 2024''; and
                                    (II) by striking ``2023, and 2027'' 
                                and inserting ``, and 2023''; and
                    (B) in paragraph (3)(A)--
                            (i) by striking ``fiscal years 2024 through 
                        2026'' and inserting ``beginning with fiscal 
                        year 2024''; and
                            (ii) by striking ``2023, or 2027'' and 
                        inserting ``, or 2023''.

SEC. 5502. END DIAPER NEED ACT OF 2021.

    (a) Targeted Funding for Diaper Assistance (Including Diapering 
Supplies and Adult Incontinence Materials and Supplies) Through the 
Social Services Block Grant Program.--
            (1) Increase in funding for social services block grant 
        program.--
                    (A) In general.--The amount specified in subsection 
                (c) of section 2003 of the Social Security Act (42 
                U.S.C. 1397b) for purposes of subsections (a) and (b) 
                of such section is deemed to be $1,900,000,000 for each 
                of fiscal years 2023 through 2026, of which, the amount 
                equal to $200,000,000, reduced by the amounts reserved 
                under subparagraph (B)(ii) for each such fiscal year, 
                shall be obligated by States in accordance with 
                paragraph (2).
                    (B) Appropriation.--
                            (i) In general.--Out of any money in the 
                        Treasury of the United States not otherwise 
                        appropriated, there is appropriated 
                        $200,000,000 for each of fiscal years 2023 
                        through 2026, to carry out this subsection.
                            (ii) Reservations.--
                                    (I) Purposes.--The Secretary shall 
                                reserve, from the amount appropriated 
                                under clause (i) to carry out this 
                                subsection--
                                            (aa) for each of fiscal 
                                        years 2023 through 2026, not 
                                        more than 2 percent of the 
                                        amount appropriated for the 
                                        fiscal year for purposes of 
                                        entering into an agreement with 
                                        a national entity described in 
                                        clause (iii) to assist in 
                                        providing technical assistance 
                                        and training, to support 
                                        effective policy, practice, 
                                        research, and cross-system 
                                        collaboration among grantees 
                                        and subgrantees, and to assist 
                                        in the administration of the 
                                        program described in this 
                                        subsection; and
                                            (bb) for fiscal year 2023, 
                                        an amount, not to exceed 
                                        $2,000,000, for purposes of 
                                        conducting an evaluation under 
                                        paragraph (4).
                                    (II) No state entitlement to 
                                reserved funds.--The State entitlement 
                                under section 2002(a) of the Social 
                                Security Act (42 U.S.C. 1397a(a)) shall 
                                not apply to the amounts reserved under 
                                subclause (I).
                            (iii) National entity described.--A 
                        national entity described in this clause is a 
                        nonprofit organization described in section 
                        501(c)(3) of the Internal Revenue Code of 1986 
                        and exempt from taxation under section 501(a) 
                        of such Code, that--
                                    (I) has experience in more than 1 
                                State in the area of--
                                            (aa) community 
                                        distributions of basic need 
                                        services, including experience 
                                        collecting, warehousing, and 
                                        distributing basic necessities 
                                        such as diapers, food, or 
                                        menstrual products;
                                            (bb) child care;
                                            (cc) child development 
                                        activities in low-income 
                                        communities; or
                                            (dd) motherhood, 
                                        fatherhood, or parent education 
                                        efforts serving low-income 
                                        parents of young children;
                                    (II) demonstrates competency to 
                                implement a project, provide fiscal 
                                accountability, collect data, and 
                                prepare reports and other necessary 
                                documentation; and
                                    (III) demonstrates a willingness to 
                                share information with researchers, 
                                practitioners, and other interested 
                                parties.
            (2) Rules governing use of additional funds.--
                    (A) In general.--Funds are used in accordance with 
                this paragraph if--
                            (i) the State, in consultation with 
                        relevant stakeholders, including agencies, 
                        professional associations, and nonprofit 
                        organizations, distributes the funds to 
                        eligible entities to--
                                    (I) decrease the need for diapers 
                                and diapering supplies and adult 
                                incontinence materials and supplies in 
                                low-income families and meet such unmet 
                                needs of infants and toddlers, 
                                medically complex children, and low-
                                income adults and adults with 
                                disabilities in such families through--
                                            (aa) the distribution of 
                                        free diapers and diapering 
                                        supplies, medically necessary 
                                        diapers, and adult incontinence 
                                        materials and supplies;
                                            (bb) community outreach to 
                                        assist in participation in 
                                        existing diaper distribution 
                                        programs or programs that 
                                        distribute medically necessary 
                                        diapers or adult incontinence 
                                        materials and supplies; or
                                            (cc) improving access to 
                                        diapers and diapering supplies, 
                                        medically necessary diapers, 
                                        and adult incontinence 
                                        materials and supplies; and
                                    (II) increase the ability of 
                                communities and low-income families in 
                                such communities to provide for the 
                                need for diapers and diapering 
                                supplies, medically necessary diapers, 
                                and adult continence materials and 
                                supplies, of infants and toddlers, 
                                medically complex children, and low-
                                income adults and adults with 
                                disabilities;
                            (ii) the funds are used subject to the 
                        limitations in section 2005 of the Social 
                        Security Act (42 U.S.C. 1397d);
                            (iii) the funds are used to supplement, not 
                        supplant, State general revenue funds provided 
                        for the purposes described in clause (i); and
                            (iv) the funds are not used for costs that 
                        are reimbursable by the Federal Emergency 
                        Management Agency, under a contract for 
                        insurance, or by self-insurance.
                    (B) Allowable uses by eligible entities.--An 
                eligible entity receiving funds made available under 
                paragraph (1) shall use the funds for any of the 
                following:
                            (i) To pay for the purchase and 
                        distribution of diapers and diapering supplies, 
                        medically necessary diapers, and funding diaper 
                        (including medically necessary diapers) 
                        distribution that serves low-income families 
                        with--
                                    (I) 1 or more children 3 years of 
                                age or younger; or
                                    (II) 1 or more medically complex 
                                children.
                            (ii) To pay for the purchase and 
                        distribution of adult incontinence materials 
                        and supplies and funding distribution of such 
                        materials and supplies that serves low-income 
                        families with 1 or more low-income adults or 
                        adults with disabilities who rely on adult 
                        incontinence materials and supplies.
                            (iii) To integrate activities carried out 
                        under clause (i) with other basic needs 
                        assistance programs serving eligible children 
                        and their families, including the following:
                                    (I) Programs funded by the 
                                temporary assistance for needy families 
                                program under part A of title IV of the 
                                Social Security Act (42 U.S.C. 601 et 
                                seq.), including the State maintenance 
                                of effort provisions of such program.
                                    (II) Programs designed to support 
                                the health of eligible children, such 
                                as the Children's Health Insurance 
                                Program under title XXI of the Social 
                                Security Act, the Medicaid program 
                                under title XIX of such Act, or State 
                                funded health care programs.
                                    (III) Programs funded through the 
                                special supplemental nutrition program 
                                for women, infants, and children under 
                                section 17 of the Child Nutrition Act 
                                of 1966.
                                    (IV) Programs that offer early home 
                                visiting services, including the 
                                maternal, infant, and early childhood 
                                home visiting program (including the 
                                Tribal home visiting program) under 
                                section 511 of the Social Security Act 
                                (42 U.S.C. 711).
                                    (V) Programs to provide improved 
                                and affordable access to child care, 
                                including programs funded through the 
                                Child Care and Development Fund, the 
                                temporary assistance for needy families 
                                program under part A of title IV of the 
                                Social Security Act (42 U.S.C. 601 et 
                                seq.), or a State-funded program.
                    (C) Availability of funds.--
                            (i) Funds distributed to eligible 
                        entities.--Funds made available under paragraph 
                        (1) that are distributed to an eligible entity 
                        by a State for a fiscal year may be expended by 
                        the eligible entity only in such fiscal year or 
                        the succeeding fiscal year.
                            (ii) Evaluation.--Funds reserved under 
                        paragraph (1)(B)(ii)(I)(aa) to carry out the 
                        evaluation under paragraph (4) shall be 
                        available for expenditure during the 3-year 
                        period that begins on the date of enactment of 
                        this Act.
                    (D) No effect on other programs.--Any assistance or 
                benefits received by a family through funds made 
                available under paragraph (1) shall be disregarded for 
                purposes of determining the family's eligibility for, 
                or amount of, benefits under any other Federal needs-
                based programs.
            (3) Annual reports.--A State shall include in the annual 
        report required under section 2006 of the Social Security Act 
        (42 U.S.C. 1397e) covering each of fiscal years 2022 through 
        2025, information detailing how eligible entities, including 
        subgrantees, used funds made available under paragraph (1) to 
        distribute diapers and diapering supplies and adult 
        incontinence materials and supplies to families in need. Each 
        such report shall include the following:
                    (A) The number and age of infants, toddlers, 
                medically complex children, and low-income adults and 
                adults with disabilities who received assistance or 
                benefits through such funds.
                    (B) The number of families that have received 
                assistance or benefits through such funds.
                    (C) The number of diapers, medically necessary 
                diapers, or adult incontinence materials and supplies 
                (such as adult diapers, briefs, protective underwear, 
                pull-ons, pull-ups, liners, shields, guards, pads, 
                undergarments), and the number of each type of 
                diapering or adult incontinence supply, distributed 
                through the use of such funds.
                    (D) The ZIP Code or ZIP Codes where the eligible 
                entity (or subgrantee) distributed diapers and 
                diapering supplies and adult incontinence materials and 
                supplies.
                    (E) The method or methods the eligible entity (or 
                subgrantee) uses to distribute diapers and diapering 
                supplies and, adult incontinence materials and 
                supplies.
                    (F) Such other information as the Secretary may 
                specify.
            (4) Evaluation.--The Secretary, in consultation with 
        States, the national entity described in paragraph (1)(B)(iii), 
        and eligible entities receiving funds made available under this 
        subsection, shall--
                    (A) not later than 2 years after the date of 
                enactment of this Act--
                            (i) complete an evaluation of the 
                        effectiveness of the assistance program carried 
                        out pursuant to this subsection, such as the 
                        effect of activities carried out under this 
                        section on mitigating the health and 
                        developmental risks of unmet diaper need among 
                        infants, toddlers, medically complex children, 
                        and other family members in low-income 
                        families, including the risks of diaper 
                        dermatitis, urinary tract infections, and 
                        parental and child depression and anxiety;
                            (ii) submit to the relevant congressional 
                        committees a report on the results of such 
                        evaluation; and
                            (iii) publish the results of the evaluation 
                        on the internet website of the Department of 
                        Health and Human Services;
                    (B) not later than 3 years after the date of 
                enactment of this Act, update the evaluation required 
                by subparagraph (A)(i); and
                    (C) not later than 90 days after completion of the 
                updated evaluation under subparagraph (B)--
                            (i) submit to the relevant congressional 
                        committees a report describing the results of 
                        such updated evaluation; and
                            (ii) publish the results of such evaluation 
                        on the internet website of the Department of 
                        Health and Human Services.
            (5) Guidance.--Not later than 180 days after enactment of 
        this Act, the Secretary shall issue guidance regarding how the 
        provisions of this subsection should be carried out, including 
        information regarding eligible entities, allowable use of 
        funds, and reporting requirements.
            (6) Definitions.--In this subsection:
                    (A) Adult incontinence materials and supplies.--The 
                term ``adult incontinence materials and supplies'' 
                means those supplies that are used to assist low-income 
                adults or adults with disabilities and includes adult 
                diapers, briefs, protective underwear, pull-ons, pull-
                ups, liners, shields, guards, pads, undergarments, 
                disposable wipes, over-the-counter adult diaper rash 
                cream products, intermittent catheterization, 
                indwelling catheters, condom catheters, urinary 
                drainage bags, external collection devices, wearable 
                urinals, and penile clamps.
                    (B) Adults with disabilities.--The term ``adults 
                with disabilities'' means individuals who--
                            (i) have attained age 18; and
                            (ii) have a disability (as such term is 
                        defined, with respect to an individual, in 
                        section 3 of the Americans with Disabilities 
                        Act of 1990 (42 U.S.C. 12102)).
                    (C) Diaper.--The term ``diaper'' means an absorbent 
                garment that--
                            (i) is washable or disposable that may be 
                        worn by an infant or toddler who is not toilet-
                        trained; and
                            (ii) if disposable--
                                    (I) does not use any latex or 
                                common allergens; and
                                    (II) meets or exceeds the quality 
                                standards for diapers commercially 
                                available through retail sale in the 
                                following categories:
                                            (aa) Absorbency (with 
                                        acceptable rates for first and 
                                        second wetting).
                                            (bb) Waterproof outer 
                                        cover.
                                            (cc) Flexible leg openings.
                                            (dd) Refastening closures.
                    (D) Diapering supplies.--The term ``diapering 
                supplies'' means items, including diaper wipes and 
                diaper cream, necessary to ensure that--
                            (i) an eligible child using a diaper is 
                        properly cleaned and protected from diaper 
                        rash; or
                            (ii) a medically complex child who uses a 
                        medically necessary diaper is properly cleaned 
                        and protected from diaper rash.
                    (E) Eligible child.--The term ``eligible child'' 
                means a child who--
                            (i) has not attained 4 years of age; and
                            (ii) is a member of a low-income family.
                    (F) Eligible entities.--The term ``eligible 
                entity'' means a State or local governmental entity, an 
                Indian tribe or tribal organization (as defined in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act), or a nonprofit organization 
                described in section 501(c)(3) of the Internal Revenue 
                Code of 1986 and exempt from taxation under section 
                501(a) of such Code that--
                            (i) has experience in the area of--
                                    (I) community distributions of 
                                basic need services, including 
                                experience collecting, warehousing, and 
                                distributing basic necessities such as 
                                diapers, food, or menstrual products;
                                    (II) child care;
                                    (III) child development activities 
                                in low-income communities; or
                                    (IV) motherhood, fatherhood, or 
                                parent education efforts serving low-
                                income parents of young children;
                            (ii) demonstrates competency to implement a 
                        project, provide fiscal accountability, collect 
                        data, and prepare reports and other necessary 
                        documentation; and
                            (iii) demonstrates a willingness to share 
                        information with researchers, practitioners, 
                        and other interested parties.
                    (G) Federal poverty line.--The term ``Federal 
                poverty line'' means the Federal poverty line as 
                defined by the Office of Management and Budget and 
                revised annually in accordance with section 673(2) of 
                the Omnibus Budget Reconciliation Act of 1981 
                applicable to a family of the size involved.
                    (H) Low-income.--The term ``low-income'', with 
                respect to a family, means a family whose self-
                certified income is not more than 200 percent of the 
                Federal poverty line.
                    (I) Medically complex child.--The term ``medically 
                complex child'' means an individual who has attained 
                age 3 and for whom a licensed health care provider has 
                provided a diagnosis of bowel or bladder incontinence, 
                a bowel or bladder condition that causes excess urine 
                or stool (such as short gut syndrome or diabetes 
                insipidus), or a severe skin condition that causes skin 
                erosions (such as epidermolysis bullosa).
                    (J) Medically necessary diaper.--The term 
                ``medically necessary diaper'' means an absorbent 
                garment that is--
                            (i) washable or disposable;
                            (ii) worn by a medically complex child who 
                        has been diagnosed with bowel or bladder 
                        incontinence, a bowel or bladder condition that 
                        causes excess urine or stool (such as short gut 
                        syndrome or diabetes insipidus), or a severe 
                        skin condition that causes skin erosions (such 
                        as epidermolysis bullosa) and needs such 
                        garment to correct or ameliorate such 
                        condition; and
                            (iii) if disposable--
                                    (I) does not use any latex or 
                                common allergens; and
                                    (II) meets or exceeds the quality 
                                standards for diapers commercially 
                                available through retail sale in the 
                                following categories:
                                            (aa) Absorbency (with 
                                        acceptable rates for first and 
                                        second wetting).
                                            (bb) Waterproof outer 
                                        cover.
                                            (cc) Flexible leg openings.
                                            (dd) Refastening closures.
            (7) Exemption of program from sequestration.--
                    (A) In general.--Section 255(h) of the Balanced 
                Budget and Emergency Deficit Control Act of 1985 (2 
                U.S.C. 905(h)) is amended by inserting after 
                ``Supplemental Security Income Program (28-0406-0-1-
                609).'' the following:
            ``Targeted funding for States for diaper assistance 
        (including diapering supplies and adult incontinence materials 
        and supplies) through the Social Services Block Grant 
        Program.''.
                    (B) Applicability.--The amendment made by this 
                paragraph shall apply to any sequestration order issued 
                under the Balanced Budget and Emergency Deficit Control 
                Act of 1985 (2 U.S.C. 900 et seq.) on or after the date 
                of enactment of this Act.
    (b) Improving Access to Diapers for Medically Complex Children.--
Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is 
amended by adding at the end the following new paragraph:
    ``(11)(A) In the case of any waiver under this subsection that 
provides medical assistance to a medically complex child who has been 
diagnosed with bowel or bladder incontinence, a bowel or bladder 
condition that causes excess urine or stool (such as short gut syndrome 
or diabetes insipidus), or a severe skin condition that causes skin 
erosions (such as epidermolysis bullosa), such medical assistance shall 
include, for the duration of the waiver, the provision of 200 medically 
necessary diapers per month and diapering supplies. Such medical 
assistance may include the provision of medically necessary diapers in 
amounts greater than 200 if a licensed health care provider (such as a 
physician, nurse practitioner, or physician assistant) specifies that 
such greater amounts are necessary for such medically complex child.
    ``(B) For purposes of this paragraph:
            ``(i) The term `medically complex child' means an 
        individual who has attained age 3 and for whom a licensed 
        health care provider has provided a diagnosis of 1 or more 
        significant chronic conditions.
            ``(ii) The term `medically necessary diaper' means an 
        absorbent garment that is--
                    ``(I) washable or disposable;
                    ``(II) worn by a medically complex child who has 
                been diagnosed with a condition described in 
                subparagraph (A) and needs such garment to correct or 
                ameliorate such condition; and
                    ``(III) if disposable--
                            ``(aa) does not use any latex or common 
                        allergens; and
                            ``(bb) meets or exceeds the quality 
                        standards for diapers commercially available 
                        through retail sale in the following 
                        categories:
                                    ``(AA) Absorbency (with acceptable 
                                rates for first and second wetting).
                                    ``(BB) Waterproof outer cover.
                                    ``(CC) Flexible leg openings.
                                    ``(DD) Refastening closures.
            ``(iii) The term `diapering supplies' means items, 
        including diaper wipes and diaper creams, necessary to ensure 
        that a medically complex child who has been diagnosed with a 
        condition described in subparagraph (A) and uses a medically 
        necessary diaper is properly cleaned and protected from diaper 
        rash.''.
    (c) Inclusion of Diapers and Diapering Supplies as Qualified 
Medical Expenses.--
            (1) Health savings accounts.--Section 223(d)(2) of the 
        Internal Revenue Code of 1986 is amended--
                    (A) by inserting ``, medically necessary diapers, 
                and diapering supplies'' after ``menstrual care 
                products'' in the last sentence of subparagraph (A); 
                and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(E) Medically necessary diapers and diapering 
                supplies.--For purposes of this paragraph--
                            ``(i) Medically necessary diapers.--The 
                        term `medically necessary diaper' means an 
                        absorbent garment which is washable or 
                        disposable and which is worn by an individual 
                        who has attained 3 years of age because of 
                        medical necessity, such as someone who has been 
                        diagnosed with bowel or bladder incontinence, a 
                        bowel or bladder condition that causes excess 
                        urine or stool (such as short gut syndrome or 
                        diabetes insipidus), or a severe skin condition 
                        that causes skin erosions (such as 
                        epidermolysis bullosa) and needs such garment 
                        to correct or ameliorate such condition, to 
                        serve a preventative medical purpose, or to 
                        correct or ameliorate defects or physical or 
                        mental illnesses or conditions diagnosed by a 
                        licensed health care provider, and, if 
                        disposable--
                                    ``(I) does not use any latex or 
                                common allergens; and
                                    ``(II) meets or exceeds the quality 
                                standards for diapers commercially 
                                available through retail sale in the 
                                following categories:
                                            ``(aa) Absorbency (with 
                                        acceptable rates for first and 
                                        second wetting).
                                            ``(bb) Waterproof outer 
                                        cover.
                                            ``(cc) Flexible leg 
                                        openings.
                                            ``(dd) Refastening 
                                        closures.
                            ``(ii) Diapering supplies.--The term 
                        `diapering supplies' means items, including 
                        diaper wipes and diaper creams, necessary to 
                        ensure that an individual wearing medically 
                        necessary diapers is properly cleaned and 
                        protected from diaper rash.''.
            (2) Archer msas.--The last sentence of section 220(d)(2)(A) 
        of such Code is amended by inserting ``, medically necessary 
        diapers (as defined in section 223(d)(2)(E)), and diapering 
        supplies (as defined in section 223(d)(2)(E))'' after 
        ``menstrual care products (as defined in section 
        223(d)(2)(D))''.
            (3) Health flexible spending arrangements and health 
        reimbursement arrangements.--Section 106(f) of such Code is 
        amended--
                    (A) by inserting ``, medically necessary diapers 
                (as defined in section 223(d)(2)(E)), and diapering 
                supplies (as defined in section 223(d)(2)(E))'' after 
                ``menstrual care products (as defined in section 
                223(d)(2)(D))''; and
                    (B) in the heading, by inserting ``, Medically 
                Necessary Diapers, and Diapering Supplies'' after 
                ``Menstrual Care Products''.
            (4) Effective dates.--
                    (A) Distributions from certain accounts.--The 
                amendments made by paragraphs (1) and (2) shall apply 
                to amounts paid after December 31, 2023.
                    (B) Reimbursements.--The amendment made by 
                paragraph (3) shall apply to expenses incurred after 
                December 31, 2023.

SEC. 5503. DECREASING THE RISK FACTORS FOR SUDDEN UNEXPECTED INFANT 
              DEATH AND SUDDEN UNEXPLAINED DEATH IN CHILDHOOD.

    (a) Establishment.--The Secretary of Health and Human Services, 
acting through the Administrator of the Health Resources and Services 
Administration and in consultation with the Director of the Centers for 
Disease Control and Prevention and the Director of the National 
Institutes of Health (in this section referred to as the 
``Secretary''), shall establish and implement a culturally and 
linguistically competent public health awareness and education campaign 
to provide information that is focused on decreasing the risk factors 
for sudden unexpected infant death and sudden unexplained death in 
childhood, including educating individuals about safe sleep 
environments, sleep positions, and reducing exposure to smoking during 
pregnancy and after birth.
    (b) Targeted Populations.--The campaign under subsection (a) shall 
be designed to reduce health inequities through the targeting of 
populations with high rates of sudden unexpected infant death and 
sudden unexplained death in childhood.
    (c) Consultation.--In establishing and implementing the campaign 
under subsection (a), the Secretary shall consult with national 
organizations representing health care providers, including nurses and 
physicians, parents, child care providers, children's advocacy and 
safety organizations, maternal and child health programs, nutrition 
professionals focusing on people, infants, and children, and other 
individuals and groups determined necessary by the Secretary for such 
establishment and implementation.
    (d) Grants.--
            (1) In general.--In carrying out the campaign under 
        subsection (a), the Secretary shall award grants to national 
        organizations, State and local health departments, and 
        community-based organizations for the conduct of education and 
        outreach programs for nurses, parents, child care providers, 
        public health agencies, and community organizations.
            (2) Application.--To be eligible to receive a grant under 
        paragraph (1), an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2023 through 2027.

          Subtitle G--Nutrition for Women, Children, Families

SEC. 5601. REMOVING BARRIERS TO HEALTH CARE AND NUTRITION ASSISTANCE 
              FOR CHILDREN, PREGNANT PERSONS, AND LAWFULLY PRESENT 
              INDIVIDUALS.

    (a) Medicaid.--Paragraph (4) of section 1903(v) of the Social 
Security Act (42 U.S.C. 1396b(v)) is amended to read as follows:
    ``(4)(A) Notwithstanding sections 401(a), 402(b), 403, and 421 of 
the Personal Responsibility and Work Opportunity Reconciliation Act of 
1996 and paragraph (1), payment shall be made to a State under this 
section for medical assistance furnished to an alien under this title 
(including an alien described in such paragraph) who meets any of the 
following conditions:
            ``(i) The alien is otherwise eligible for such assistance 
        under the State plan approved under this title (other than the 
        requirement of the receipt of aid or assistance under title IV, 
        supplemental security income benefits under title XVI, or a 
        State supplementary payment) within either or both of the 
        following eligibility categories:
                    ``(I) Children under 21 years of age, including any 
                optional targeted low-income child (as such term is 
                defined in section 1905(u)(2)(B)).
                    ``(II) Pregnant persons during pregnancy and during 
                the 12-month period beginning on the last day of the 
                pregnancy.
            ``(ii) The alien is lawfully present in the United States.
    ``(B) No debt shall accrue under an affidavit of support against 
any sponsor of an alien who meets the conditions specified in 
subparagraph (A) on the basis of the provision of medical assistance to 
such alien under this paragraph and the cost of such assistance shall 
not be considered as an unreimbursed cost.''.
    (b) CHIP.--Subparagraph (N) of section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
                    ``(N) Paragraph (4) of section 1903(v) (relating to 
                coverage of categories of children, pregnant persons, 
                and other lawfully present individuals).''.
    (c) Supplemental Nutrition Assistance for Lawfully Present 
Individuals.--
            (1) In general.--Section 402(a)(2)(J) of the Personal 
        Responsibility and Work Opportunity Reconciliation Act of 1996 
        (8 U.S.C. 1612(a)(2)(J)) is amended--
                    (A) in the subparagraph heading, by striking 
                ``certain children'' inserting ``children and lawfully 
                present individuals''; and
                    (B) by striking ``who is under 18 years of age.'' 
                and inserting ``who is--
                            ``(i) under 21 years of age; or
                            ``(ii) lawfully present in the United 
                        States.''.
            (2) Conforming amendments.--
                    (A) Section 402(a)(3) of such Act (8 U.S.C. 
                1612(a)(3)) is amended by striking subparagraph (B) and 
                inserting the following:
                    ``(B) SNAP (food stamp program).--The supplemental 
                nutrition assistance program established under the Food 
                and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) 
                (referred to in this title as `SNAP' or the `food stamp 
                program').''.
                    (B) Section 403(c)(2)(L) of such Act (42 U.S.C. 
                1613(c)(2)(L)) is amended by striking ``18'' and all 
                that follows through the period and inserting ``21, or 
                to individuals who are lawfully present in the United 
                States, under the supplemental nutrition assistance 
                program established under the Food and Nutrition Act of 
                2008 (7 U.S.C. 2011 et seq.).''.
                    (C) Section 5(i)(2)(E) of the Food and Nutrition 
                Act of 2008 (7 U.S.C. 2014(i)(2)(E)) is amended by 
                striking ``18 years of age.'' and inserting ``21 years 
                of age, or who is lawfully present in the United 
                States.''.
    (d) Nonapplication of Sponsor Deeming; Assuring Eligibility for 
Families.--Section 421(d) of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631(d)) is amended by 
striking paragraph (3) and inserting the following:
            ``(3) This section shall not apply to assistance or 
        benefits under the supplemental nutrition assistance program 
        established under the Food and Nutrition Act of 2008 (7 U.S.C. 
        2011 et seq.) for a qualified alien who is eligible under 
        section 402(a)(2)(J) and for any member of the household of 
        such qualified alien.''.
    (e) Ensuring Proper Screening.--Section 11(e)(2)(B) of the Food and 
Nutrition Act of 2008 (7 U.S.C. 2020(e)(2)(B)) is amended--
            (1) by redesignating clauses (vi) and (vii) as clauses 
        (vii) and (viii), respectively; and
            (2) by inserting after clause (v) the following:
                            ``(vi) shall provide a method for 
                        implementing section 421 of the Personal 
                        Responsibility and Work Opportunity 
                        Reconciliation Act of 1996 (8 U.S.C. 1631) that 
                        does not require any unnecessary information 
                        from applicants who may be exempt from that 
                        provision;''.

SEC. 5602. CLOSING THE MEAL GAP.

    (a) Elimination of Time Limit.--
            (1) In general.--Section 6 of the Food and Nutrition Act of 
        2008 (7 U.S.C. 2015) is amended--
                    (A) by striking subsection (o); and
                    (B) by redesignating subsections (p) through (s) as 
                subsections (o) through (r), respectively.
            (2) Additional allocations for states that ensure 
        availability of work opportunities.--Section 16(h) of the Food 
        and Nutrition Act of 2008 (7 U.S.C. 2025(h)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (C)(iv)(I)--
                                    (I) by striking ``(F)(viii)'' each 
                                place it appears and inserting 
                                ``(E)(viii)'';
                                    (II) by striking ``(F)(vii)(I)'' 
                                each place it appears and inserting 
                                ``(E)(vii)(I)'';
                                    (III) in item (bb)(BB), by striking 
                                ``(F)(vii)(II)'' and inserting 
                                ``(E)(vii)(II)''; and
                                    (IV) in item (cc), by striking 
                                ``(F)(vii)'' and inserting 
                                ``(E)(vii)'';
                            (ii) by striking subparagraph (E); and
                            (iii) by redesignating subparagraph (F) as 
                        subparagraph (E);
                    (B) in paragraphs (3) and (4), by striking 
                ``(1)(F)'' each place it appears and inserting 
                ``(1)(E)''; and
                    (C) in paragraph (5)(C)--
                            (i) in clause (ii), by adding ``and'' at 
                        the end;
                            (ii) in clause (iii), by striking ``; and'' 
                        and inserting a period; and
                            (iii) by striking clause (iv).
            (3) Conforming amendments.--
                    (A) Section 5(a) of the Food and Nutrition Act of 
                2008 (7 U.S.C. 2014(a)) is amended in the second 
                sentence, by striking ``(r)'' and inserting ``(q)''.
                    (B) Section 6(d)(4) of the Food and Nutrition Act 
                of 2008 (7 U.S.C. 2015(d)(4)) is amended--
                            (i) in subparagraph (B)(ii)(I)(bb)(DD), by 
                        striking ``or subsection (o)''; and
                            (ii) in subparagraph (N), by striking ``or 
                        subsection (o)'' each place it appears.
                    (C) Section 7(i)(1) of the Food and Nutrition Act 
                of 2008 (7 U.S.C. 2016(i)(1)) is amended by striking 
                ``section 6(o)(2) of this Act or''.
                    (D) Section 16(h)(1) of the Food and Nutrition Act 
                of 2008 (7 U.S.C. 2025(h)) is amended--
                            (i) in subparagraph (B), in the matter 
                        preceding clause (i), by striking ``that--'' 
                        and all that follows through the period at the 
                        end of clause (ii) and inserting ``that is 
                        determined and adjusted by the Secretary.''; 
                        and
                            (ii) in clause (ii)(III)(ee)(AA) of 
                        subparagraph (E) (as redesignated by paragraph 
                        (2)(A)(iii)), by striking ``, individuals 
                        subject to the requirements under section 
                        6(o),''.
                    (E) Section 51(d)(8)(A)(ii) of the Internal Revenue 
                Code of 1986 is amended--
                            (i) in subclause (I), by striking ``, or'' 
                        at the end and inserting a period;
                            (ii) in the matter preceding subclause (I), 
                        by striking ``family--'' and all that follows 
                        through ``receiving'' in subclause (I) and 
                        inserting ``family receiving''; and
                            (iii) by striking subclause (II).
                    (F) Section 103(a)(2) of the Workforce Innovation 
                and Opportunity Act (29 U.S.C. 3113) is amended--
                            (i) by striking subparagraph (D); and
                            (ii) by redesignating subparagraphs (E) 
                        through (K) as subparagraphs (D) through (J), 
                        respectively.
                    (G) Section 121(b)(2)(B) of the Workforce 
                Innovation and Opportunity Act (29 U.S.C. 3151) is 
                amended--
                            (i) by striking clause (iv); and
                            (ii) by redesignating clauses (v) through 
                        (vii) as clauses (iv) through (vi), 
                        respectively.
    (b) Participation of Puerto Rico, American Samoa, and the Northern 
Mariana Islands in Supplemental Nutrition Assistance Program.--
            (1) Definition of state.--Subsection (r) of section 3 of 
        the Food and Nutrition Act of 2008 (7 U.S.C. 2012) is amended 
        by inserting ``the Commonwealth of Puerto Rico, American Samoa, 
        the Commonwealth of the Northern Mariana Islands,'' after 
        ``Guam,''.
            (2) Eligible households.--Section 5 of the Food and 
        Nutrition Act of 2008 (7 U.S.C. 2014) is amended--
                    (A) in subsection (c), in the undesignated matter 
                at the end, by striking ``States or Guam'' and 
                inserting ``States, Guam, the Commonwealth of Puerto 
                Rico, American Samoa, or the Commonwealth of the 
                Northern Mariana Islands''; and
                    (B) by adding at the end the following:
    ``(o) Puerto Rico, American Samoa, and the Northern Mariana 
Islands.--Notwithstanding any other provision of this Act, including 
the requirements under this section, the Commonwealth of Puerto Rico, 
American Samoa, and the Commonwealth of the Northern Mariana Islands 
shall each establish their own standards of eligibility for 
participation by households in the supplemental nutrition assistance 
program.''.
            (3) Effective date.--
                    (A) In general.--The amendments made by paragraphs 
                (1) and (2) shall be effective with respect to the 
                Commonwealth of Puerto Rico, American Samoa, and the 
                Commonwealth of the Northern Mariana Islands, as 
                applicable, on the date described in subparagraph (B) 
                if the Secretary of Agriculture submits to Congress a 
                certification under subsection (f)(2)(B) of section 19 
                of the Food and Nutrition Act of 2008 (7 U.S.C. 2028).
                    (B) Date described.--The date referred to in 
                subparagraph (A) is, with respect to the Commonwealth 
                of Puerto Rico, American Samoa, and the Commonwealth of 
                the Northern Mariana Islands, the date established by 
                the Commonwealth of Puerto Rico, American Samoa, or the 
                Commonwealth of the Northern Mariana Islands, 
                respectively, in the applicable plan of operation 
                submitted to the Secretary of Agriculture under 
                subsection (f)(1)(A) of section 19 of the Food and 
                Nutrition Act of 2008 (7 U.S.C. 2028).
    (c) Transition of Puerto Rico, American Samoa, and the Northern 
Mariana Islands to Supplemental Nutrition Assistance Program.--Section 
19 of the Food and Nutrition Act of 2008 (7 U.S.C. 2028) is amended--
            (1) in subsection (a)(1)--
                    (A) in subparagraph (A), by striking ``and'' at the 
                end;
                    (B) in subparagraph (B), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(C) the Commonwealth of the Northern Mariana 
                Islands.''; and
            (2) by adding at the end the following:
    ``(f) Transition of Puerto Rico, American Samoa, and the Northern 
Mariana Islands to Supplemental Nutrition Assistance Program.--
            ``(1) Request for participation.--A governmental entity may 
        submit to the Secretary a request to participate in the 
        supplemental nutrition assistance program, which shall include 
        a plan of operation described in section 11(d), which shall 
        include the date on which the governmental entity intends to 
        begin participation in the program.
            ``(2) Certification by secretary.--
                    ``(A) In general.--The Secretary shall certify a 
                governmental entity that submits a request under 
                paragraph (1) as qualified to participate in the 
                supplemental nutrition assistance program if the 
                Secretary--
                            ``(i) approves the plan of operation 
                        submitted with the request, in accordance with 
                        this subsection; and
                            ``(ii) approves the applications described 
                        in paragraph (4) in accordance with that 
                        paragraph.
                    ``(B) Submission of certification to congress.--The 
                Secretary shall submit each certification under 
                subparagraph (A) to Congress.
            ``(3) Determination of plan of operation.--
                    ``(A) Approval.--The Secretary shall approve a plan 
                of operation submitted with a request under paragraph 
                (1) if the plan satisfies the requirements under this 
                Act for a plan of operation.
                    ``(B) Disapproval.--If the Secretary does not 
                approve a plan of operation submitted with a request 
                under paragraph (1), the Secretary shall provide to the 
                governmental entity a statement that describes each 
                requirement under this Act that is not satisfied by the 
                plan.
            ``(4) Approval of retail food stores.--
                    ``(A) Solicitation of applications.--If the 
                Secretary approves a plan of operation under paragraph 
                (3)(A) for a governmental entity, the Secretary shall 
                accept applications from retail food stores located in 
                that governmental entity to be authorized under section 
                9 to participate in the supplemental nutrition 
                assistance program.
                    ``(B) Determination.--The Secretary shall authorize 
                a retail food store applying to participate in the 
                supplemental nutrition assistance program under 
                subparagraph (A) if the application satisfies the 
                requirements under this Act for authorization of a 
                retail food store.
            ``(5) Puerto rico.--In the case of a request under 
        paragraph (1) by the Commonwealth of Puerto Rico, 
        notwithstanding subsection (g), the Secretary shall allow the 
        Commonwealth of Puerto Rico to continue to carry out under the 
        supplemental nutrition assistance program the Family Market 
        Program established pursuant to this section.
            ``(6) Authorization of appropriations.--There are 
        authorized to be appropriated to the Secretary to carry out 
        this subsection such sums as are necessary for fiscal year 
        2023, to remain available until expended.
    ``(g) Termination of Effectiveness.--
            ``(1) In general.--Subsections (a) through (e) shall cease 
        to be effective with respect to the Commonwealth of Puerto 
        Rico, American Samoa, and the Commonwealth of the Northern 
        Mariana Islands, as applicable, on the date described in 
        paragraph (2) if the Secretary submits to Congress a 
        certification under subsection (f)(2)(B) for that governmental 
        entity.
            ``(2) Date described.--The date referred to in paragraph 
        (1) is, with respect to the Commonwealth of Puerto Rico, 
        American Samoa, and the Commonwealth of the Northern Mariana 
        Islands, the date established by the Commonwealth of Puerto 
        Rico, American Samoa, or the Commonwealth of the Northern 
        Mariana Islands, respectively, in the applicable plan of 
        operation submitted to the Secretary under subsection 
        (f)(1)(A).''.

SEC. 5603. REPEAL OF DENIAL OF SUPPLEMENTAL NUTRITION ASSISTANCE 
              PROGRAM BENEFITS.

    Section 115 of the Personal Responsibility and Work Opportunity 
Reconciliation Act of 1996 (21 U.S.C. 862a) is amended--
            (1) in subsection (a), by striking ``for--'' and all that 
        follows and inserting ``for assistance under any State program 
        funded under part A of title IV of the Social Security Act (42 
        U.S.C. 601 et seq.).'';
            (2) in subsection (b)--
                    (A) by striking ``Others.--'' and all that follows 
                through ``families.--The'' and insert ``Others.--The''
                    (B) by striking paragraph (2); and
            (3) in subsection (e), by striking ``it--'' and all that 
        follows and inserting ``the term in section 419(5) of the 
        Social Security Act (42 U.S.C. 619(5)) when referring to 
        assistance provided under a State program funded under 
        paragraph A of title IV of the Social Security Act (42 U.S.C. 
        601 et seq.).''.

               Subtitle H--Universal School Meals Program

SEC. 5701. SHORT TITLE.

    This subtitle may be cited as the ``Universal School Meals Program 
Act of 2022''.

SEC. 5702. EFFECTIVE DATE.

    Unless otherwise provided, this subtitle, and the amendments made 
by this subtitle, shall take effect 1 year after the date of enactment 
of this section.

SEC. 5703. FREE SCHOOL BREAKFAST PROGRAM.

    (a) In General.--Section 4(a) of the Child Nutrition Act of 1966 
(42 U.S.C. 1773(a)) is amended, in the first sentence--
            (1) by striking ``is hereby'' and inserting ``are''; and
            (2) by inserting ``to provide free breakfast to all 
        children enrolled at those schools'' before ``in accordance''.
    (b) Apportionment to States.--Section 4(b) of the Child Nutrition 
Act of 1966 (42 U.S.C. 1773(b)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (A)(i), by striking subclause 
                (II) and inserting the following:
                                    ``(II) the national average payment 
                                for free breakfasts, as specified in 
                                subparagraph (B).'';
                    (B) by striking subparagraph (B) and inserting the 
                following:
                    ``(B) Payment amounts.--
                            ``(i) In general.--The national average 
                        payment for each free breakfast shall be $2.72, 
                        adjusted annually for inflation in accordance 
                        with clause (ii) and rounded in accordance with 
                        clause (iii).
                            ``(ii) Inflation adjustment.--
                                    ``(I) In general.--The annual 
                                inflation adjustment under clause (i) 
                                shall reflect changes in the cost of 
                                operating the free breakfast program 
                                under this section, as indicated by the 
                                change in the Consumer Price Index for 
                                food away from home for all urban 
                                consumers.
                                    ``(II) Basis.--Each inflation 
                                annual adjustment under clause (i) 
                                shall reflect the changes in the 
                                Consumer Price Index for food away from 
                                home for the most recent 12-month 
                                period for which that data is 
                                available.
                            ``(iii) Rounding.--On July 1, 2021, and 
                        annually thereafter, the national average 
                        payment rate for free breakfast shall be--
                                    ``(I) adjusted to the nearest 
                                lower-cent increment; and
                                    ``(II) based on the unrounded 
                                amounts for the preceding 12-month 
                                period.'';
                    (C) by striking subparagraphs (C) and (E); and
                    (D) by redesignating subparagraph (D) as 
                subparagraph (C);
            (2) by striking paragraphs (2) and (3);
            (3) by redesignating paragraphs (4) and (5) as paragraphs 
        (2) and (3), respectively; and
            (4) in paragraph (3) (as so redesignated), by striking 
        ``paragraph (3) or (4)'' and inserting ``paragraph (2)''.
    (c) State Disbursement to Schools.--Section 4 of the Child 
Nutrition Act of 1966 (42 U.S.C. 1773) is amended by striking 
subsection (c) and inserting the following:
    ``(c) State Disbursement to Schools.--Funds apportioned and paid to 
any State for the purpose of this section shall be disbursed by the 
State educational agency to schools selected by the State educational 
agency to assist those schools in operating a breakfast program.''.
    (d) No Collection of Debt.--
            (1) In general.--Notwithstanding any other provision of the 
        Child Nutrition Act of 1966 (42 U.S.C. 1771 et seq.) or any 
        other provision of law, effective beginning on the date of 
        enactment of this Act, as a condition of participation in the 
        breakfast program under section 4 of that Act (42 U.S.C. 1773), 
        a school--
                    (A) shall not collect any debt owed to the school 
                for unpaid meal charges; and
                    (B) shall continue to accrue debt for unpaid meal 
                charges--
                            (i) for the purpose of receiving 
                        reimbursement under section 5715; and
                            (ii) until the effective date specified in 
                        section 5702.
            (2) Child nutrition act of 1966.--
                    (A) In general.--Section 4 of the Child Nutrition 
                Act of 1966 (42 U.S.C. 1773) is amended by striking 
                subsection (d) and inserting the following:
    ``(d) No Collection of Debt.--A school participating in the free 
breakfast program under this section shall not collect any debt owed to 
the school for unpaid meal charges.''.
                    (B) Conforming amendment.--Section 23(a) of the 
                Child Nutrition Act of 1966 (42 U.S.C. 1793(a)) is 
                amended by striking ``school in severe need, as 
                described in section 4(d)(1)'' and inserting the 
                following: ``school--
            ``(1) that has a free breakfast program under section 4 or 
        seeks to initiate a free breakfast program under that section; 
        and
            ``(2) of which not less than 40 percent of the students are 
        identified students (as defined in paragraph (8) of section 
        1113(a) of the Elementary and Secondary Education Act of 1965 
        (20 U.S.C. 6313(a)))''.
    (e) Nutritional and Other Program Requirements.--Section 4(e) of 
the Child Nutrition Act of 1966 (42 U.S.C. 1773(e)) is amended--
            (1) in paragraph (1)(A), in the second sentence, by 
        striking ``free or'' and all that follows through the period at 
        the end and inserting ``free to all children enrolled at a 
        school participating in the school breakfast program.''; and
            (2) in paragraph (2), in the second sentence, by striking 
        ``the full charge to the student for a breakfast meeting the 
        requirements of this section or''.
    (f) Prohibition on Breakfast Shaming, Meal Denial.--
            (1) In general.--Effective beginning on the date of 
        enactment of this Act, a school or school food authority--
                    (A) shall not--
                            (i) physically segregate or otherwise 
                        discriminate against any child participating in 
                        the breakfast program under section 4 of the 
                        Child Nutrition Act of 1966 (42 U.S.C. 1773); 
                        or
                            (ii) overtly identify a child described in 
                        clause (i) by a special token or ticket, an 
                        announced or published list of names, or any 
                        other means; and
                    (B) shall provide the program meal to any child 
                eligible under the program.
            (2) Child nutrition act of 1966.--Section 4 of the Child 
        Nutrition Act of 1966 (42 U.S.C. 1773) is amended by adding at 
        the end the following:
    ``(f) Prohibition on Breakfast Shaming.--A school or school food 
authority shall not--
            ``(1) physically segregate or otherwise discriminate 
        against any child participating in the free breakfast program 
        under this section; or
            ``(2) overtly identify a child described in paragraph (1) 
        by a special token or ticket, an announced or published list of 
        names, or any other means.''.
    (g) Department of Defense Overseas Dependents' Schools.--Section 
20(b) of the Child Nutrition Act of 1966 (42 U.S.C. 1789(b)) is 
amended--
            (1) by striking ``and reduced-price''; and
            (2) by striking ``and shall'' and all that follows through 
        ``section''.
    (h) Conforming Amendments.--The Child Nutrition Act of 1966 (42 
U.S.C. 1771 et seq.) is amended--
            (1) by striking ``or reduced price'' each place it appears;
            (2) by striking ``and reduced price'' each place it 
        appears; and
            (3) by striking ``a reduced price'' each place it appears.

SEC. 5704. APPORTIONMENT TO STATES.

    Section 4(b) of the Richard B. Russell National School Lunch Act 
(42 U.S.C. 1753(b)) is amended--
            (1) by striking paragraph (2) and inserting the following:
            ``(2) Payment amounts.--
                    ``(A) In general.--The national average payment for 
                each free lunch shall be $3.81, adjusted annually for 
                inflation in accordance with subparagraph (C) and 
                rounded in accordance with subparagraph (D).
                    ``(B) Additional payment for local food.--
                            ``(i) Definition of locally-sourced farm 
                        product.--In this subparagraph, the term 
                        `locally-sourced farm product' means a farm 
                        product that--
                                    ``(I) is marketed to consumers--
                                            ``(aa) directly; or
                                            ``(bb) through 
                                        intermediated channels (such as 
                                        food hubs and cooperatives); 
                                        and
                                    ``(II) with respect to the school 
                                food authority purchasing the farm 
                                product, is produced and distributed--
                                            ``(aa) in the State in 
                                        which the school food authority 
                                        is located; or
                                            ``(bb) not more than 250 
                                        miles from the location of the 
                                        school food authority.
                            ``(ii) Additional payment eligibility.--
                        During a school year, a school food authority 
                        shall receive an additional payment described 
                        in clause (iii) if the State certifies that the 
                        school food authority served meals (including 
                        breakfasts, lunches, suppers, and supplements) 
                        during the last school year of which not less 
                        than 25 percent were made with locally-sourced 
                        farm products.
                            ``(iii) Payment amount.--
                                    ``(I) In general.--The additional 
                                payment amount under this subparagraph 
                                shall be--
                                            ``(aa) $0.30 for each free 
                                        lunch and supper;
                                            ``(bb) $0.21 for each free 
                                        breakfast; and
                                            ``(cc) $0.08 for each free 
                                        supplement.
                                    ``(II) Adjustments.--Each 
                                additional payment amount under 
                                subclause (I) shall be adjusted 
                                annually in accordance with 
                                subparagraph (C) and rounded in 
                                accordance with subparagraph (D).
                            ``(iv) Disbursement.--The State agency 
                        shall disburse funds made available under this 
                        clause to school food authorities eligible to 
                        receive additional reimbursement.
                    ``(C) Inflation adjustment.--
                            ``(i) In general.--The annual inflation 
                        adjustment under subparagraphs (A) and (B)(iii) 
                        shall reflect changes in the cost of operating 
                        the free lunch program under this Act, as 
                        indicated by the change in the Consumer Price 
                        Index for food away from home for all urban 
                        consumers.
                            ``(ii) Basis.--Each annual inflation 
                        adjustment under subparagraphs (A) and (B)(iii) 
                        shall reflect the changes in the Consumer Price 
                        Index for food away from home for the most 
                        recent 12-month period for which that data is 
                        available.
                    ``(D) Rounding.--On July 1, 2021, and annually 
                thereafter, the national average payment rate for free 
                lunch and the additional payment amount for free 
                breakfast, lunch, supper, and supplement under 
                subparagraph (B) shall be--
                            ``(i) adjusted to the nearest lower-cent 
                        increment; and
                            ``(ii) based on the unrounded amounts for 
                        the preceding 12-month period.''; and
            (2) by striking paragraph (3).

SEC. 5705. NUTRITIONAL AND OTHER PROGRAM REQUIREMENTS.

    (a) Elimination of Free Lunch Eligibility Requirements.--
            (1) In general.--Section 9 of the Richard B. Russell 
        National School Lunch Act (42 U.S.C. 1758) is amended by 
        striking subsection (b) and inserting the following:
    ``(b) Eligibility.--All children enrolled in a school that 
participates in the school lunch program under this Act shall be 
eligible to receive free lunch under this Act.''.
            (2) Conforming amendments.--
                    (A) Section 9 of the Richard B. Russell National 
                School Lunch Act (42 U.S.C. 1758) is amended--
                            (i) in subsection (c), in the third 
                        sentence, by striking ``or at a reduced cost''; 
                        and
                            (ii) in subsection (e), by striking ``, 
                        reduced price,''.
                    (B) Section 18 of the Richard B. Russell National 
                School Lunch Act (42 U.S.C. 1769) is amended--
                            (i) by striking subsection (j); and
                            (ii) by redesignating subsection (k) as 
                        subsection (j).
                    (C) Section 28(b)(4) of the Richard B. Russell 
                National School Lunch Act (42 U.S.C. 1769i(b)(4)) is 
                amended--
                            (i) by striking subparagraph (B); and
                            (ii) in subparagraph (A), by striking the 
                        subparagraph designation and heading and all 
                        that follows through ``the Secretary'' and 
                        inserting ``The Secretary''.
                    (D) Section 17 of the Child Nutrition Act of 1966 
                (42 U.S.C. 1786) is amended--
                            (i) in subsection (d)(2)(A)--
                                    (I) by striking clause (i); and
                                    (II) by redesignating clauses (ii) 
                                and (iii) as clauses (i) and (ii), 
                                respectively; and
                            (ii) in subsection (f)(17), by striking 
                        ``Notwithstanding subsection (d)(2)(A)(i), not 
                        later'' and inserting ``Not later''.
                    (E) Section 1902(a) of the Social Security Act (42 
                U.S.C. 1396a(a)) is amended by striking paragraph (7) 
                and inserting the following:
            ``(7) provide safeguards which restrict the use or 
        disclosure of information concerning applicants and recipients 
        to purposes directly connected with the administration of the 
        plan;''.
                    (F) Section 1154(a)(2)(A)(i) of title 10, United 
                States Code, is amended by striking ``in accordance 
                with section 9(b)(1) of the Richard B. Russell National 
                School Lunch Act (42 U.S.C. 1758(b)(1)''.
                    (G) Section 4301 of the Food, Conservation, and 
                Energy Act of 2008 (42 U.S.C. 1758a) is repealed.
    (b) No Collection of Debt.--
            (1) In general.--Notwithstanding any other provision of the 
        Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et 
        seq.) or any other provision of law, effective beginning on the 
        date of enactment of this Act, as a condition of participation 
        in the school lunch program under that Act, a school--
                    (A) shall not collect any debt owed to the school 
                for unpaid meal charges; and
                    (B) shall continue to accrue debt for unpaid meal 
                charges--
                            (i) for the purpose of receiving 
                        reimbursement under section 5716; and
                            (ii) until the effective date specified in 
                        section 5702.
            (2) National school lunch act.--
                    (A) In general.--Section 9 of the Richard B. 
                Russell National School Lunch Act (42 U.S.C. 1758) is 
                amended by striking subsection (d) and inserting the 
                following:
    ``(d) No Collection of Debt.--A school participating in the school 
lunch program under this Act shall not collect any debt owed to the 
school for unpaid meal charges.''.
                    (B) Conforming amendments.--Section 9(b)(8)(A) of 
                the Richard B. Russell National School Lunch Act (42 
                U.S.C. 1758(b)(8)(A)) is amended by striking ``or 
                subsection (d)''.

SEC. 5706. SPECIAL ASSISTANCE PROGRAM.

    (a) In General.--Section 11 of the Richard B. Russell National 
School Lunch Act (42 U.S.C. 1759a) is repealed.
    (b) Conforming Amendments.--
            (1) Section 6 of the Richard B. Russell National School 
        Lunch Act (42 U.S.C. 1755) is amended--
                    (A) in subsection (a)(2), by striking ``sections 11 
                and 13'' and inserting ``section 13''; and
                    (B) in subsection (e)(1), in the matter preceding 
                subparagraph (A), by striking ``section 4, this 
                section, and section 11'' and inserting ``this section 
                and section 4''.
            (2) Section 7(d) of the Richard B. Russell National School 
        Lunch Act (42 U.S.C. 1756(d)) is amended by striking ``or 11''.
            (3) Section 8(g) of the Richard B. Russell National School 
        Lunch Act (42 U.S.C. 1757(g)) is amended by striking ``and 
        under section 11 of this Act''.
            (4) Section 12(f) of the Richard B. Russell National School 
        Lunch Act (42 U.S.C. 1760(f)) is amended by striking ``11,''.
            (5) Section 7(a) of the Child Nutrition Act of 1966 (42 
        U.S.C. 1766(a)) is amended--
                    (A) in paragraph (1)(A), by striking ``4, 11, and 
                17'' and inserting ``4 and 17''; and
                    (B) in paragraph (2)(A), by striking ``sections 4 
                and 11'' and inserting ``section 4''.

SEC. 5707. PRICE FOR A PAID LUNCH.

    Section 12 of the Richard B. Russell National School Lunch Act (42 
U.S.C. 1760) is amended--
            (1) by striking subsection (p); and
            (2) by redesignating subsections (q) and (r) as subsections 
        (p) and (q), respectively.

SEC. 5708. SUMMER FOOD SERVICE PROGRAM FOR CHILDREN.

    Section 13 of the Richard B. Russell National School Lunch Act (42 
U.S.C. 1761) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (2), by adding at the end the 
                following:
                    ``(C) Waiver.--If the Secretary determines that a 
                program requirement under this section limits the 
                access of children to meals served under this section, 
                the Secretary may waive that program requirement.
                    ``(D) Eligibility.--All children shall be eligible 
                to participate in the program under this section.''; 
                and
                    (B) in paragraph (5), by striking ``only for'' and 
                all that follows through the period at the end and 
                inserting ``for meals served to all children.'';
            (2) in subsection (b)(2), by striking ``may only serve'' 
        and all that follows through ``migrant children'';
            (3) by striking subsection (c) and inserting the following:
    ``(c) Payments.--
            ``(1) In general.--Payments shall be made to service 
        institutions for meals served--
                    ``(A) during the months of May through September;
                    ``(B) during school vacation at any time during an 
                academic school year;
                    ``(C) during a teacher in-service day; and
                    ``(D) on days that school is closed during the 
                months of October through April due to a natural 
                disaster, building repair, court order, or similar 
                cause, as determined by the Secretary.
            ``(2) Limitation on payments.--A service institution shall 
        receive payments under this section for not more than 3 meals 
        and 1 supplement per child per day.''; and
            (4) in subsection (f)(3), by striking ``, except that'' and 
        all that follows through ``section''.

SEC. 5709. SUMMER ELECTRONIC BENEFIT TRANSFER FOR CHILDREN PROGRAM.

    Section 13(a) of the Richard B. Russell National School Lunch Act 
(42 U.S.C. 1761(a)) is amended by adding at the end the following:
            ``(13) Summer electronic benefit transfer for children 
        program.--
                    ``(A) Definitions.--In this paragraph:
                            ``(i) EBT card.--The term `EBT card' means 
                        an electronic benefit transfer card.
                            ``(ii) Eligible household.--The term 
                        `eligible household' means a household with--
                                    ``(I) an income that does not 
                                exceed 200 percent of the poverty line 
                                (as defined in section 673 of the 
                                Community Services Block Grant Act (42 
                                U.S.C. 9902)); and
                                    ``(II) 1 or more children.
                            ``(iii) Program.--The term `Program' means 
                        the Summer Electronic Benefit Transfer for 
                        Children Program established under subparagraph 
                        (B).
                    ``(B) Establishment.--The Secretary shall establish 
                a national program, to be known as the `Summer 
                Electronic Benefit Transfer for Children Program', 
                under which the Secretary shall issue EBT cards to 
                eligible households to provide food assistance during 
                the summer months.
                    ``(C) EBT amount.--
                            ``(i) In general.--The value of an EBT card 
                        provided under the Program to an eligible 
                        household shall be $60 per month per child 
                        (adjusted for inflation).
                            ``(ii) Annual limitation.--No eligible 
                        household shall receive benefits under the 
                        Program for more than 3 months in a calendar 
                        year.
                    ``(D) Administration.--
                            ``(i) In general.--Except as provided under 
                        this paragraph, the Program shall be based on 
                        the summer electronic benefit transfer for 
                        children demonstration program carried out 
                        pursuant to section 749(g) of the Agriculture, 
                        Rural Development, Food and Drug 
                        Administration, and Related Agencies 
                        Appropriations Act, 2010 (Public Law 111-80; 
                        123 Stat. 2132).
                            ``(ii) SNAP or WIC.--
                                    ``(I) In general.--Subject to 
                                subclause (II), a State shall 
                                administer the Program through the 
                                supplemental nutrition assistance 
                                program established under the Food and 
                                Nutrition Act of 2008 (7 U.S.C. 2011 et 
                                seq.).
                                    ``(II) WIC option.--If a State has 
                                participated in the demonstration 
                                program described in clause (i) before 
                                the effective date specified in section 
                                5702 of the Universal School Meals 
                                Program Act of 2022, the State may 
                                elect to administer the Program through 
                                the special supplemental nutrition 
                                program for women, infants, and 
                                children established by section 17 of 
                                the Child Nutrition Act of 1966 (42 
                                U.S.C. 1786).
                    ``(E) Authorization of appropriations.--There are 
                authorized to be appropriated to the Secretary to carry 
                out this paragraph such sums as are necessary for 
                fiscal year 2021 and each fiscal year thereafter.''.

SEC. 5710. CHILD AND ADULT CARE FOOD PROGRAM.

    Section 17 of the Richard B. Russell National School Lunch Act (42 
U.S.C. 1766) is amended--
            (1) in subsection (a)(2), by striking subparagraph (B) and 
        inserting the following:
                    ``(B) any other private organization providing 
                nonresidential child care or day care outside school 
                hours for school children;'';
            (2) by striking subsection (c) and inserting the following:
    ``(c) Free Meals.--Notwithstanding any other provision of law--
            ``(1) all meals and supplements served under the program 
        authorized under this section shall be provided for free to 
        participants of the program; and
            ``(2) an institution that serves those meals and 
        supplements shall be reimbursed--
                    ``(A) in the case of breakfast, at the rate 
                established for free breakfast under section 
                4(b)(1)(B)(i) of the Child Nutrition Act of 1966 (42 
                U.S.C. 1773(b)(1)(B)(i));
                    ``(B) in the case of lunch, at the rate established 
                for free lunch under section 4(b)(2)(A); and
                    ``(C) in the case of a supplemental meal, $0.96, 
                adjusted for inflation in accordance with section 
                4(b)(2)(C).'';
            (3) in subsection (f)--
                    (A) in paragraph (2), by striking subparagraph (B) 
                and inserting the following:
                    ``(B) Limitation to reimbursements.--An institution 
                may claim reimbursement under this paragraph for not 
                more than 3 meals and 1 supplement per day per 
                child.''; and
                    (B) by striking paragraph (3); and
            (4) in subsection (r)--
                    (A) in the subsection heading, by striking 
                ``Program for At-Risk School Children'' and inserting 
                ``Afterschool Meal and Snack Program'';
                    (B) by striking ``at-risk school'' each place it 
                appears and inserting ``eligible'';
                    (C) in paragraph (1)--
                            (i) in the paragraph heading, by striking 
                        ``at-risk school'' and inserting ``eligible''; 
                        and
                            (ii) in subparagraph (B), by striking 
                        ``operated'' and all that follows through the 
                        period at the end and inserting a period; and
                    (D) in paragraph (4)(A), by striking ``only for'' 
                and all that follows through the period at the end and 
                inserting the following: ``for--
                            ``(i) not more than 1 meal and 1 supplement 
                        per child per day served on a regular school 
                        day; and
                            ``(ii) not more than 3 meals and 1 
                        supplement per child per day served on any day 
                        other than a regular school day.''.

SEC. 5711. MEALS AND SUPPLEMENTS FOR CHILDREN IN AFTERSCHOOL CARE.

    Section 17A of the Richard B. Russell National School Lunch Act (42 
U.S.C. 1766a) is amended--
            (1) in the section heading, by striking ``meal 
        supplements'' and inserting ``meals and supplements'';
            (2) in subsection (a)(1), by striking ``meal supplements'' 
        and inserting ``free meals and supplements'';
            (3) in subsection (b), by inserting ``meals and'' before 
        ``supplements''; and
            (4) by striking subsection (c) and inserting the following:
    ``(c) Reimbursement.--
            ``(1) In general.--
                    ``(A) Meals.--A free meal provided under this 
                section to a child shall be reimbursed at a rate of 
                $3.81, adjusted annually for inflation in accordance 
                with paragraph (3)(A) and rounded in accordance with 
                paragraph (3)(B).
                    ``(B) Supplements.--A free supplement provided 
                under this section to a child shall be reimbursed at 
                the rate at which free supplements are reimbursed under 
                section 17(c)(2)(C).
            ``(2) Limitation to reimbursements.--An institution may 
        claim reimbursement under this section for not more than 1 meal 
        and 1 supplement per day per child served on a regular school 
        day.
            ``(3) Inflation; rounding.--
                    ``(A) Inflation adjustment.--
                            ``(i) In general.--The annual inflation 
                        adjustment under paragraph (1)(A) shall reflect 
                        changes in the cost of operating the program 
                        under this section, as indicated by the change 
                        in the Consumer Price Index for food away from 
                        home for all urban consumers.
                            ``(ii) Basis.--Each inflation annual 
                        adjustment under paragraph (1)(A) shall reflect 
                        the changes in the Consumer Price Index for 
                        food away from home for the most recent 12-
                        month period for which that data is available.
                    ``(B) Rounding.--On July 1, 2021, and annually 
                thereafter, the reimbursement rate for a free meal 
                under this section shall be--
                            ``(i) adjusted to the nearest lower-cent 
                        increment; and
                            ``(ii) based on the unrounded amounts for 
                        the preceding 12-month period.''.

SEC. 5712. ACCESS TO LOCAL FOODS: FARM TO SCHOOL PROGRAM.

    Section 18(g)(5) of the Richard B. Russell National School Lunch 
Act (42 U.S.C. 1769(g)(5)) is amended by striking subparagraph (B) and 
inserting the following:
                    ``(B) serve a high proportion of identified 
                students (as defined in paragraph (8) of section 
                1113(a) of the Elementary and Secondary Education Act 
                of 1965 (20 U.S.C. 6313(a)));''.

SEC. 5713. FRESH FRUIT AND VEGETABLE PROGRAM.

    Section 19(d) of the Richard B. Russell National School Lunch Act 
(42 U.S.C. 1769a(d)) is amended--
            (1) in paragraph (1)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``paragraph (2) of this subsection and'';
                    (B) in subparagraph (A), in the matter preceding 
                clause (i), by striking ``school--'' and all that 
                follows through ``submits'' in clause (ii) and 
                inserting ``school that submits'';
                    (C) in subparagraph (B), by striking ``schools'' 
                and all that follows through ``Act'' and inserting 
                ``high-need schools (as defined in section 2211(b) of 
                the Elementary and Secondary Education Act of 1965 (20 
                U.S.C. 6631(b)))''; and
                    (D) in subparagraph (D)--
                            (i) by striking clause (i); and
                            (ii) by redesignating clauses (ii) through 
                        (iv) as clauses (i) through (iii), 
                        respectively; and
            (2) by striking paragraphs (2) and (3) and inserting the 
        following:
            ``(2) Outreach to high-need schools.--Prior to making 
        decisions regarding school participation in the program, a 
        State agency shall inform high-need schools (as defined in 
        section 2211(b) of the Elementary and Secondary Education Act 
        of 1965 (20 U.S.C. 6631(b))), including Tribal schools, of the 
        eligibility of the schools for the program.''.

SEC. 5714. TRAINING, TECHNICAL ASSISTANCE, AND FOOD SERVICE MANAGEMENT 
              INSTITUTE.

    Section 21(a)(1)(B) of the Richard B. Russell National School Lunch 
Act (42 U.S.C. 1769b-1(a)(1)(B)) is amended in the matter preceding 
clause (i) by striking ``certified to receive free or reduced price 
meals'' and inserting ``who are identified students (as defined in 
paragraph (8) of section 1113(a) of the Elementary and Secondary 
Education Act of 1965 (20 U.S.C. 6313(a))''.

SEC. 5715. REIMBURSEMENT OF SCHOOL MEAL DELINQUENT DEBT PROGRAM.

    (a) Definitions.--In this section:
            (1) Delinquent debt.--The term ``delinquent debt'' means 
        the debt owed by a parent or guardian of a child to a school--
                    (A) as of the effective date specified in section 
                5702; and
                    (B) for meals served by the school under--
                            (i) the school breakfast program under 
                        section 4 of the Child Nutrition Act of 1966 
                        (42 U.S.C. 1773);
                            (ii) the school lunch program established 
                        under the Richard B. Russell National School 
                        Lunch Act (42 U.S.C. 1751 et seq.); or
                            (iii) both of the programs described in 
                        clauses (i) and (ii).
            (2) Program.--The term ``program'' means the program 
        established under subsection (b)(1).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Agriculture.
    (b) Reimbursement Program.--
            (1) Establishment.--Not later than 60 days after the 
        effective date specified in section 5702, the Secretary shall 
        establish a program under which the Secretary shall reimburse 
        each school participating in a program described in clause (i) 
        or (ii) of subsection (a)(1)(B) for all delinquent debt.
            (2) Form for reimbursement.--To carry out the program, the 
        Secretary shall design and distribute a form to State agencies 
        to collect data on all delinquent debt in applicable schools in 
        the State, grouped by school food authority.
            (3) Completion date.--The Secretary shall provide all 
        reimbursements under the program not later than 180 days after 
        the effective date specified in section 5702.
    (c) Report.--Not later than 2 years after the effective date 
specified in section 5702, the Comptroller General of the United States 
shall submit to Congress and make publicly available a report that 
describes the successes and challenges of the program.

SEC. 5716. CONFORMING AMENDMENTS.

    The Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et 
seq.) is amended--
            (1) by striking ``or reduced price'' each place it appears;
            (2) by striking ``or a reduced price'' each place it 
        appears;
            (3) by striking ``and reduced price'' each place it 
        appears; and
            (4) by striking ``a reduced price'' each place it appears.

SEC. 5717. MEASURE OF POVERTY.

    Section 1113(a) of the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 6313(a)) is amended--
            (1) in paragraph (5)(A), by striking ``the number of 
        children eligible for a free or reduced price lunch under the 
        Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et 
        seq.)'' and inserting ``the number of identified students''; 
        and
            (2) by adding at the end the following:
            ``(8) Identified students defined.--
                    ``(A) In general.--In this subsection, the term 
                `identified students' means the number of students--
                            ``(i) who are--
                                    ``(I) homeless children and youths, 
                                as defined under section 725(2) of the 
                                McKinney-Vento Homeless Assistance Act 
                                (42 U.S.C. 11434a(2));
                                    ``(II) runaway and homeless youth 
                                served by programs established under 
                                the Runaway and Homeless Youth Act (34 
                                U.S.C. 11201 et seq.);
                                    ``(III) migratory children, as 
                                defined under section 1309; or
                                    ``(IV) foster children;
                            ``(ii) who are eligible for and receiving 
                        medical assistance under the program of medical 
                        assistance established under title XIX of the 
                        Social Security Act (42 U.S.C. 1396 et seq.); 
                        or
                            ``(iii) who participate (or who are part of 
                        a household that participates) in at least one 
                        of the following:
                                    ``(I) The supplemental nutrition 
                                assistance program established under 
                                the Food and Nutrition Act of 2008 (7 
                                U.S.C. 2011 et seq.).
                                    ``(II) A State program funded under 
                                the program of block grants to States 
                                for temporary assistance for needy 
                                families established under part A of 
                                title IV of the Social Security Act (42 
                                U.S.C. 601 et seq.).
                                    ``(III) The food distribution 
                                program on Indian reservations 
                                established under section 4(b) of the 
                                Food and Nutrition Act of 2008 (7 
                                U.S.C. 2013(b)).
                                    ``(IV) A Head Start program 
                                authorized under the Head Start Act (42 
                                U.S.C. 9831 et seq.) or a comparable 
                                State-funded Head Start or pre-
                                kindergarten program.
                    ``(B) Multiplier.--In determining the number of 
                identified students under subparagraph (A), the local 
                educational agency shall multiply the number determined 
                under such subparagraph by 1.6.''.

SEC. 5718. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM.

    (a) Agreement for Direct Certification.--
            (1) In general.--Section 11 of the Food and Nutrition Act 
        of 2008 (7 U.S.C. 2020) is amended--
                    (A) by striking subsection (u); and
                    (B) by redesignating subsections (v) through (x) as 
                subsections (u) through (w), respectively.
            (2) Conforming amendments.--Section 11(e) of the Food and 
        Nutrition Act of 2008 (7 U.S.C. 2020(e)) is amended--
                    (A) in paragraph (8)(F), by striking ``or 
                subsection (u)''; and
                    (B) in paragraph (26)(B), by striking ``(x)'' and 
                inserting ``(w)''.
    (b) Nutrition Education and Obesity Prevention Grant Program.--
Section 28(a) of the Food and Nutrition Act of 2008 (7 U.S.C. 2036a(a)) 
is amended by striking paragraph (1) and inserting the following:
            ``(1) an individual eligible for benefits under this 
        Act;''.

SEC. 5719. HIGHER EDUCATION ACT OF 1965.

    (a) Teacher Quality Enhancement.--Subparagraph (A) of section 
200(11) of the Higher Education Act of 1965 (20 U.S.C. 1021(11)) is 
amended to read as follows:
                    ``(A) In general.--The term `high-need school' 
                means a school that is in the highest quartile of 
                schools in a ranking of all schools served by a local 
                educational agency, ranked in descending order by 
                percentage of students from low-income families 
                enrolled in such schools, as determined by the local 
                educational agency based on one of the following 
                measures of poverty:
                            ``(i) The percentage of students aged 5 
                        through 17 in poverty counted in the most 
                        recent census data approved by the Secretary.
                            ``(ii) The percentage of students in 
                        families receiving assistance under the State 
                        program funded under the program of block 
                        grants to States for temporary assistance for 
                        needy families established under part A of 
                        title IV of the Social Security Act (42 U.S.C. 
                        601 et seq.).
                            ``(iii) The percentage of students eligible 
                        to receive medical assistance under the program 
                        of medical assistance established under title 
                        XIX of the Social Security Act (42 U.S.C. 1396 
                        et seq.).
                            ``(iv) A composite of two or more of the 
                        measures described in clauses (i) through 
                        (iii).''.
    (b) GEAR Up.--Subparagraph (A) of section 404B(d)(1) of the Higher 
Education Act of 1965 (20 U.S.C. 1070a-22(d)(1)) is amended to read as 
follows:
                    ``(A) provide services under this chapter to at 
                least one grade level of students, beginning not later 
                than 7th grade, in a participating school--
                            ``(i) that has a 7th grade; and
                            ``(ii) in which--
                                    ``(I) at least 50 percent of the 
                                students enrolled are identified 
                                students (as defined in section 
                                1113(a)(8) of the Elementary and 
                                Secondary Education Act of 1965); or
                                    ``(II) if an eligible entity 
                                determines that it would promote the 
                                effectiveness of a program, an entire 
                                grade level of students, beginning not 
                                later than the 7th grade, reside in 
                                public housing, as defined in section 
                                3(b)(1) of the United States Housing 
                                Act of 1937 (42 U.S.C. 1437a(b)(1)).''.
    (c) Simplified Needs Test.--Section 479(d)(2) of the Higher 
Education Act of 1965 (20 U.S.C. 1087ss(d)(2)) is amended--
            (1) by striking subparagraph (C); and
            (2) by redesignating subparagraphs (D) through (F) as 
        subparagraphs (C) through (E), respectively.
    (d) Early Federal Pell Grant Commitment Demonstration Program.--
Section 894(b) of the Higher Education Act of 1965 (20 U.S.C. 1161y(b)) 
is amended--
            (1) in paragraph (1)(B), by striking ``qualify for a free 
        or reduced price school lunch under the Richard B. Russell 
        National School Lunch Act (42 U.S.C. 1751 et seq.) or the Child 
        Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)'' and inserting 
        ``are identified students (as defined in section 1113(a)(8) of 
        the Elementary and Secondary Education Act of 1965)''; and
            (2) in paragraph (5), by striking ``eligible for a free or 
        reduced price school lunch under the Richard B. Russell 
        National School Lunch Act (42 U.S.C. 1751 et seq.) or the Child 
        Nutrition Act of 1966 (42 U.S.C. 1771 et seq.)'' and inserting 
        ``identified students (as defined in section 1113(a)(8) of the 
        Elementary and Secondary Education Act of 1965)''.

SEC. 5720. ELEMENTARY AND SECONDARY EDUCATION ACT OF 1965.

    (a) Literacy Education for All.--Section 2221(b)(3)(B) of the 
Elementary and Secondary Education Act of 1965 (20 U.S.C. 
6641(b)(3)(B)) is amended--
            (1) by striking clause (i); and
            (2) by redesignating clauses (ii) and (iii) as clauses (i) 
        and (ii), respectively.
    (b) Grants for Education Innovation and Research.--Section 
4611(d)(2) of the Elementary and Secondary Education Act of 1965 (20 
U.S.C. 7261(d)(2)) is amended--
            (1) by striking subparagraph (B); and
            (2) by redesignating subparagraphs (C) and (D) as 
        subparagraphs (B) and (C), respectively.
    (c) Eligibility for Heavily Impacted Local Educational Agencies.--
Item (bb) of section 7003(b)(2)(B)(i)(III) of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 7703(b)(2)(B)(i)(III)) is 
amended to read as follows:
                                            ``(bb) has an enrollment of 
                                        children described in 
                                        subsection (a)(1) that 
                                        constitutes a percentage of the 
                                        total student enrollment of the 
                                        agency that is not less than 30 
                                        percent; or''.

SEC. 5721. AMERICA COMPETES ACT.

    Section 6122(3) of the America COMPETES Act (20 U.S.C. 9832(3)) is 
amended by striking ``data on children eligible for free or reduced-
price lunches under the Richard B. Russell National School Lunch 
Act,''.

SEC. 5722. WORKFORCE INNOVATION AND OPPORTUNITY ACT.

    Section 3(36)(A) of the Workforce Innovation and Opportunity Act 
(29 U.S.C. 3102(36)(A)) is amended--
            (1) by striking clause (iv); and
            (2) by redesignating clauses (v) and (vi) as clauses (iv) 
        and (v), respectively.

SEC. 5723. NATIONAL SCIENCE FOUNDATION AUTHORIZATION ACT OF 2002.

    Section 4(8) of the National Science Foundation Authorization Act 
of 2002 (42 U.S.C. 1862n note) is amended--
            (1) by striking subparagraph (A); and
            (2) by redesignating subparagraphs (B) and (C) as 
        subparagraphs (A) and (B), respectively.

SEC. 5724. CHILD CARE AND DEVELOPMENT BLOCK GRANT.

    Section 658O(b) of the Child Care and Development Block Grant Act 
of 1990 (42 U.S.C. 9858m(b)) is amended--
            (1) in paragraph (1)(B), by striking ``school lunch 
        factor'' and inserting ``identified students factor''; and
            (2) by striking paragraph (3) and inserting the following:
            ``(3) Identified students factor.--The term `identified 
        students factor' means the ratio of the number of children in 
        the State who are identified students (as defined in paragraph 
        (8) of section 1113(a) of the Elementary and Secondary 
        Education Act of 1965 (20 U.S.C. 6313(a))) to the number of 
        such children in all the States as determined annually by the 
        Secretary of Education.''.

SEC. 5725. CHILDREN'S HEALTH ACT OF 2000.

    Section 1404(b) of the Children's Health Act of 2000 (42 U.S.C. 
9859c(b)) is amended--
            (1) in paragraph (1)(B), by striking ``school lunch 
        factor'' and inserting ``identified students factor''; and
            (2) by amending paragraph (3) to read as follows:
            ``(3) Identified students factor.--In this subsection, the 
        term `identified students factor' means the ratio of the number 
        of children in the State who are identified students (as 
        defined in paragraph (8) of section 1113(a) of the Elementary 
        and Secondary Education Act of 1965 (20 U.S.C. 6313(a))) to the 
        number of such children in all the States as determined 
        annually by the Secretary of Education.''.

SEC. 5726. JUVENILE JUSTICE AND DELINQUENCY PREVENTION.

    Section 252(i) of the Juvenile Justice and Delinquency Prevention 
Act of 1974 (34 U.S.C. 11162(i)) is amended to read as follows:
    ``(i) Free School Lunches for Incarcerated Juveniles.--
            ``(1) In general.--A juvenile who is incarcerated in an 
        eligible juvenile detention center is eligible to receive free 
        lunch under the Richard B. Russell National School Lunch Act 
        (42 U.S.C. 1751 et seq.).
            ``(2) Guidance.--Not later than 1 year after the date of 
        the enactment of the Universal School Meals Program Act of 
        2022, the Attorney General, in consultation with the Secretary 
        of Agriculture, shall provide guidance to States relating to 
        the options for school food authorities in the States to apply 
        for reimbursement for free lunches under the Richard B. Russell 
        National School Lunch Act (42 U.S.C. 1751 et seq.) for 
        juveniles who are incarcerated.
            ``(3) Eligible juvenile detention center defined.--In this 
        subsection, the term `eligible juvenile detention center' does 
        not include any private, for-profit detention center.''.

                         Subtitle I--Elder Care

SEC. 5801. EXPENSES FOR HOUSEHOLD AND ELDER CARE SERVICES NECESSARY FOR 
              GAINFUL EMPLOYMENT.

    (a) In General.--Subpart A of part IV of subchapter A of chapter 1 
of the Internal Revenue Code of 1986 is amended by adding at the end 
the following new section:

``SEC. 25E. EXPENSES FOR HOUSEHOLD AND ELDER CARE SERVICES NECESSARY 
              FOR GAINFUL EMPLOYMENT.

    ``(a) Allowance of Credit.--
            ``(1) In general.--In the case of an individual for which 
        there are one or more qualifying individuals (as defined in 
        subsection (b)(1)) with respect to such individual, there shall 
        be allowed as a credit against the tax imposed by this chapter 
        for the taxable year an amount equal to the applicable 
        percentage of the employment-related expenses (as defined in 
        subsection (b)(2)) paid by such individual during the taxable 
        year.
            ``(2) Applicable percentage defined.--For purposes of 
        paragraph (1), the term `applicable percentage' means 35 
        percent reduced (but not below 20 percent) by 1 percentage 
        point for each $2,000 (or fraction thereof) by which the 
        taxpayer's adjusted gross income for the taxable year exceeds 
        $15,000.
    ``(b) Definitions of Qualifying Individual and Employment-Related 
Expenses.--For purposes of this section--
            ``(1) Qualifying individual.--The term `qualifying 
        individual' means an individual who--
                    ``(A) has attained age 50, and
                    ``(B) is one of the following:
                            ``(i) An individual who bears a 
                        relationship to the taxpayer described in 
                        subparagraph (C) or (D) of section 152(d)(2) 
                        (relating to fathers, mothers, and ancestors).
                            ``(ii) An individual would be a dependent 
                        of the taxpayer (as defined in section 152, 
                        determined without regard to subsections (b)(1) 
                        and (b)(2)) as a qualifying relative described 
                        in section 152(d)(1) if--
                                    ``(I) in lieu of subparagraphs (B) 
                                and (C) thereof the following applied 
                                with respect to the individual:
                                            ``(aa) the taxpayer has 
                                        provided over one-half of the 
                                        individual's support for the 
                                        calendar year in which such 
                                        taxable year begins and each of 
                                        the preceding 4 taxable years, 
                                        and
                                            ``(bb) the individual's 
                                        modified adjusted gross income 
                                        for the calendar year in which 
                                        such taxable year begins is 
                                        less than the exemption amount 
                                        (as defined in section 151(d)),
                                    ``(II) the individual is physically 
                                or mentally incapable of caring for 
                                himself or herself, and
                                    ``(III) the individual who has the 
                                same principal place of abode as the 
                                taxpayer for more than one-half of such 
                                taxable year.
                            ``(iii) The spouse of the taxpayer who is 
                        physically or mentally incapable of caring for 
                        himself or herself.
            ``(2) Modified adjusted gross income.--The term `modified 
        adjusted gross income' means adjusted gross income determined 
        without regard to section 86.
            ``(3) Employment-related expenses.--
                    ``(A) In general.--The term `employment-related 
                expenses' means amounts paid for the following 
                expenses, but only if such expenses are incurred to 
                enable the taxpayer to be gainfully employed for any 
                period for which there are one or more qualifying 
                individuals with respect to the taxpayer:
                            ``(i) expenses for household services, and
                            ``(ii) expenses for the care of a 
                        qualifying individual, including expenses for 
                        respite care and hospice care.
                    ``(B) Exception.--Employment-related expenses 
                described in subparagraph (A) which are incurred for 
                services outside the taxpayer's household shall be 
                taken into account only if incurred for the care of--
                            ``(i) a qualifying individual described in 
                        paragraph (1)(A), or
                            ``(ii) a qualifying individual (not 
                        described in paragraph (1)(A)) who regularly 
                        spends at least 8 hours each day in the 
                        taxpayer's household.
                    ``(C) Dependent care centers.--Employment-related 
                expenses described in subparagraph (A) which are 
                incurred for services provided outside the taxpayer's 
                household by a dependent care center (as defined in 
                subparagraph (D)) shall be taken into account only if--
                            ``(i) such center complies with all 
                        applicable laws and regulations of a State or 
                        unit of local government, and
                            ``(ii) the requirements of subparagraph (B) 
                        are met.
                    ``(D) Dependent care center defined.--For purposes 
                of this paragraph, the term `dependent care center' 
                means any facility which--
                            ``(i) provides care for more than six 
                        individuals (other than individuals who reside 
                        at the facility), and
                            ``(ii) receives a fee, payment, or grant 
                        for providing services for any of the 
                        individuals (regardless of whether such 
                        facility is operated for profit).
    ``(c) Dollar Limit on Amount Creditable.--The amount of the 
employment-related expenses incurred during any taxable year which may 
be taken into account under subsection (a) shall not exceed--
            ``(1) $3,000 if there is 1 qualifying individual with 
        respect to the taxpayer for such taxable year, or
            ``(2) $6,000 if there are two or more qualifying 
        individuals with respect to the taxpayer for such taxable year.
The amount determined under paragraph (1) or (2) (whichever is 
applicable) shall be reduced by the aggregate amount excludable from 
gross income under section 129 for the taxable year.
    ``(d) Earned Income Limitation.--Except as otherwise provided in 
this subsection, the amount of the employment-related expenses incurred 
during any taxable year which may be taken into account under 
subsection (a) shall not exceed--
            ``(1) in the case of an individual who is not married at 
        the close of such year, such individual's earned income for 
        such year, or
            ``(2) in the case of an individual who is married at the 
        close of such year, the lesser of such individual's earned 
        income or the earned income of his spouse for such year.
    ``(e) Special Rules.--For purposes of this section--
            ``(1) Place of abode.--An individual shall not be treated 
        as having the same principal place of abode of the taxpayer if 
        at any time during the taxable year of the taxpayer the 
        relationship between the individual and the taxpayer is in 
        violation of local law.
            ``(2) Married couples must file joint return.--If the 
        taxpayer is married at the close of the taxable year, the 
        credit shall be allowed under subsection (a) only if the 
        taxpayer and his spouse file a joint return for the taxable 
        year.
            ``(3) Marital status.--An individual legally separated from 
        his spouse under a decree of divorce or of separate maintenance 
        shall not be considered as married.
            ``(4) Certain married individuals living apart.--If--
                    ``(A) an individual who is married and who files a 
                separate return--
                            ``(i) maintains as his home a household 
                        which constitutes for more than one-half of the 
                        taxable year the principal place of abode of a 
                        qualifying individual, and
                            ``(ii) furnishes over half of the cost of 
                        maintaining such household during the taxable 
                        year, and
                    ``(B) during the last 6 months of such taxable year 
                such individual's spouse is not a member of such 
                household, such individual shall not be considered as 
                married.
            ``(5) Payments to related individuals.--No credit shall be 
        allowed under subsection (a) for any amount paid by the 
        taxpayer to an individual--
                    ``(A) with respect to whom, for the taxable year, a 
                deduction under section 151(c) (relating to deduction 
                for personal exemptions for dependents) is allowable 
                either to the taxpayer or his spouse, or
                    ``(B) who is a child of the taxpayer (within the 
                meaning of section 152(f)(1)) who has not attained the 
                age of 19 at the close of the taxable year.
        For purposes of this paragraph, the term `taxable year' means 
        the taxable year of the taxpayer in which the service is 
        performed.
            ``(6) Identifying information required with respect to 
        service provider.--No credit shall be allowed under subsection 
        (a) for any amount paid to any person unless--
                    ``(A) the name, address, and taxpayer 
                identification number of such person are included on 
                the return claiming the credit, or
                    ``(B) if such person is an organization described 
                in section 501(c)(3) and exempt from tax under section 
                501(a), the name and address of such person are 
                included on the return claiming the credit.
        In the case of a failure to provide the information required 
        under the preceding sentence, the preceding sentence shall not 
        apply if it is shown that the taxpayer exercised due diligence 
        in attempting to provide the information so required.
            ``(7) Identifying information required with respect to 
        qualifying individuals.--No credit shall be allowed under this 
        section with respect to any qualifying individual unless the 
        TIN of such individual is included on the return claiming the 
        credit.
    ``(f) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the purposes of this section.''.
    (b) Clerical Amendment.--The table of sections for subpart A of 
part IV of subchapter A of chapter 1 of the Internal Revenue Code of 
1986 is amended by adding at the end the following new item:

``Sec. 25E. Expenses for household and elder care services necessary 
                            for gainful employment.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after the date of the enactment of 
this Act.

                  Subtitle J--Miscellaneous Provisions

SEC. 5901. CLARIFICATION SUPPORTING PERMISSIBLE USE OF FUNDS FOR 
              STILLBIRTH PREVENTION ACTIVITIES.

    Section 501(a) of the Social Security Act (42 U.S.C. 701(a)) is 
amended--
            (1) in paragraph (1)(B), by inserting ``to reduce the 
        incidence of stillbirth,'' after ``among children,''; and
            (2) in paragraph (2), by inserting after ``follow-up 
        services'' the following: ``, and for evidence-based programs 
        and activities and outcome research to reduce the incidence of 
        stillbirth (including tracking and awareness of fetal 
        movements, improvement of birth timing for pregnancies with 
        risk factors, initiatives that encourage safe sleeping 
        positions during pregnancy, screening and surveillance for 
        fetal growth restriction, efforts to achieve smoking cessation 
        during pregnancy, community-based programs that provide home 
        visits or other types of support, and any other research or 
        evidence-based programming to prevent stillbirths)''.

          TITLE VI--MENTAL HEALTH AND SUBSTANCE USE DISORDERS

SEC. 6001. MENTAL HEALTH FINDINGS.

    Congress finds the following:
            (1) Despite the existence of effective treatments, 
        inequities lie in the availability, accessibility, and quality 
        of mental health services for racial and ethnic minorities and 
        people with disabilities.
            (2) These inequities have powerful significance for 
        minority groups and for society as a whole.
            (3) Racial and ethnic minorities bear a greater burden from 
        unmet mental health needs and thus suffer a greater loss to 
        their overall health and productivity.
            (4) Improving community conditions and one's home 
        environment, paired with high-quality, accessible, and 
        culturally and linguistically tailored mental health services, 
        can reduce the likelihood, frequency, and intensity of 
        challenges to one's mental health.
            (5) The presence of strong social connections and trust, 
        opportunities to experience and share cultural identity, safe 
        gathering places, and economic opportunity are community 
        factors that benefit mental health.
            (6) The social, physical, economic, and other conditions, 
        otherwise known as social determinants of health, in 
        communities can have tremendous influence on daily stressors 
        that shape mental health outcomes.
            (7) Significant barriers include the cost of and access to 
        quality care, societal stigma, mental health workforce 
        shortages, the fragmented organization of services and needed 
        social supports, and the history of racism and discrimination 
        in the mental health system.
            (8) People with severe and persistent mental illness who 
        are racial or ethnic minorities often have co-occurring health 
        and mental health conditions and experience direct inequities 
        in access to necessary supports, resources, and services which, 
        without proper accommodations and support, further stigmatize 
        them and limit their participation in society.
            (9) African-American, Latinx, Asian American, Pacific 
        Islander, Native, Middle Eastern and North African (MENA), and 
        other people of color communities are more likely to experience 
        systemic discrimination by health care and social service 
        providers and may be reluctant to seek mental health care and 
        other health interventions.
            (10) Mental health conditions and substance abuse disorders 
        retain considerable stigma in many communities of color and 
        seeking treatment is not always encouraged.
            (11) Addressing mental health stigma and increasing access 
        to culturally and linguistically appropriate treatments and 
        supports in communities will help to increase utilization of 
        mental health services for people who have functional 
        difficulties because of mental health challenges.
            (12) There is a link between a mental health diagnosis and 
        the likelihood of an individual committing suicide.
            (13) A comprehensive public health approach to behavioral 
        health is one that fosters and finances protective factors in 
        racial and ethnic communities that support mental health.
            (14) Approaches to mental health and trauma must keep in 
        mind the historical and present day and cultural trauma that 
        impacts many communities of color, including trauma and loss 
        caused by adverse weather events and structural violence.
            (15) Culturally and linguistically appropriate treatments 
        and supports must keep approaches of individual communities to 
        mental health in mind, including by considering--
                    (A) approaches to cultural healing practices; and
                    (B) the diverse mental health professionals needed 
                for such practices, such as peer support specialists.
            (16) Approaches to mental health and addressing trauma must 
        keep in mind the concept of intersectionality of individuals; 
        that individuals may experience many inequities that shape the 
        way they process and experience everyday life.

SEC. 6002. SENSE OF CONGRESS.

    It is the sense of the Congress that it is imperative that a 
comprehensive public health approach to addressing trauma and mental 
health care be focused on care delivery that is culturally and 
linguistically appropriate.

             Subtitle A--Access to Care and Funding Streams

SEC. 6011. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES, MENTAL 
              HEALTH COUNSELOR SERVICES, SUBSTANCE ABUSE COUNSELOR 
              SERVICES, AND PEER SUPPORT SPECIALIST SERVICES UNDER PART 
              B OF THE MEDICARE PROGRAM.

    (a) Coverage of Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)), as amended by the previous 
        provisions, is amended--
                    (A) in subparagraph (HH), by striking ``and'' at 
                the end;
                    (B) in subparagraph (II), by adding ``and'' after 
                the semicolon at the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(JJ) marriage and family therapist services (as defined 
        in subsection (nnn)(1)), mental health counselor services (as 
        defined in subsection (nnn)(3)), substance abuse counselor 
        services (as defined in subsection (nnn)(5)), and peer support 
        specialist services (as defined in subsection (nnn)(7));''.
            (2) Definitions.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x), as amended by the previous provisions, is 
        amended by adding at the end the following new subsection:

     ``Marriage and Family Therapist Services; Marriage and Family 
 Therapist; Mental Health Counselor Services; Mental Health Counselor; 
  Substance Abuse Counselor Services; Substance Abuse Counselor; Peer 
         Support Specialist Services; Peer Support Specialist.

    ``(nnn)(1) The term `marriage and family therapist services' means 
services performed by a marriage and family therapist (as defined in 
paragraph (2)) for the diagnosis and treatment of mental illnesses, 
which the marriage and family therapist is legally authorized to 
perform under State law (or the State regulatory mechanism provided by 
State law) of the State in which such services are performed, as would 
otherwise be covered if furnished by a physician or as an incident to a 
physician's professional service, but only if no facility or other 
provider charges or is paid any amounts with respect to the furnishing 
of such services.
    ``(2) The term `marriage and family therapist' means an individual 
who--
            ``(A) possesses a master's or doctoral degree that 
        qualifies for licensure or certification as a marriage and 
        family therapist pursuant to State law, including but not 
        limited to, clinical social workers and occupational 
        therapists;
            ``(B) after obtaining such degree has performed at least 2 
        years of clinical supervised experience in marriage and family 
        therapy; and
            ``(C) in the case of an individual performing services in a 
        State that provides for licensure or certification of marriage 
        and family therapists, is licensed or certified as a marriage 
        and family therapist in such State.
    ``(3) The term `mental health counselor services' means services 
performed by a mental health counselor (as defined in paragraph (4)) 
for the diagnosis and treatment of mental health conditions and 
disabilities that the mental health counselor is legally authorized to 
perform under State law (or the State regulatory mechanism provided by 
the State law) of the State in which such services are performed, as 
would otherwise be covered if furnished by a physician or as incident 
to a physician's professional service, but only if no facility or other 
provider charges or is paid any amounts with respect to the furnishing 
of such services.
    ``(4) The term `mental health counselor' means an individual who--
            ``(A) possesses a master's or doctor's degree in mental 
        health counseling or a related field, including clinical social 
        workers and occupational therapists;
            ``(B) after obtaining such a degree has performed at least 
        2 years of supervised mental health counselor practice; and
            ``(C) in the case of an individual performing services in a 
        State that provides for licensure or certification of mental 
        health counselors or professional counselors, is licensed or 
        certified as a mental health counselor or professional 
        counselor in such State.
    ``(5) The term `substance abuse counselor services' means services 
performed by a substance abuse counselor (as defined in paragraph (6)) 
for the diagnosis and treatment of substance abuse and addiction that 
the substance abuse counselor is legally authorized to perform under 
State law (or the State regulatory mechanism provided by the State law) 
of the State in which such services are performed, as would otherwise 
be covered if furnished by a physician or as incident to a physician's 
professional service, but only if no facility or other provider charges 
or is paid any amounts with respect to the furnishing of such services.
    ``(6) The term `substance abuse counselor' means an individual 
who--
            ``(A) has performed at least 2 years of supervised 
        substance abuse counselor practice;
            ``(B) in the case of an individual performing services in a 
        State that provides for licensure or certification of substance 
        abuse counselors or professional counselors, is licensed or 
        certified as a substance abuse counselor or professional 
        counselor in such State; or
            ``(C) is a drug and alcohol counselor as defined in section 
        40.281 of title 49, Code of Federal Regulations.
    ``(7) The term `peer support specialist services' means services 
performed by a peer support specialist (as defined in paragraph (8)) 
for the well-being of individuals needing mental health support that 
the peer support specialist is legally authorized to perform under 
State law (or the State regulatory mechanism provided by the State law) 
of the State in which such services are performed, as would otherwise 
be covered if furnished by a physician or as incident to a physician's 
professional service, but only if no facility or other provider charges 
or is paid any amounts with respect to the furnishing of such services.
    ``(8) The term `peer support specialist' means an individual who--
            ``(A) is an individual living in recovery with mental 
        illness, addiction, or systems involvement;
            ``(B) has skills learned in formal training;
            ``(C) uses assets-based framing in speaking about mental 
        health, recovery, and well-being; and
            ``(D) delivers services in behavioral health settings to 
        promote mind-body recovery and resiliency.''.
            (3) Provision for payment under part b.--Section 
        1832(a)(2)(B) of the Social Security Act (42 U.S.C. 
        1395k(a)(2)(B)) is amended--
                    (A) by striking ``and'' at the end of clause (iv); 
                and
                    (B) by adding at the end the following new clause:
                            ``(v) marriage and family therapist 
                        services, mental health counselor services, 
                        substance abuse counselor services, and peer 
                        support specialist services; and''.
            (4) Amount of payment.--Section 1833(a)(1) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 
        431(c)(3), is amended--
                    (A) by striking ``and'' before ``(DD)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (EE) with respect to marriage 
                and family therapist services, mental health counselor 
                services, substance abuse counselor services, and peer 
                support specialist services under section 
                1861(s)(2)(JJ), the amounts paid shall be 80 percent of 
                the lesser of the actual charge for the services or 75 
                percent of the amount determined for payment of a 
                psychologist under subparagraph (L)''.
            (5) Exclusion of marriage and family therapist services, 
        mental health counselor services, and peer support specialist 
        services from skilled nursing facility prospective payment 
        system.--Section 1888(e)(2)(A)(ii) of the Social Security Act 
        (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 
        ``marriage and family therapist services (as defined in section 
        1861(nnn)(1)), mental health counselor services (as defined in 
        section 1861(nnn)(3)), and peer support specialist services (as 
        defined in section 1861(nnn)(7))'' after ``qualified 
        psychologist services,''.
            (6) Inclusion of marriage and family therapists, mental 
        health counselors, and substance abuse counselors as 
        practitioners for assignment of claims.--Section 1842(b)(18)(C) 
        of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is 
        amended by adding at the end the following new clauses:
            ``(vii) A marriage and family therapist (as defined in 
        section 1861(nnn)(2)).
            ``(viii) A mental health counselor (as defined in section 
        1861(nnn)(4)).
            ``(ix) A substance abuse counselor (as defined in section 
        1861(nnn)(6)).
            ``(x) A peer support specialist (as defined in section 
        1861(nnn)(8)).''.
    (b) Coverage of Certain Mental Health Services Provided in Certain 
Settings.--
            (1) Rural health clinics and federally qualified health 
        centers.--Section 1861(aa)(1)(B) of the Social Security Act (42 
        U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a 
        clinical social worker (as defined in subsection (hh)(1)),'' 
        and inserting ``, by a clinical social worker (as defined in 
        subsection (hh)(1)), by a marriage and family therapist (as 
        defined in subsection (nnn)(2)), or by a mental health 
        counselor (as defined in subsection (nnn)(4)), or by a 
        substance abuse counselor (as defined in section 1861 
        (nnn)(6)), or by a peer support specialist (as defined in 
        section 1861(nnn)(8)).''.
            (2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of 
        the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is 
        amended by inserting ``or one marriage and family therapist (as 
        defined in subsection (nnn)(2))'' after ``social worker''.
    (c) Authorization of Marriage and Family Therapists To Develop 
Discharge Plans for Posthospital Services.--Section 1861(ee)(2)(G) of 
the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by 
inserting ``marriage and family therapist (as defined in subsection 
(nnn)(2)),'' after ``social worker,''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to services furnished on or after January 1, 2023.

SEC. 6012. REAUTHORIZATION OF MINORITY FELLOWSHIP PROGRAM.

    Section 597(c) of the Public Health Service Act (42 U.S.C. 
297ll(c)) is amended by striking ``$12,669,000 for each of fiscal years 
2018 through 2022'' and inserting ``$25,000,000 for each of fiscal 
years 2023 through 2027''.

SEC. 6013. ADDITIONAL FUNDS FOR NATIONAL INSTITUTES OF HEALTH.

    (a) In General.--In addition to amounts otherwise authorized to be 
appropriated to the National Institutes of Health, there is authorized 
to be appropriated to such Institutes $100,000,000 for each of fiscal 
years 2023 through 2027 to build relations with communities and conduct 
or support clinical research, including clinical research on racial or 
ethnic disparities in physical and mental health.
    (b) Definition.--In this section, the term ``clinical research'' 
has the meaning given to such term in section 409 of the Public Health 
Service Act (42 U.S.C. 284d).

SEC. 6014. ADDITIONAL FUNDS FOR NATIONAL INSTITUTE ON MINORITY HEALTH 
              AND HEALTH DISPARITIES.

    In addition to amounts otherwise authorized to be appropriated to 
the National Institute on Minority Health and Health Disparities, there 
is authorized to be appropriated to such Institute $650,000,000 for 
each of fiscal years 2023 through 2027.

SEC. 6015. GRANTS FOR INCREASING RACIAL AND ETHNIC MINORITY ACCESS TO 
              HIGH-QUALITY TRAUMA SUPPORT SERVICES AND MENTAL HEALTH 
              CARE.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Assistant Secretary for Mental Health and Substance Use, shall award 
grants to eligible entities to establish or expand programs for the 
purpose of increasing racial and ethnic minority access to high-quality 
trauma support services and mental health care.
    (b) Eligible Entities.--To seek a grant under this section, an 
entity shall be a community-based program or organization that--
            (1) provides culturally and linguistically appropriate 
        programs and resources that are aligned with evidence-based 
        practices for trauma-informed care; and
            (2) has demonstrated expertise in serving communities of 
        color or can partner with a program that has such demonstrated 
        expertise.
    (c) Use of Funds.--As a condition on receipt of a grant under this 
section, a grantee shall agree to use the grant to increase racial and 
ethnic minority access to high-quality trauma support services and 
mental health care, such as by--
            (1) establishing and maintaining community-based programs 
        providing evidence-based services in trauma-informed care and 
        culturally specific services and other resources;
            (2) developing innovative, culturally specific strategies 
        and projects to enhance access to trauma-informed care and 
        resources for racial and ethnic minorities who face obstacles 
        to using more traditional services and resources (such as 
        obstacles in geographic access to providers, insurance 
        coverage, and access to audio and video technologies);
            (3) working with State and local governments and social 
        service agencies to develop and enhance effective strategies to 
        provide culturally specific services to racial and ethnic 
        minorities;
            (4) increasing communities' capacity to provide culturally 
        specific resources and support for communities of color;
            (5) working in cooperation with the community to develop 
        education and prevention strategies highlighting culturally 
        specific issues and resources regarding racial and ethnic 
        minorities;
            (6) providing culturally specific programs for racial and 
        ethnic minorities exposed to law enforcement violence; and
            (7) examining the dynamics of culture and its impact on 
        victimization and healing.
    (d) Priority.--In awarding grants under this section, the Secretary 
shall give priority to eligible entities proposing to serve communities 
that have faced high rates of community trauma, including from exposure 
to law enforcement violence, intergenerational poverty, civil unrest, 
discrimination, or oppression.
    (e) Grant Period.--The period of a grant under this section shall 
be 4 years.
    (f) Evaluation.--Not later than 6 months after the end of the 
period of all grants under this section, the Secretary shall--
            (1) conduct an evaluation of the programs funded by a grant 
        under this section;
            (2) include in such evaluation an assessment of the 
        outcomes of each such program; and
            (3) submit a report on the results of such evaluation to 
        the Congress.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $20,000,000 for each of fiscal 
years 2023 through 2027.

SEC. 6016. GRANTS FOR UNARMED 9-1-1 RESPONSE PROGRAMS.

    Part D of title V of the Public Health Service Act, as amended by 
sections 6022, 6023, and 6052, is further amended adding at the end the 
following new section:

``SEC. 556. GRANTS FOR UNARMED 9-1-1 RESPONSE PROGRAMS.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, may award grants to 
States, territories, political subdivisions of States and territories, 
Tribal governments, and consortia of Tribal governments to establish an 
unarmed 9-1-1 response program under which nonviolent 9-1-1 calls are 
referred to unarmed professional service providers for response, 
instead of to a law enforcement agency.
    ``(b) Program Requirements.--An unarmed 9-1-1 response program 
funded under this section shall--
            ``(1) dispatch unarmed professional service providers in 
        groups of two or more in a timely manner;
            ``(2) be capable of providing screening, assessment, de-
        escalation, trauma-informed culturally and linguistically 
        appropriate services, referrals to treatment providers, and 
        transportation to immediately necessary treatment;
            ``(3) when necessary, coordinate with health or social 
        services;
            ``(4) not be subject to oversight of State or local law 
        enforcement agencies; and
            ``(5) clearly outline the scope of calls that must or may 
        be referred to the unarmed 9-1-1 response program.
    ``(c) Uses of Funds.--A grant under this section may be used for--
            ``(1) hiring unarmed professional service providers and 9-
        1-1 dispatchers;
            ``(2) training unarmed professional service providers to 
        respond to 9-1-1 calls by identifying, understanding, and 
        responding to signs of mental illnesses, developmental or 
        intellectual disabilities, and substance use disorders, 
        including by means of--
                    ``(A) de-escalation;
                    ``(B) crisis intervention; and
                    ``(C) connecting individuals to local social 
                service providers, health care providers, community-
                based organizations, and the full range of other 
                available providers and resources, with a focus on 
                culturally and linguistically appropriate service 
                providers;
            ``(3) updating 9-1-1 response systems to enable triage 
        between nonviolent 9-1-1 calls and those that require a 
        response from law enforcement;
            ``(4) training 9-1-1 dispatchers on call diversion;
            ``(5) building the capacity--
                    ``(A) to coordinate with local social service 
                providers, health care providers, suicide hotline 
                operators, and community-based organizations; and
                    ``(B) to provide multilingual and culturally and 
                linguistically appropriate services; and
            ``(6) collecting data for reports to the Secretary.
    ``(d) Application.--An applicant seeking a grant under this section 
shall submit to the Secretary an application at such time, in such 
manner, and containing such information as the Secretary may reasonably 
require, including the applicant's plan to train 9-1-1 dispatchers to 
determine when a call should be diverted to the unarmed 9-1-1 response 
program.
    ``(e) Reports to Secretary.--A recipient of a grant under this 
section shall submit to the Secretary, on a biannual basis, a report on 
the following:
            ``(1) The number of calls placed to 9-1-1 that were 
        diverted to the grantee's unarmed 9-1-1 response program.
            ``(2) Demographic information on the individuals served by 
        the grantee's unarmed 9-1-1 response program, disaggregated by 
        race, ethnicity, age, sex, sexual orientation, gender identity, 
        and location.
            ``(3) The effects of the grantee's unarmed 9-1-1 response 
        program on emergency room visits, hospitalizations, use of 
        ambulances, and involvement of law enforcement in mental health 
        or substance use disorder crises.
            ``(4) An assessment of the types of events and crises to 
        which the grantee's unarmed 9-1-1 response program responded 
        and the services provided, including--
                    ``(A) the number of individuals to whom services 
                were provided who were involuntarily committed for 
                treatment;
                    ``(B) the number of individuals successfully 
                transferred to an alternative destination;
                    ``(C) the time between notification by a 9-1-1 
                dispatcher and arrival at the scene by a provider; and
                    ``(D) the time spent by providers at scene.
            ``(5) A cost analysis of the grantee's unarmed 9-1-1 
        response program.
            ``(6) An assessment of data sharing limitations or problems 
        associated with adherence to--
                    ``(A) Federal regulations (concerning the privacy 
                of individually identifiable health information) 
                promulgated under section 264(c) of the Health 
                Insurance Portability and Accountability Act of 1996; 
                and
                    ``(B) part II of title 42, Code of Federal 
                Regulations.
    ``(f) Reports to Congress.--The Secretary shall submit to the 
Congress, on a biannual basis, a report on the program under this 
section, including a summary of the reports submitted by grantees 
pursuant to subsection (e).
    ``(g) Grant Amount.--The Secretary may make grants to applicants 
that do not meet all of the criteria under subsection (b)(1), but 
applicants that do not meet all such criteria may not receive the full 
grant amount.
    ``(h) Definitions.--In this section:
            ``(1) The term `alternative destination'--
                    ``(A) means any service- or care-providing site 
                other than a hospital emergency department or jail; and
                    ``(B) includes a clinic, primary care office, 
                crisis center, and community care center.
            ``(2) The term `nonviolent 9-1-1 call' means a 9-1-1 call 
        that--
                    ``(A) relates to mental health, homelessness, 
                addiction problems, social services, truancy, 
                intellectual and developmental disabilities, or public 
                intoxication; and
                    ``(B) does not involve obvious violent behavior.
            ``(3) The term `unarmed professional service provider' 
        means a professional (which may include a nurse, social worker, 
        emergency medical technician, counselor, community health 
        worker, trauma-informed personnel, social service provider, or 
        peer support specialist) who--
                    ``(A) is trained to deal with mental health or 
                substance abuse crises or intellectual and 
                developmental disabilities; and
                    ``(B) does not carry a firearm.''.

                   Subtitle B--Interprofessional Care

SEC. 6021. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC 
              MENTAL HEALTH INEQUITIES.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Assistant Secretary for Mental Health and Substance Use, 
shall award grants to qualified national organizations for the purposes 
of--
            (1) developing, and disseminating to health professional 
        educational programs culturally and linguistically appropriate 
        curricula or core competencies addressing mental health 
        inequities among racial and ethnic minority groups for use in 
        the training of students in the professions of social work, 
        psychology, psychiatry, marriage and family therapy, mental 
        health counseling, peer support, and substance abuse 
        counseling; and
            (2) certifying community health workers and peer wellness 
        specialists with respect to such curricula and core 
        competencies and integrating and expanding the use of such 
        workers and specialists into health care and community-based 
        settings to address mental health inequities among racial and 
        ethnic minority groups.
    (b) Curricula; Core Competencies.--Organizations receiving funds 
under subsection (a) may use the funds to engage in the following 
activities related to the development and dissemination of curricula or 
core competencies described in subsection (a)(1):
            (1) Formation of committees or working groups comprised of 
        experts from accredited health professions schools to identify 
        core competencies relating to mental health inequities among 
        racial and ethnic minority groups.
            (2) Planning of workshops in collaboration with community-
        based organizations and communities of color in national fora 
        to directly facilitate public input, including input from 
        communities of color with lived experience, into the 
        educational needs associated with mental health inequities 
        among racial and ethnic minority groups.
            (3) Dissemination and promotion of the use of curricula or 
        core competencies in undergraduate and graduate health 
        professions training programs nationwide.
            (4) Establishing external stakeholder advisory boards to 
        provide meaningful input into policy and program development 
        and best practices to reduce mental health inequities among 
        racial and ethnic groups, including participation and 
        leadership from communities of color with lived experience of 
        the impacts of mental health inequities.
    (c) Definitions.--In this section:
            (1) Qualified national organization.--The term ``qualified 
        national organization'' means a national organization that 
        focuses on the education of students in programs of social 
        work, occupational therapy, psychology, psychiatry, substance 
        use counseling, and marriage and family therapy.
            (2) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given to such term 
        in section 1707(g) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)), as amended by title I of this Act.
    (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 2023 through 2027.

SEC. 6022. INTERPROFESSIONAL HEALTH CARE TEAMS FOR BEHAVIORAL HEALTH 
              CARE.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd 
et seq.) is amended by adding at the end the following:

``SEC. 553. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF 
              BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.

    ``(a) Grants.--The Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, shall award grants to 
eligible entities for the purpose of establishing interprofessional 
health care teams that provide behavioral health care.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be a Federally qualified health center 
(as defined in section 1861(aa) of the Social Security Act), rural 
health clinic, women's health clinic, or behavioral health program 
(including any such program operated by a community-based organization) 
serving a high proportion of individuals from racial and ethnic 
minority groups (as defined in section 1707(g)).
    ``(c) Loan Forgiveness.--To encourage qualified and diverse allied 
health professionals to enter the mental health field, an eligible 
entity receiving a grant under this section shall agree to use not less 
than $10,000 of the grant funds on a loan forgiveness program for 
practitioners who commit to working in the mental health field for a 
period of 2 years.
    ``(d) Scientifically and Culturally Based.--Integrated health care 
funded through this section shall be scientifically and culturally 
based, taking into consideration the results of the most recent peer-
reviewed research available, including information on language 
accessibility, cultural humility, diversity of practitioners, and 
consideration of social determinants of health.
    ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $20,000,000 for each of fiscal 
years 2023 through 2027.''.

SEC. 6023. INTEGRATED HEALTH CARE DEMONSTRATION PROGRAM.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd 
et seq.), as amended by sections 6022 and 6052, is further amended by 
adding at the end the following:

``SEC. 555. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF 
              BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.

    ``(a) Grants.--The Secretary shall award grants to eligible 
entities for the purpose of establishing interprofessional health care 
teams that provide behavioral health care.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be a Federally qualified health center 
(as defined in section 1861(aa) of the Social Security Act), rural 
health clinic, or behavioral health program, serving a high proportion 
of individuals from racial and ethnic minority groups (as defined in 
section 1707(g)).
    ``(c) Scientifically Based.--Integrated health care funded through 
this section shall be scientifically based, taking into consideration 
the results of the most recent peer-reviewed research available.
    ``(d) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $20,000,000 for each of the 
first 5 fiscal years following the date of enactment of the Pursuing 
Equity in Mental Health Act.''.

                   Subtitle C--Workforce Development

SEC. 6031. BUILDING AN EFFECTIVE WORKFORCE IN MENTAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services, in 
coordination with the Assistant Secretary for Mental Health and 
Substance Use, the Administrator of the Health Resources and Services 
Administration, the Secretary of Labor, and advocacy and behavioral and 
mental health organizations serving vulnerable populations, including 
youth and young adults, people with low incomes, and people of color, 
shall--
            (1) develop, strengthen, and implement strategies to 
        bolster career pathways for diverse mental health 
        professionals;
            (2) identify the breadth of settings where mental health 
        care and behavioral health care can take place; and
            (3) identify current mental health professional workforce 
        shortages, inclusive of shortages of diverse mental health 
        professionals.
    (b) Contents.--Strategies under subsection (a) shall include--
            (1) the variety of settings where mental health 
        professionals are needed, including community-based 
        organizations, women's centers, shelters, organizations focused 
        on youth development, workforce agencies, job placement and 
        development centers, emergency rooms, the special supplemental 
        nutrition program for women, infants, and children under 
        section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786), 
        food banks, legal aid, and benefit issuers as defined in 
        section 3 of the Food and Nutrition Act of 2008 (7 U.S.C. 
        2012);
            (2) defining career pathways in mental and behavioral 
        health, to help diverse communities understand the variety of 
        careers in mental and behavioral health that are available;
            (3) building career pathways in mental and behavioral 
        health as part of the curriculum at the postsecondary education 
        level;
            (4) providing accessible training and certification 
        pathways for diverse lay health workers such as community 
        health workers and other peer support specialists to ensure 
        that careers pay a living wage;
            (5) creating incentives for students in the fields of 
        occupational therapy, social work, psychology, medicine, and 
        nursing to learn more about mental health, and to include a 
        mental health rotation, with a particular focus in racially and 
        ethnically diverse communities, as a part of the health 
        professional curricula;
            (6) including training and education for teachers about the 
        basics of section 504 of the Rehabilitation Act of 1973 (29 
        U.S.C. 794) and individualized education programs (as defined 
        in section 614(d) of the Individuals with Disabilities 
        Education Act (20 U.S.C. 1414(d)));
            (7) researching, developing, and implementing programs for 
        mental and behavioral health professionals to prevent burnout; 
        and
            (8) finding better and increased avenues to ensure equity 
        by providing better loan forgiveness programs, including a 
        focus area within the National Health Service Corps focused on 
        community trauma.
    (c) Use of Funds.--Programs and activities funded under this 
section shall be consistent with section (a)(1) and must include the 
following:
            (1) Subgrants to entities serving youth and young adults 
        which demonstrate a need for an increased mental health 
        workforce, using strategies mentioned in subsection (a)(1).
            (2) Funding towards the Health Resources and Services 
        Administration's Behavioral Health Workforce Education and 
        Training Program.
            (3) Funding towards the development and implementation of a 
        National Health Service Corps program focused on community 
        trauma.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,000 for each of fiscal 
years 2023 through 2033.

SEC. 6032. PILOT PROGRAM TO INCREASE LANGUAGE ACCESS AT FEDERALLY 
              QUALIFIED HEALTH CENTERS.

    (a) Loan Repayments to Qualified Health Care Professionals.--
            (1) In general.--For the purpose of increasing language 
        access to mental health services, the Secretary shall carry out 
        a demonstration project under which--
                    (A) the Secretary matches qualified mental health 
                professionals with Federally qualified health centers;
                    (B) the qualified mental health professionals each 
                agree to a period of obligated service at a Federally 
                qualified health center with which they are so matched; 
                and
                    (C) the Secretary agrees to make loan repayments 
                under section 338B of the Public Health Service Act (42 
                U.S.C. 254l-1) on behalf of such qualified mental 
                health professionals.
            (2) Preference.--In matching qualified mental health 
        professionals with Federally qualified health centers under 
        paragraph (1), the Secretary shall give preference to placement 
        at Federally qualified health centers at which at least 20 
        percent of the patients are best served in a language other 
        than English, as indicated by data in the Uniform Data System 
        (or any successor database).
            (3) Enhanced compensation.--For each year of obligated 
        service that a qualified mental health professional contracts 
        to serve under paragraph (1) at a Federally qualified health 
        center at which at least 20 percent of the patients are best 
        served in a language other than English, as indicated by data 
        in the Uniform Data System (or any successor database), the 
        Secretary may pay the higher of--
                    (A) $10,000 above the maximum amount otherwise 
                applicable under section 338B(g)(2)(A) of the Public 
                Health Service Act (42 U.S.C. 254l-1(g)(2)(A)); or
                    (B) if the qualified health professional is fluent 
                in a language other than English that is needed by such 
                Federally qualified health center, $15,000 above such 
                maximum amount.
            (4) Achieving fluency.--A qualified mental health 
        professional eligible to receive the enhanced pay amount 
        specified in paragraph (3)(A) at the beginning of the 
        professional's period of obligated service may transition to 
        being eligible to receive the enhanced higher pay amount 
        specified in paragraph (3)(B) if the professional is determined 
        by the Federally qualified health center at which the 
        professional serves to have achieved fluency in a language 
        other than English needed by that health center.
    (b) Grants to Health Centers.--
            (1) In general.--The Secretary shall carry out a 
        demonstration program consisting of awarding grants under 
        section 330 of the Public Health Service Act (42 U.S.C. 254b) 
        to Federally qualified health centers to recruit, hire, employ, 
        and supervise qualified mental health professionals who are 
        fluent in a language other than English to provide mental 
        health services in such other language.
            (2) Preference.--In selecting grant recipients under 
        paragraph (1), the Secretary shall give preference to Federally 
        qualified health centers at which at least 20 percent of the 
        patients are best served in a language other than English, as 
        indicated by data in the Uniform Data System (or any successor 
        database).
            (3) Marketing.--A Federally qualified health center 
        receiving a grant under this subsection shall use a portion of 
        the grant funds to disseminate information about, and otherwise 
        market, the mental health services supported through the grant.
    (c) Reports.--
            (1) Initial report.--Not later than 6 months after awarding 
        loan repayment agreements under subsection (a) and grants under 
        subsection (b), the Secretary shall submit to the Committees on 
        Appropriations of the House of Representatives and the Senate, 
        and to other appropriate congressional committees, a report on 
        the implementation of the programs under this section. Such 
        report shall include--
                    (A) the languages spoken by the qualified mental 
                health professionals receiving loan repayments pursuant 
                to subsection (a) or recruited pursuant to a grant 
                under subsection (b);
                    (B) the Federally qualified health centers at which 
                such professionals were placed;
                    (C) how many Federally qualified health centers 
                received funding through the grant program under 
                subsection (b);
                    (D) an analysis, conducted in consultation with the 
                Federally qualified health centers receiving grants 
                under section (b), of the effectiveness of such grants 
                at increasing language access to mental health 
                services; and
                    (E) best practices, developed in consultation with 
                Federally qualified health centers receiving grants 
                under section (b), for the recruitment and retention of 
                mental health professionals at Federally qualified 
                health centers.
            (2) Final report.--Not later than the end of fiscal year 
        2027, the Secretary shall submit to the Committees on 
        Appropriations of the House of Representatives and the Senate, 
        and to other appropriate congressional committees, a final 
        report on the implementation of the programs under this 
        section, including the information, analysis, and best 
        practices listed in subparagraphs (A) through (E) of paragraph 
        (1).
    (d) Definitions.--In this section:
            (1) The term ``Federally qualified health center'' has the 
        meaning given the term in section 1861(aa) of the Social 
        Security Act (42 U.S.C. 1395x(aa)).
            (2) The term ``qualified mental health professional'' 
        means--
                    (A) physicians, allopathic physicians, osteopathic 
                physicians, nurse practitioners, and physician 
                assistants with a specialty in mental health and 
                psychiatry;
                    (B) health service psychologists;
                    (C) licensed clinical social workers;
                    (D) psychiatric nurse specialists;
                    (E) marriage and family therapists;
                    (F) licensed professional counselors;
                    (G) substance use disorder counselors;
                    (H) occupational therapists; and
                    (I) other individuals who--
                            (i) have not yet been licensed or certified 
                        to serve as a professional listed in any of 
                        subparagraphs (A) through (H); and
                            (ii) will serve at the Federally qualified 
                        health center under the supervision of a 
                        licensed individual or certified professional 
                        so listed.
            (3) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
    (e) Authorization of Appropriations.--
            (1) In general.--To carry out this section, there is 
        authorized to be appropriated $75,000,000 for each of fiscal 
        years 2023 through 2027.
            (2) Supplement, not supplant.--Amounts made available to 
        carry out this section shall be in addition to amounts 
        otherwise available to provide mental health services at 
        Federally qualified health centers pursuant to sections 338B 
        and 330 of the Public Health Service Act (42 U.S.C. 254l-1, 
        254b).

SEC. 6033. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC 
              MINORITY MENTAL HEALTH DISPARITIES.

    (a) In General.--The Secretary of Health and Human Services may 
award grants to qualified national organizations for the purposes of--
            (1) developing, and disseminating to health professional 
        educational programs, best practices or core competencies 
        addressing mental health disparities among racial and ethnic 
        minority groups for use in the training of students in the 
        professions of social work, psychology, psychiatry, marriage 
        and family therapy, mental health counseling, and substance 
        abuse counseling; and
            (2) certifying community health workers and peer wellness 
        specialists with respect to such best practices and core 
        competencies and integrating and expanding the use of such 
        workers and specialists into health care to address mental 
        health disparities among racial and ethnic minority groups.
    (b) Best Practices; Core Competencies.--Organizations receiving 
funds under subsection (a) may use the funds to engage in the following 
activities related to the development and dissemination of best 
practices or core competencies described in subsection (a)(1):
            (1) Formation of committees or working groups comprised of 
        experts from accredited health professions schools to identify 
        best practices and core competencies relating to mental health 
        disparities among racial and ethnic minority groups.
            (2) Planning of workshops at the national level to allow 
        for public input into the educational needs associated with 
        mental health disparities among racial and ethnic minority 
        groups.
            (3) Dissemination and promotion of the use of best 
        practices or core competencies for culturally and 
        linguistically appropriate mental health services in 
        undergraduate and graduate health professions training programs 
        nationwide.
            (4) Establishing external stakeholder advisory boards to 
        provide meaningful input into policy and program development 
        and best practices to reduce mental health disparities among 
        racial and ethnic minority groups.
    (c) Definitions.--In this section:
            (1) Qualified national organization.--The term ``qualified 
        national organization'' means a national organization that 
        focuses on the education of students in one or more of the 
        professions of social work, psychology, psychiatry, marriage 
        and family therapy, mental health counseling, and substance 
        misuse counseling.
            (2) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given to such term 
        in section 1707(g) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)).

                  Subtitle D--Children's Mental Health

SEC. 6041. PEDIATRIC BEHAVIORAL HEALTH CARE.

    Subpart V of part D of title III of the Public Health Service Act 
(42 U.S.C. 256 et seq.) is amended by adding at the end the following:

``SEC. 340A-1. GRANTS TO SUPPORT PEDIATRIC BEHAVIORAL HEALTH CARE 
              INTEGRATION AND COORDINATION.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to eligible entities for the purpose of supporting pediatric behavioral 
health care integration and coordination within communities to meet 
local community needs.
    ``(b) Eligible Entities.--Entities eligible for grants under 
subsection (a) include--
            ``(1) pediatricians;
            ``(2) children's hospitals;
            ``(3) pediatric behavioral health providers with the 
        capacity to organize and implement activities working with 
        community organizations and providers; and
            ``(4) other entities as determined appropriate by the 
        Secretary.
    ``(c) Prioritization.--In awarding grants under subsection (a), the 
Secretary shall prioritize applicants that demonstrate the highest 
needs at the local level along the care continuum for strengthening 
children's behavioral health crisis care and access.
    ``(d) Use of Funds.--Activities that may be funded through a grant 
under subsection (a) include--
            ``(1) the recruitment and retention of community health 
        workers or navigators to coordinate family access to pediatric 
        mental, emotional, and behavioral health services;
            ``(2) training the pediatric mental, emotional, and 
        behavioral health care workforce, relevant stakeholders, and 
        community members;
            ``(3) expanding evidence-based, integrated models of care 
        for pediatric mental, emotional, and behavioral health 
        services;
            ``(4) pediatric practice integration for the provision of 
        pediatric mental, emotional, and behavioral health services;
            ``(5) addressing surge capacity for pediatric mental, 
        emotional, and behavioral health needs;
            ``(6) providing pediatric mental, emotional, and behavioral 
        health services to children as delivered by behavioral, 
        emotional, and mental health professionals utilizing telehealth 
        services;
            ``(7) establishing or maintaining initiatives to decompress 
        emergency departments, including partial hospitalization, step 
        down residency programs, and intensive outpatient programs;
            ``(8) supporting, enhancing, or expanding pediatric mental, 
        emotional, and behavioral health preventive and crisis 
        intervention services;
            ``(9) establishing or maintaining pediatric mental, 
        emotional, and behavioral health urgent care;
            ``(10) establishing or maintaining community-based 
        initiatives, such as school-based partnerships; and
            ``(11) addressing other access and coordination gaps to 
        mental, emotional, and behavioral health services in the 
        community for children.
    ``(e) Funding.--To carry out this section, there is hereby 
appropriated, out of amounts in the Treasury not otherwise obligated, 
$500,000,000 for each of fiscal years 2023 through 2027.

``SEC. 340A-2. PEDIATRIC BEHAVIORAL HEALTH WORKFORCE TRAINING PROGRAM.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to eligible entities for the purpose of supporting evidence-based 
pediatric behavioral health workforce training.
    ``(b) Eligible Entities.--Entities eligible for grants under 
subsection (a) include--
            ``(1) children's hospitals; and
            ``(2) other pediatric health care providers as determined 
        appropriate by the Secretary.
    ``(c) Use of Funds.--The training that may be supported through a 
grant under subsection (a) includes expanded training in pediatric 
behavioral health for physicians and nonphysician practitioners, 
including the following practitioner types:
            ``(1) Child and adolescent psychiatrists.
            ``(2) Psychiatric nurses.
            ``(3) Psychologists.
            ``(4) Advanced practice nurses.
            ``(5) Family therapists.
            ``(6) Social workers.
            ``(7) Mental health counselors.
            ``(8) Other practitioner types as determined appropriate by 
        the Secretary.
    ``(d) Funding.--To carry out this section, there is hereby 
appropriated, out of amounts in the Treasury not otherwise obligated, 
$100,000,000 for each of fiscal years 2023 through 2027.''.

SEC. 6042. MENTAL HEALTH IN SCHOOLS.

    (a) Purpose.-- It is the purpose of this section to--
            (1) revise, increase funding for, and expand the scope of 
        the Project AWARE State Educational Agency Grant Program 
        carried out by the Secretary of Health and Human Services, in 
        order to provide access to more comprehensive school-based 
        mental health services and supports;
            (2) provide for comprehensive staff development for school 
        and community service personnel working in the school;
            (3) provide for comprehensive training to improve health 
        and academic outcomes for children with, or who have a high 
        likelihood of developing, mental health conditions, for parents 
        or guardians, siblings, and other family members of such 
        children, and for concerned members of the community;
            (4) provide for comprehensive, universal, evidence-based 
        screening to identify children and adolescents with potential 
        mental health conditions or unmet emotional health needs;
            (5) recognize best practices for the delivery of mental 
        health care in school-based settings, including school-based 
        health centers;
            (6) provide for comprehensive training for parents or 
        guardians, siblings, other family members, and concerned 
        members of the community on behalf of children and adolescents 
        experiencing mental health trauma, disorders, cooccurring 
        conditions, or disabilities; and
            (7) establish formal working relationships among health, 
        human service, and educational entities that support the mental 
        and emotional health of children and adolescents in the school 
        setting or that have a child or youth focus.
    (b) Technical Amendments.--The second part G (relating to services 
provided through religious organizations) of title V of the Public 
Health Service Act (42 U.S.C. 290kk et seq.) is amended--
            (1) by redesignating such part as part J; and
            (2) by redesignating sections 581 through 584 as sections 
        596 through 596C, respectively.
    (c) School-Based Mental Health and Children and Violence.--Section 
581 of the Public Health Service Act (42 U.S.C. 290hh) (relating to 
children and violence) is amended to read as follows:

``SEC. 581. SCHOOL-BASED MENTAL HEALTH; CHILDREN AND ADOLESCENTS.

    ``(a) In General.--The Secretary, in consultation with the 
Secretary of Education, shall, through grants, contracts, or 
cooperative agreements awarded to eligible entities described in 
subsection (b), provide comprehensive school-based mental health 
services and supports to assist children in local communities and 
schools (including schools funded by the Bureau of Indian Education) 
dealing with traumatic experiences, grief, bereavement, risk of 
suicide, and the risk of experiencing community or interpersonal 
violence, such as abuse or neglect. All services and supports provided 
under such a grant, contract, or cooperative agreement shall be--
            ``(1) developmentally, linguistically, and culturally 
        appropriate;
            ``(2) trauma-informed; and
            ``(3) incorporate positive behavioral interventions and 
        supports.
    ``(b) Activities.--Grants, contracts, or cooperative agreements 
awarded under subsection (a), shall, as appropriate, be used for--
            ``(1) implementation of school and community-based mental 
        health programs that--
                    ``(A) build awareness of individual trauma and the 
                intergenerational continuum of impacts of trauma on 
                populations;
                    ``(B) train appropriate staff to identify, and 
                screen for, signs of trauma exposure, mental health and 
                cooccurring conditions, or risk of suicide; and
                    ``(C) incorporate positive behavioral 
                interventions, family engagement, student treatment, 
                and multigenerational supports to foster the health and 
                development of children, prevent mental health 
                disorders, and ameliorate the impact of trauma;
            ``(2) technical assistance to local communities with 
        respect to the development of programs described in paragraph 
        (1);
            ``(3) facilitating diverse community partnerships among 
        families, students, education agencies, mental health and 
        substance use disorder service systems, family-based mental 
        health service systems, child welfare agencies, health care 
        providers (including primary care physicians, mental health 
        professionals, and other professionals who specialize in 
        children's mental health such as child and adolescent 
        psychiatrists), institutions of higher education, faith-based 
        programs, trauma networks, and other community-based systems to 
        address child and adolescent trauma, as well as unmet mental 
        health needs; and
            ``(4) establishing and promoting best practices that are 
        either evidence-based or culturally based for children and 
        adolescents to share their experiences of individual and 
        community trauma, including their exposure to community and 
        domestic violence, with trusted adults.
    ``(c) Requirements.--
            ``(1) In general.--To be eligible for a grant, contract, or 
        cooperative agreement under subsection (a), an entity shall be 
        a partnership that includes--
                    ``(A) a State educational agency, as defined in 
                section 8101 of the Elementary and Secondary Education 
                Act of 1965, in coordination with one or more local 
                educational agencies, as defined in section 8101 of the 
                Elementary and Secondary Education Act of 1965, or a 
                consortium of any entities described in subparagraph 
                (B), (C), (D), or (E) of section 8101(30) of such Act; 
                and
                    ``(B) at least 1 community-based mental health 
                provider, including a public or private mental health 
                entity, health care entity, family-based mental health 
                entity, trauma network, or other community-based 
                entity, as determined by the Secretary (and which may 
                include additional entities such as a human services 
                agency, child welfare agency, an institution of higher 
                education, or another entity, as determined by the 
                Secretary).
            ``(2) Compliance with hipaa.--Any patient records developed 
        by covered entities through activities under the grant shall 
        meet the regulations promulgated under section 264(c) of the 
        Health Insurance Portability and Accountability Act of 1996.
            ``(3) Compliance with ferpa.--Section 444 of the General 
        Education Provisions Act (commonly known as the `Family 
        Educational Rights and Privacy Act of 1974') shall apply to any 
        entity that is a member of the partnership in the same manner 
        that such section applies to an educational agency or 
        institution (as that term is defined in such section).
    ``(d) Geographical Distribution.--The Secretary shall ensure that 
grants, contracts, or cooperative agreements under subsection (a) will 
be distributed equitably among the regions of the country and among 
urban and rural areas.
    ``(e) Duration of Awards.--With respect to a grant, contract, or 
cooperative agreement under subsection (a), the period during which 
payments under such an award will be made to the recipient shall be 5 
years, with options for renewal.
    ``(f) Evaluation and Measures of Outcomes.--
            ``(1) Development of process.--The Assistant Secretary 
        shall develop a fiscally appropriate process for evaluating 
        activities carried out under this section. Such process shall 
        include--
                    ``(A) the development of guidelines for the 
                submission of program data by grant, contract, or 
                cooperative agreement recipients;
                    ``(B) the development of measures of outcomes (in 
                accordance with paragraph (2)) to be applied by such 
                recipients in evaluating programs carried out under 
                this section; and
                    ``(C) the submission of annual reports by such 
                recipients concerning the effectiveness of programs 
                carried out under this section.
            ``(2) Measures of outcomes.--The Assistant Secretary shall 
        develop measures of outcomes to be applied by recipients of 
        assistance under this section to evaluate the effectiveness of 
        programs carried out under this section, including outcomes 
        related to the student, family, and local educational systems 
        supported by this Act.
            ``(3) Submission of annual data.--An eligible entity 
        described in subsection (c) that receives a grant, contract, or 
        cooperative agreement under this section shall annually submit 
        to the Assistant Secretary a report that includes data to 
        evaluate the success of the program carried out by the entity 
        based on whether such program is achieving the purposes of the 
        program. Such reports shall utilize the measures of outcomes 
        under paragraph (2) in a reasonable manner to demonstrate the 
        progress of the program in achieving such purposes.
            ``(4) Evaluation by assistant secretary.--Based on the data 
        submitted under paragraph (3), the Assistant Secretary shall 
        annually submit to Congress a report concerning the results and 
        effectiveness of the programs carried out with assistance 
        received under this section.
            ``(5) Limitation.--An eligible entity shall use not more 
        than 20 percent of amounts received under a grant under this 
        section to carry out evaluation activities under this 
        subsection.
    ``(g) Information and Education.--The Secretary shall disseminate 
best practices based on findings made pursuant to this section.
    ``(h) Amount of Grants and Authorization of Appropriations.--
            ``(1) Amount of grants.--A grant under this section shall 
        be in an amount that is not more than $2,000,000 for each of 
        the first 5 fiscal years following the date of enactment of 
        this section. The Secretary shall determine the amount of each 
        such grant based on the population of children up to age 21 of 
        the area to be served under the grant.
            ``(2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this section, $130,000,000 for 
        each of fiscal years 2023 through 2026.''.
    (d) Conforming Amendment.--Part G of title V of the Public Health 
Service Act (42 U.S.C. 290hh et seq.), as amended by this section, is 
further amended, in the part heading by striking ``projects for 
children and violence'' and inserting the following: ``school-based 
mental health''.
    (e) School-Based Mental Health Services.--
            (1) In general.--The Secretary of Education shall award 
        grants to State educational agencies to support services 
        provided by school-based mental health services providers at 
        schools receiving funds under part A of title I of the 
        Elementary and Secondary Education Act of 1965 (20 U.S.C. 6311 
        et seq.).
            (2) Use of funds.--Grants under this subsection shall be 
        used to help meet the recommended ratios of--
                    (A) 250 students per school counselor;
                    (B) 500 students per school psychologist; and
                    (C) 250 students per school social worker.
            (3) Condition.--The Secretary shall ensure that funds made 
        available under this subsection are used to provide services 
        that are developmentally, linguistically, and culturally 
        appropriate, trauma-informed, and incorporate positive 
        behavioral interventions and supports.
            (4) Definitions.--For purposes of this subsection:
                    (A) The term ``school-based mental health service 
                provider'' has the meaning given such term in section 
                4102 of the Elementary and Secondary Education Act of 
                1965 (20 U.S.C. 7112).
                    (B) The term ``State educational agency'' has the 
                meaning given such term in section 8101 of the 
                Elementary and Secondary Education Act of 1965 (20 
                U.S.C. 7801).

SEC. 6043. ADDITIONAL SUPPORT FOR YOUTH AND YOUNG ADULT MENTAL HEALTH 
              SERVICE PROVISION.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) Youth and Young Adult Intervention Services.--
            ``(1) In general.--Notwithstanding section 1902(a)(1) 
        (relating to Statewideness), section 1902(a)(10)(B) (relating 
        to comparability), section 1902(a)(23)(A) (relating to freedom 
        of choice of providers), or section 1902(a)(27) (relating to 
        provider agreements), a State may, during the 5-year period 
        beginning on the first day of the fiscal year quarter that 
        begins on or after January 1, 2024, provide medical assistance 
        for qualifying youth and young adult mental health and 
        substance use intervention services (as defined in paragraph 
        (2)(C)) under a State plan amendment or waiver approved under 
        section 1115 or 1915(c).
            ``(2) Definitions.--For the purposes of this subsection:
                    ``(A) Priority service.--The term `priority 
                service' means any of the following if voluntarily 
                received and provided in a manner that maintains the 
                privacy and confidentiality of patient information 
                consistent with Federal and State requirements:
                            ``(i) Community based mobile crisis 
                        intervention services, as defined in section 
                        1947.
                            ``(ii) Telehealth.
                            ``(iii) Youth peer support.
                            ``(iv) Screening for adverse childhood 
                        experiences.
                            ``(v) Trauma responsive care.
                            ``(vi) Other priority services for youth, 
                        as defined by the Secretary.
                    ``(B) Qualified mental health providers.--The term 
                `qualified mental health providers' means a behavioral 
                health care professional who is capable of conducting 
                an assessment of the individual, in accordance with the 
                professional's permitted scope of practice under State 
                law, and other professionals or paraprofessionals with 
                appropriate expertise in youth and young adult 
                behavioral health or mental health, including social 
                workers, peer support specialists, recovery coaches, 
                community health workers, mental health clinicians, and 
                others, as designated by the State and approved by the 
                Secretary.
                    ``(C) Qualifying youth and young adult mental 
                health and substance use intervention services 
                defined.--The term `qualifying youth and young adult 
                mental health and substance use intervention services' 
                means, with respect to a State, items and services for 
                which medical assistance is available under the State 
                plan under this title or a waiver of such plan, that 
                are--
                            ``(i) furnished to an individual 16 to 25 
                        years of age who is--
                                    ``(I) experiencing a mental health 
                                or substance use disorder crisis;
                                    ``(II) subject to the juvenile or 
                                adult justice system as defined in 
                                section 3102 of title 29, United States 
                                Code;
                                    ``(III)(aa) experiencing 
                                homelessness (as defined in section 
                                41403(6) of the Violence Against Women 
                                Act of 1994 (42 U.S.C. 14043e-2(6)));
                                    ``(bb) a homeless child or youth 
                                (as defined in section 725(2) of the 
                                McKinney-Vento Homeless Assistance Act 
                                (42 U.S.C. 11434a(2)));
                                    ``(cc) a runaway, in foster care, 
                                or has aged out of the foster care 
                                system;
                                    ``(dd) a child eligible for 
                                assistance under section 477 of the 
                                Social Security Act (42 U.S.C. 677); or
                                    ``(ee) in an out-of-home placement;
                                    ``(IV) pregnant or parenting as 
                                defined in section 3102 of title 29, 
                                United States Code;
                                    ``(V) a youth who is an individual 
                                with a disability as defined in section 
                                3102 of title 29, United States Code;
                                    ``(VI) a low income youth requiring 
                                additional assistance to enter or 
                                complete an educational program or to 
                                secure or hold employment as defined in 
                                section 3102 of title 29, United States 
                                Code; or
                                    ``(VII) living in a community that 
                                has faced acute or long-term exposure 
                                to substantial discrimination, 
                                historical oppression, 
                                intergenerational poverty, civil 
                                unrest, or a high rate of violence or 
                                drug overdose deaths;
                            ``(ii) furnished by qualified mental health 
                        providers; and
                            ``(iii) a priority service.
                    ``(D) Telehealth.--The term `telehealth' means use 
                of electronic information and telecommunications 
                technologies, including voice only audio, text, remote 
                patient monitoring, and mHealth via applications, to 
                support clinical mental health care, patient and 
                professional health-related education, public health, 
                and health administration.
            ``(3) Payments.--Notwithstanding section 1905(b), beginning 
        January 1, 2024, during each of the first 20 fiscal quarters 
        that a State meets the requirements described in paragraph (4), 
        the Federal medical assistance percentage applicable to amounts 
        expended by the State for medical assistance for qualifying 
        youth and young adult mental health and substance use 
        intervention services furnished during such quarter shall be 
        equal to 100 percent.
            ``(4) Requirements.--The requirements described in this 
        paragraph are the following:
                    ``(A) The State demonstrates, to the satisfaction 
                of the Secretary--
                            ``(i) that it will be able to support the 
                        provision of qualifying youth and young adult 
                        mental health and substance use intervention 
                        services that meet the conditions specified in 
                        paragraphs (1) and (2)); and
                            ``(ii) how it will support coordination 
                        between qualified mental health providers and 
                        substance use teams and community partners, 
                        including health care providers, to enable the 
                        provision of services, needed referrals, and 
                        other activities identified by the Secretary.
                    ``(B) The State provides assurances satisfactory to 
                the Secretary that--
                            ``(i) any additional Federal funds received 
                        by the State for qualifying youth and young 
                        adult mental health and substance use 
                        intervention services provided under this 
                        subsection that are attributable to the 
                        increased Federal medical assistance percentage 
                        under paragraph (3)(A) will be used to 
                        supplement, and not supplant, the level of 
                        State funds expended for such services for 
                        fiscal year 2024;
                            ``(ii) if the State made qualifying youth 
                        and young adult mental health and substance use 
                        intervention services available in a region of 
                        the State in fiscal year 2023 the State will 
                        continue to make such services available in 
                        such region under this subsection at the same 
                        level that the State made such services 
                        available in such fiscal year; and
                            ``(iii) the State will conduct the 
                        evaluation and assessment, and submit the 
                        report required under paragraph (5).
            ``(5) State evaluation and report.--
                    ``(A) State evaluation.--Not later than 4 fiscal 
                quarters after a State begins providing qualifying 
                youth and young adult mental health and substance use 
                intervention services in accordance with this 
                subsection, the State shall enter into a contract with 
                an independent entity or organization to conduct an 
                evaluation for the purposes of--
                            ``(i) determining the effect of the 
                        provision of such services on--
                                    ``(I) emergency room visits;
                                    ``(II) use of ambulatory services;
                                    ``(III) hospitalizations;
                                    ``(IV) the involvement of law 
                                enforcement in mental health or 
                                substance use disorder crisis events; 
                                and
                                    ``(V) the diversion of individuals 
                                from jails or similar settings; and
                            ``(ii) assessing--
                                    ``(I) the types of services 
                                provided to individuals;
                                    ``(II) the types of events 
                                responded to;
                                    ``(III) cost savings or cost-
                                effectiveness attributable to such 
                                services;
                                    ``(IV) the experiences of 
                                individuals who receive qualifying 
                                youth and young adult mental health and 
                                substance use intervention services;
                                    ``(V) the successful connection of 
                                individuals with follow-up services; 
                                and
                                    ``(VI) other relevant outcomes 
                                identified by the Secretary.
                    ``(B) Comparison to historical measures.--The 
                contract described in subparagraph (A) shall specify 
                that the evaluation is based on a comparison of the 
                historical measures of State performance with respect 
                to the outcomes specified under such subparagraph to 
                the State's performance with respect to such outcomes 
                during the period beginning with the first quarter in 
                which the State begins providing qualifying youth and 
                young adult mental health and substance use 
                intervention services in accordance with this 
                subsection.
                    ``(C) Report.--Not later than 2 years after a State 
                begins to provide qualifying youth and young adult 
                mental health and substance use intervention services 
                in accordance with this subsection, the State shall 
                submit a report to the Secretary on the following:
                            ``(i) The results of the evaluation carried 
                        out under subparagraph (A).
                            ``(ii) The number of individuals who 
                        received qualifying youth and young adult 
                        mental health and substance use intervention 
                        services.
                            ``(iii) Demographic information regarding 
                        such individuals when available, including the 
                        race and ethnicity, age, sex, sexual 
                        orientation, gender identity, and geographic 
                        location of such individuals.
                            ``(iv) The processes and models developed 
                        by the State to provide qualifying youth and 
                        young adult mental health and substance use 
                        intervention services under such the State plan 
                        or waiver, including the processes developed to 
                        provide referrals for, or coordination with, 
                        follow-up care and services.
                            ``(v) Lessons learned regarding the 
                        provision of such services.
                    ``(D) Public availability.--The State shall make 
                the report required under subparagraph (C) publicly 
                available, including on the website of the appropriate 
                State agency, upon submission of such report to the 
                Secretary.
            ``(6) Best practices report.--
                    ``(A) In general.--Not later than 3 years after the 
                first State begins to provide qualifying youth and 
                young adult mental health and substance use 
                intervention services in accordance with this 
                subsection, the Secretary shall submit a report to 
                Congress that--
                            ``(i) identifies the States that elected to 
                        provide services in accordance with this 
                        subsection;
                            ``(ii) summarizes the information reported 
                        by such States under paragraph (5)(C); and
                            ``(iii) identifies best practices for the 
                        effective delivery of youth and young adult 
                        mental health and substance use intervention 
                        services.
                    ``(B) Public availability.--The report required 
                under subparagraph (A) shall be made publicly 
                available, including on the website of the Department 
                of Health and Human Services, upon submission to 
                Congress.
            ``(7) Nondiscrimination.--
                    ``(A) Federally funded activities.--(i) For the 
                purpose of applying the prohibitions against 
                discrimination on the basis of age under the Age 
                Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), on 
                the basis of handicap under section 504 of the 
                Rehabilitation Act of 1973 (29 U.S.C. 794), on the 
                basis of sex under title IX of the Education Amendments 
                of 1972 (20 U.S.C. 1681 et seq.), or on the basis of 
                race, color, or national origin under title VI of the 
                Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), 
                programs and activities funded in whole or in part with 
                funds made available under this subchapter are 
                considered to be programs and activities receiving 
                Federal financial assistance.
                    ``(ii) No person shall on the ground of sex or 
                religion be excluded from participation in, be denied 
                the benefits of, or be subjected to discrimination 
                under, any program or activity funded in whole or in 
                part with funds made available under this title.
                    ``(B) Compliance.--Whenever the Secretary finds 
                that a State, or an entity that has received a payment 
                from an allotment to a State under section 702(c) of 
                this title, has failed to comply with a provision of 
                law referred to in subsection (a)(1), with subsection 
                (a)(2), or with an applicable regulation (including one 
                prescribed to carry out subsection (a)(2)), he shall 
                notify the chief executive officer of the State and 
                shall request him to secure compliance. If within a 
                reasonable period of time, not to exceed 60 days, the 
                chief executive officer fails or refuses to secure 
                compliance, the Secretary may--
                            ``(i) refer the matter to the Attorney 
                        General with a recommendation that an 
                        appropriate civil action be instituted;
                            ``(ii) exercise the powers and functions 
                        provided by title VI of the Civil Rights Act of 
                        1964 (42 U.S.C. 2000d et seq.), the Age 
                        Discrimination Act of 1975 (42 U.S.C. 6101 et 
                        seq.), or section 504 of the Rehabilitation Act 
                        of 1973 (29 U.S.C. 794), as may be applicable; 
                        or
                            ``(iii) take such other action as may be 
                        provided by law.
                    ``(C) Authority of attorney general; civil 
                actions.--When a matter is referred to the Attorney 
                General pursuant to subsection (b)(1), or whenever he 
                has reason to believe that the entity is engaged in a 
                pattern or practice in violation of a provision of law 
                referred to in subsection (a)(1) or in violation of 
                subsection (a)(2), the Attorney General may bring a 
                civil action in any appropriate district court of the 
                United States for such relief as may be appropriate, 
                including injunctive relief.''.

SEC. 6044. EARLY INTERVENTION AND PREVENTION PROGRAMS FOR TRANSITION-
              AGE YOUTH.

    (a) In General.--Section 1912(b)(1) of the Public Health Service 
Act (42 U.S.C. 300x-1(b)(1)) is amended--
            (1) by redesignating subparagraph (E) as (F); and
            (2) by inserting after subparagraph (D) the following:
                    ``(E) Early intervention and prevention programs 
                for transition-age youth.--The plan shall describe the 
                State's plans to carry out demonstration grants or 
                contracts for early intervention and prevention 
                programs for transition-age youth of 16 to 25 years of 
                age who meet one or more of the criteria specified in 
                section 129(1)(B) of the Workforce Innovation and 
                Opportunity Act to be considered out-of-school 
                youth.''.
    (b) Set-Aside.--Section 1920 of the Public Health Service Act (42 
U.S.C. 300x-9) is amended by adding at the end the following:
    ``(d) Early Intervention and Prevention Programs for Transition-Age 
Youth.--
            ``(1) In general.--Except as provided in paragraph (2), a 
        State shall expend at least 15 percent of the amount of the 
        allotment of the State pursuant to a funding agreement under 
        section 1911 for each fiscal year to support programs described 
        in section 1912(b)(1)(E).
            ``(2) State flexibility.--In lieu of expending 15 percent 
        of the amount the allotment for a fiscal year as required by 
        paragraph (1), a State may elect to expend not less than 30 
        percent of such amount to support such programs by the end of 
        two consecutive fiscal years.''.

SEC. 6045. STRATEGIES TO INCREASE ACCESS TO TELEHEALTH UNDER MEDICAID 
              AND CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) Guidance.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
issue and disseminate guidance to States to clarify strategies to 
overcome existing barriers and increase access to telehealth under the 
Medicaid program under title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) and the Children's Health Insurance Program under title 
XXI of such Act (42 U.S.C. 1397aa et seq.). Such guidance shall include 
technical assistance and best practices regarding--
            (1) telehealth delivery of covered services;
            (2) recommended voluntary billing codes, modifiers, and 
        place-of-service designations for telehealth and other virtual 
        health care services;
            (3) the simplification or alignment (including through 
        reciprocity) of provider licensing, credentialing, and 
        enrollment protocols with respect to telehealth across States, 
        State Medicaid plans under such title XIX, and Medicaid managed 
        care organizations, including during national public health 
        emergencies;
            (4) existing strategies States can use to integrate 
        telehealth and other virtual health care services into value-
        based health care models; and
            (5) examples of States that have used waivers under the 
        Medicaid program to test expanded access to telehealth, 
        including during the emergency period described in section 
        1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
        5(g)(1)(B)).
    (b) Studies.--
            (1) Telehealth impact on health care access.--Not later 
        than 1 year after the date of the enactment of this Act, the 
        Medicaid and CHIP Payment and Access Commission shall conduct a 
        study, with respect to a minimum of 10 States across geographic 
        regions of the United States, and submit to Congress a report, 
        on the impact of telehealth on health care access, utilization, 
        cost, and outcomes, broken down by race, ethnicity, sex, age, 
        disability status, and zip code. Such report shall--
                    (A) evaluate cost, access, utilization, outcomes, 
                and patient experience data from across the health care 
                field, including States, Medicaid managed care 
                organizations, provider organizations, and other 
                organizations that provide or pay for telehealth under 
                the Medicaid program and Children's Health Insurance 
                Program;
                    (B) identify barriers and potential solutions to 
                provider entry and participation in telehealth that 
                States are experiencing, as well as barriers to 
                providing telehealth across State lines, including 
                during times of public health crisis or public health 
                emergency;
                    (C) determine the frequency at which out-of-State 
                telehealth is provided to patients enrolled in the 
                Medicaid program and the potential impact on access to 
                telehealth if State Medicaid policies were more 
                aligned; and
                    (D) identify and evaluate opportunities for more 
                alignment among such policies to promote access to 
                telehealth across all States, State Medicaid plans 
                under title XIX of the Social Security Act (42 U.S.C. 
                1396 et seq.), State child health plans under title XXI 
                of such Act (42 U.S.C. 1397aa et seq.), and Medicaid 
                managed care organizations, including the potential for 
                regional compacts or reciprocity agreements.
            (2) Federal agency telehealth collaboration.--Not later 
        than 1 year after the date of the enactment of this Act, the 
        Comptroller General of the United States shall conduct a study 
        and submit to Congress a report evaluating collaboration 
        between Federal agencies with respect to telehealth services 
        furnished under the Medicaid or CHIP program to individuals 
        under the age of 18, including such services furnished to such 
        individuals in early care and education settings. Such report 
        shall include recommendations on--
                    (A) opportunities for Federal agencies to improve 
                collaboration with respect to such telehealth services; 
                and
                    (B) opportunities for collaboration between Federal 
                agencies to expand telehealth access to such 
                individuals enrolled under the Medicaid or CHIP 
                program, including in early care and education 
                settings.

SEC. 6046. YOUTH AND YOUNG ADULT MENTAL HEALTH PROMOTION, PREVENTION, 
              INTERVENTION, AND TREATMENT.

    Title III of the Public Health Service Act is amended by inserting 
after section 399Z-2 (42 U.S.C. 280h-5) the following:

``SEC. 399Z-3. YOUTH AND YOUNG ADULT MENTAL HEALTH PROMOTION, 
              PREVENTION, INTERVENTION, AND TREATMENT.

    ``(a) Grants.--The Secretary shall--
            ``(1) award grants to eligible entities to develop, 
        maintain, or enhance youth and young adult mental health 
        promotion, prevention, intervention, and treatment programs, 
        including--
                    ``(A) programs for youth and young adults who may 
                be likely to develop, are showing early signs of, or 
                have been diagnosed with a mental health condition, 
                including a serious emotional disturbance; and
                    ``(B) infrastructure and organization change at a 
                State, tribal, or territorial level to improve cross-
                system collaboration, service capacity and expertise 
                related to youth and young adults; and
            ``(2) ensure that programs funded through grants under this 
        section use community-driven, evidence-informed, or evidence-
        based models, practices, and methods that are, as appropriate, 
        culturally and linguistically appropriate, and can be 
        replicated in other appropriate settings.
    ``(b) Eligible Transition Age Youth and Entities.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means--
                    ``(A) a local educational agency;
                    ``(B) a State educational agency;
                    ``(C) an institution of higher education (or 
                consortia of such institutions), which may include a 
                recovery program at an institution of higher education;
                    ``(D) a local board, or a one-stop operator as 
                defined in section 3 of the Workforce Innovation and 
                Opportunity Act;
                    ``(E) a nonprofit organization with appropriate 
                expertise in providing services or programs for 
                children, adolescents, or young adults, excluding a 
                school;
                    ``(F) a State, political subdivision of a State, 
                Indian tribe, or tribal organization; or
                    ``(G) a high school or dormitory serving high 
                school students that receives funding from the Bureau 
                of Indian Education.
            ``(2) Eligible transition age youth.--The term `eligible 
        transition age youth' means a youth or young adult from age 16 
        to not more than 25 years of age who is--
                    ``(A) an out-of-school youth as defined in section 
                129(a)(1)(B) of the Workforce Innovation and 
                Opportunity Act;
                    ``(B) a homeless individual (as defined in section 
                41403(6) of the Violence Against Women Act of 1994), a 
                homeless child or youth (as defined in section 725(2) 
                of the McKinney-Vento Homeless Assistance Act) a 
                runaway, in foster care or has aged out of the foster 
                care system, a child eligible for assistance under 
                section 477 of the Social Security Act, or in an out-
                of-home placement;
                    ``(C) an individual who is pregnant or parenting, 
                as referred to in section 129(a)(1)(B) of the Workforce 
                Innovation and Opportunity Act;
                    ``(D) a youth who is an individual with a 
                disability, as referred to in section 129(a)(1)(B) of 
                the Workforce Innovation and Opportunity Act;
                    ``(E) a low-income individual who requires 
                additional assistance to enter or complete an 
                educational program or to secure or hold employment, as 
                referred to in section 129(a)(1)(B) of the Workforce 
                Innovation and Opportunity Act; or
                    ``(F) living in a community that has faced acute or 
                long-term exposure to substantial discrimination, 
                historical oppression, intergenerational poverty, civil 
                unrest, a high rate of violence, or drug overdose 
                deaths.
    ``(c) Application.--An eligible entity seeking a grant under 
subsection (a) shall submit to the Secretary an application at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(d) Use of Funds for Mental Health Promotion, Prevention, 
Intervention and Treatment Programs.--An eligible entity may use 
amounts awarded under a grant under subsection (a)(1) to carry out the 
following:
            ``(1) Creation, implementation, and expansion of services 
        and supports that are culturally and linguistically appropriate 
        and youth-guided, involve and include family and community 
        members (including business leaders and faith-based 
        organizations), and provide for continuity of care between 
        child- and adult-serving systems to ensure seamless transition.
            ``(2) Infrastructure and organization change at a State, 
        Tribal, or territorial level to improve cross-system 
        collaboration, service capacity, and expertise related to youth 
        and young adults with, or at-risk of, mental health conditions 
        and substance use disorders as they transition into adult roles 
        and responsibilities.
            ``(3) Public awareness and cross-system provider training 
        for individuals employed at institutions of higher education 
        and community colleges, behavioral health providers, 
        individuals working in the criminal justice system, primary 
        care providers, vocational service providers, and child welfare 
        workers.
    ``(e) Matching Funds.--The Secretary may not award a grant under 
this section to an eligible entity unless the eligible entity agrees, 
with respect to the costs to be incurred by the eligible entity in 
carrying out the activities described in subsection (d), to make 
available non-Federal contributions (in cash or in kind) toward such 
costs in an amount that is not less than 10 percent of the total amount 
of Federal funds provided in the grant.
    ``(f) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $25,000,000 for each of fiscal 
years 2024 through 2033.''.

SEC. 6047. STUDY ON THE EFFECTS OF SMARTPHONE AND SOCIAL MEDIA USE ON 
              ADOLESCENTS.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall conduct 
or support research on--
            (1) smartphone and social media use by adolescents; and
            (2) the effects of such use on--
                    (A) emotional, behavioral, and physical health and 
                development; and
                    (B) disparities in minority and underserved 
                populations.
    (b) Report.--Not later than 5 years after the date of the enactment 
of this Act, the Secretary shall submit to the Congress, and make 
publicly available, a report on the findings of research described in 
this section.

                    Subtitle E--Community-Based Care

SEC. 6051. MENTAL HEALTH AT THE BORDER.

    (a) Short Title.--This section may be cited as the ``Immigrants' 
Mental Health Act of 2022''.
    (b) Training for Certain CBP Personnel in Mental Health Issues.--
            (1) Training to identify risk factors and warning signs in 
        immigrants and refugees.--
                    (A) In general.--The Commissioner of U.S. Customs 
                and Border Protection, in consultation with the 
                Assistant Secretary for Mental Health and Substance 
                Use, the Administrator of the Health Resources and 
                Services Administration, and nongovernmental experts in 
                the delivery of health care in humanitarian crises and 
                in the delivery of health care to children, shall 
                develop and implement a training curriculum for U.S. 
                Customs and Border Protection agents and officers 
                assigned to U.S. Customs and Border Protection 
                facilities to enable such agents and officers to 
                identify the risk factors and warning signs in 
                immigrants and refugees of mental health issues 
                relating to trauma.
                    (B) Requirements.--The training curriculum 
                described in subparagraph (A) shall--
                            (i) apply to all U.S. Customs and Border 
                        Protection agents and officers working at U.S. 
                        Customs and Border Protection facilities;
                            (ii) provide for crisis intervention using 
                        a trauma-informed approach; and
                            (iii) provide for mental health screenings 
                        for immigrants and refugees arriving at the 
                        border in their preferred language or with 
                        appropriate language assistance.
            (2) Training to address mental health and wellness of cbp 
        agents and officers.--
                    (A) In general.--The Commissioner of U.S. Customs 
                and Border Protection, in consultation with the 
                Assistant Secretary for Mental Health and Substance 
                Use, the Administrator of the Health Resources and 
                Services Administration, and nongovernmental experts in 
                the delivery of mental health care, shall develop and 
                implement a training curriculum for U.S. Customs and 
                Border Protection agents and officers assigned to U.S. 
                Customs and Border Protection facilities to address the 
                mental health and wellness of individuals working at 
                such facilities.
                    (B) Requirement.--The training curriculum described 
                in subparagraph (A) shall be designed to help U.S. 
                Customs and Border Protection agents and officers 
                working at U.S. Customs and Border Protection 
                facilities to--
                            (i) better manage their own stress and the 
                        stress of their coworkers; and
                            (ii) be more aware of the psychological 
                        pressures experienced during their jobs.
            (3) Annual review of training.--Beginning with respect to 
        fiscal year 2023, the Assistant Secretary for Mental Health and 
        Substance Use shall--
                    (A) conduct an annual review of the training 
                implemented pursuant to paragraphs (1) and (2); and
                    (B) submit the results of each such review, 
                including any recommendations for improvement of such 
                training, to--
                            (i) the Commissioner of U.S. Customs and 
                        Border Protection; and
                            (ii) the Committees on Appropriations, 
                        Energy and Commerce, Homeland Security, and the 
                        Judiciary of the House of Representatives and 
                        the Committees on Appropriations, Health, 
                        Education, Labor, and Pensions, and Homeland 
                        Security and Governmental Affairs of the 
                        Senate.
            (4) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated--
                    (A) for fiscal year 2023, $50,000 to develop the 
                training under paragraphs (1) and (2); and
                    (B) for each of fiscal years 2024 through 2028--
                            (i) $20,000 to implement such training 
                        pursuant to paragraphs (1) and (2); and
                            (ii) such sums as may be necessary to 
                        review and make recommendations for such 
                        training pursuant to paragraph (3).
    (c) Staffing Border Facilities and Detention Centers.--
            (1) In general.--To adequately evaluate the mental health 
        needs of immigrants, refugees, border patrol agents, and staff, 
        the Commissioner of U.S. Customs and Border Protection shall 
        assign at least one qualified mental or behavioral health 
        expert to each U.S. Customs and Border Protection facility.
            (2) Qualifications.--To be qualified for purposes of 
        paragraph (1), a mental or behavioral health expert shall be--
                    (A) bilingual;
                    (B) well-versed in culturally and linguistically 
                appropriate and trauma-informed interventions; and
                    (C) have particular expertise in child or 
                adolescent mental health or family mental health.
            (3) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $3,000,000 
        for each of fiscal years 2023 through 2027.
    (d) No Sharing of Department of Health and Human Services Mental 
Health Information for Asylum Determinations, Immigration Hearings, or 
Deportation Proceedings.--The officers, employees, and agents of the 
Department of Health and Human Services, including the Office of 
Refugee Resettlement, may not share with the Department of Homeland 
Security, and the officers, employees, and agents of the Department of 
Homeland Security may not request or receive from the Department of 
Health and Human Services, for the purposes of an asylum determination, 
immigration hearing, or deportation proceeding, any information or 
record that--
            (1) concerns the mental health of an alien; and
            (2) was obtained or produced by a mental or behavioral 
        health professional while the alien was in a shelter or 
        otherwise in the custody of the Federal Government.
    (e) Definitions.--In this section:
            (1) The term ``forward operating base'' means a permanent 
        facility established by U.S. Customs and Border Protection in 
        forward or remote locations, and designated as such by U.S. 
        Customs and Border Protection.
            (2) The term ``U.S. Customs and Border Protection 
        facility'' means any of the following facilities that typically 
        detain migrants on behalf of U.S. Customs and Border 
        Protection:
                    (A) U.S. Border Patrol stations.
                    (B) Ports of entry.
                    (C) Checkpoints.
                    (D) Forward operating bases.
                    (E) Secondary inspection areas.
                    (F) Short-term custody facilities.

SEC. 6052. ASIAN AMERICAN, AFRICAN AMERICAN, NATIVE HAWAIIAN, PACIFIC 
              ISLANDER, INDIGENOUS, MIDDLE EASTERN AND NORTH AFRICAN, 
              AND HISPANIC AND LATINO BEHAVIORAL AND MENTAL HEALTH 
              OUTREACH AND EDUCATION STRATEGY.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd 
et seq.), as amended by section 6022, is further amended by adding at 
the end the following new section:

``SEC. 554. BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION 
              STRATEGY.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, shall, in coordination 
with advocacy and behavioral and mental health organizations serving 
populations of Asian American, African American, Native Hawaiian, 
Pacific Islander, Indigenous, Middle Eastern and North African (in this 
section referred to as `MENA'), and Hispanic and Latino/a/x individuals 
or communities, develop and implement an outreach and education 
strategy to promote behavioral and mental health, emphasize that 
behavioral and mental health conditions are treatable and that 
reasonable accommodations under section 504 of the Rehabilitation Act 
of 1973 and titles II and III of the Americans with Disabilities Act of 
1990 are necessary and may help, as well as reduce stigma associated 
with mental health conditions and substance abuse among the Asian 
American, African American, Native Hawaiian, Pacific Islander, 
Indigenous, MENA, and Hispanic and Latino/a/x populations. Such 
strategy shall--
            ``(1) be designed to--
                    ``(A) meet the diverse cultural and language needs 
                of the various Asian American, African American, 
                Indigenous, MENA, Native Hawaiian, Pacific Islander, 
                and Hispanic and Latino/a/x populations; and
                    ``(B) ensure that approaches recommended in the 
                strategy are developmentally (with respect to the 
                beneficiary's relative age and experience) and age 
                appropriate, as well as cognitively accessible to 
                persons with cognitive disabilities;
            ``(2) increase awareness of symptoms of mental illnesses 
        common among such populations, taking into account differences 
        within subgroups (such as gender, gender identity, age, sexual 
        orientation, disability, and ethnicity) of such populations;
            ``(3) provide information on evidence-based, culturally and 
        linguistically appropriate and adapted interventions and 
        treatments;
            ``(4) ensure full participation of, and engage, both 
        consumers and community members representing the communities of 
        focus in the development and implementation of materials; and
            ``(5) seek to broaden the perspective among both 
        individuals in such communities and stakeholders serving such 
        communities to use a comprehensive public health approach to 
        promoting behavioral and mental health that addresses a 
        holistic view of health by focusing on the intersection between 
        behavioral and physical health.
    ``(b) Reports.--Beginning not later than 1 year after the date of 
the enactment of this section and annually thereafter, the Secretary, 
acting through the Assistant Secretary, shall submit to the Congress, 
and make publicly available, a report on the extent to which the 
strategy developed and implemented under subsection (a) increased 
behavioral and mental health outcomes associated with mental health 
conditions and substance abuse among Asian American, African American, 
Native Hawaiian, Pacific Islander, Indigenous, MENA, and Hispanic and 
Latino/a/x populations.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $10,000,000 for each of fiscal 
years 2024 through 2028.''.

                          Subtitle F--Reports

SEC. 6061. ADDRESSING RACIAL AND ETHNIC MENTAL HEALTH INEQUITIES 
              RESEARCH GAPS.

    (a) In General.--Not later than 6 months after the date of the 
enactment of this Act--
            (1) the Director of the National Institute on Minority 
        Health and Health Disparities shall enter into an arrangement 
        with the National Academy of Sciences to carry out the 
        activities under subsection (b); or
            (2) if the National Academy of Sciences declines to enter 
        into such an arrangement, the Director of the National 
        Institute on Minority Health and Health Disparities, in 
        cooperation with the Agency for Healthcare Research and 
        Quality, shall carry out the activities under subsection (b).
    (b) Activities.--The applicable entity under subsection (a) shall--
            (1) conduct a study with respect to mental health 
        inequities in racial and ethnic minority groups (as defined in 
        section 1707(g) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)), as amended by title I of this Act); and
            (2) submit to the Congress a report on the results of such 
        study, including--
                    (A) a compilation of information on the dynamics of 
                mental health outcomes in such racial and ethnic 
                minority groups;
                    (B) the degree and impacts of the co-occurrence of 
                mental conditions with other disabilities in such 
                racial and ethnic groups, including physical 
                disabilities, mental disabilities, substance use 
                disorders, severe and persistent mental illness, and 
                mental disorders or mental health conditions which co-
                occur with one another;
                    (C) a compilation of information on the impact of 
                community violence, community trauma, adverse childhood 
                experiences, weather extremes worsened by climate 
                change (such as heat waves, flooding, hurricanes, and 
                wildfires), substance use, and other psychological 
                traumas, on mental disorders in such racial and ethnic 
                minority groups, stratified by household income level;
                    (D) a compilation of information on the impact of 
                the intersectionality of transgender individuals, 
                gender nonbinary individuals, sexual orientation, and 
                age in racial and ethnic minority groups; and
                    (E) a description of how protective factors 
                contrast and compare among different communities of 
                color, identifying cultural strengths.

SEC. 6062. RESEARCH ON ADVERSE HEALTH EFFECTS ASSOCIATED WITH 
              INTERACTIONS WITH LAW ENFORCEMENT.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Director of the Office of Minority Health of the Centers for Disease 
Control and Prevention (established pursuant to section 1707A of the 
Public Health Service Act (42 U.S.C. 300u-6a)), shall conduct research 
on the adverse health effects associated with interactions with law 
enforcement.
    (b) Effects Among Racial and Ethnic Minorities.--The research under 
subsection (a) shall include research on--
            (1) the health consequences, both individual and community-
        wide, of trauma related to violence committed by law 
        enforcement among racial and ethnic minorities; and
            (2) the disproportionate burden of morbidity and mortality 
        associated with such trauma.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary shall--
            (1) complete the research under this section; and
            (2) submit to the Congress a report on the findings, 
        conclusions, and recommendations resulting from such research.

SEC. 6063. GEOACCESS STUDY.

    The Assistant Secretary for Mental Health and Substance Use shall--
            (1) conduct a study to--
                    (A) determine which geographic areas of the United 
                States have shortages of racially and ethnically 
                diverse mental health providers, as well as mental 
                health providers trained to work with racially and 
                ethnically diverse clients and clients with multiple 
                mental health, cognitive, and developmental 
                disabilities; and
                    (B) assess the preparedness of mental health 
                providers to deliver culturally and linguistically 
                appropriate, affordable, and accessible services; and
            (2) submit a report to Congress on the results of such 
        study.

SEC. 6064. COOCCURRING CONDITIONS.

    (a) GAO Report.--Not later than two years after the date of 
enactment of this Act, the Comptroller General of the United States 
shall submit to Congress a report on barriers to care for persons with 
cooccurring conditions and access to care in the United States. Such 
report shall include the information and recommendations described in 
subsection (b).
    (b) Content of Report.--The report under subsection (a) shall 
include--
            (1) an assessment of current barriers to behavioral health 
        and substance use disorder treatment for low-income, uninsured, 
        and Medicaid-enrolled adults, and recommendations for 
        addressing such barriers, particularly for women and diverse 
        racial and ethnic groups;
            (2) an assessment of--
                    (A) how many adults have a behavioral health 
                condition and options for adults to receive behavioral 
                health and substance use disorder treatment in 
                nonexpansion States;
                    (B) Medicaid expansion States who provide 
                behavioral health coverage for newly eligible 
                enrollees;
                    (C) how enrollment in coverage affects treatment 
                availability; and
                    (D) the impacts of COVID-19 to receiving and 
                accessing treatment for behavioral health, substance 
                use disorders, diverse racial and ethnic groups, and 
                recommendations for addressing such barriers;
            (3) an assessment of current barriers, inclusive of social 
        determinants of health and cultural barriers, that prevent 
        adults from receiving behavioral health and substance use 
        disorder treatment, recommendations for addressing such 
        barriers, particularly for low-income women and adults from 
        racial and ethnic groups;
            (4) an assessment of disparities in access to addiction 
        counselors, mental or behavioral health care providers acting 
        in accordance with State law, stratified by race, ethnicity, 
        gender identity, geographic location, and insurance type and 
        recommendations to promote greater access equity; and
            (5) recommendations to promote greater equity in access to 
        care for behavioral services and substance use disorders, 
        particularly for low-income women and adults from diverse 
        racial and ethnic groups.

SEC. 6065. TECHNICAL CORRECTION.

    Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) 
is amended--
            (1) by redesignating the second section 550 (42 U.S.C. 
        290ee-10) (relating to Sobriety Treatment And Recovery Teams) 
        as section 552A; and
            (2) by moving such section, as so redesignated, so as to 
        appear after section 552 (42 U.S.C. 290ee-7).

                  Subtitle G--Miscellaneous Provisions

SEC. 6071. CHILDREN'S MENTAL HEALTH INFRASTRUCTURE ACT.

     Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by inserting after subpart V the following new 
subpart:

  ``Subpart VI--Increasing Investment in Pediatric Behavioral Health 
                                Services

``SEC. 340A-1. GRANTS TO CHILDREN'S HOSPITALS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall make grants 
to eligible entities for the purpose of improving their ability to 
provide pediatric behavioral health services, including by--
            ``(1) constructing or modernizing sites of care for 
        pediatric behavioral health services;
            ``(2) expanding capacity to provide pediatric behavioral 
        health services, including enhancements to digital 
        infrastructure, telehealth capabilities, or other improvements 
        to patient care infrastructure; and
            ``(3) supporting the reallocation of existing resources to 
        accommodate pediatric behavioral health patients, including 
        by--
                    ``(A) converting or adding a sufficient number of 
                beds to establish or increase the hospital's inventory 
                of licensed and operational, short-term psychiatric and 
                substance use inpatient beds; and
                    ``(B) ensuring compliance with safety standards.
    ``(b) Eligibility.--To be eligible to seek a grant under this 
section, an entity shall be a hospital that predominantly treats 
individuals under the age of 21, including any hospital that receives 
funds under section 340E.
    ``(c) Funding.--To carry out this section, there is hereby 
appropriated, out of amounts in the Treasury not otherwise obligated, 
$2,000,000,000 for each of fiscal years 2022 through 2026.''.

SEC. 6072. MENTAL HEALTH FOR LATINOS.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd 
et seq.) is amended by adding at the end the following new section:

``SEC. 553. BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION 
              STRATEGY.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary, shall, in coordination with advocacy and behavioral and 
mental health organizations serving populations of Hispanic and Latino 
individuals or communities, develop and implement an outreach and 
education strategy to promote behavioral and mental health and reduce 
stigma associated with mental health conditions and substance abuse 
among the Hispanic and Latino populations. Such strategy shall--
            ``(1) be designed to--
                    ``(A) meet the diverse cultural and language needs 
                of the various Hispanic and Latino populations; and
                    ``(B) be developmentally and age-appropriate;
            ``(2) increase awareness of symptoms of mental illnesses 
        common among such populations, taking into account differences 
        within subgroups, such as gender, gender identity, age, sexual 
        orientation, or ethnicity, of such populations;
            ``(3) provide information on evidence-based, culturally and 
        linguistically appropriate and adapted interventions and 
        treatments;
            ``(4) ensure full participation of, and engage, both 
        consumers and community members in the development and 
        implementation of materials;
            ``(5) seek to broaden the perspective among both 
        individuals in these communities and stakeholders serving these 
        communities to use a comprehensive public health approach to 
        promoting behavioral health that addresses a holistic view of 
        health by focusing on the intersection between behavioral and 
        physical health; and
            ``(6) address the impact of the SARS-CoV-2 pandemic on the 
        mental and behavioral health of the Hispanic and Latino 
        populations.
    ``(b) Reports.--Beginning not later than 1 year after the date of 
the enactment of this section and annually thereafter, the Secretary, 
acting through the Assistant Secretary, shall submit to Congress, and 
make publicly available, a report on the extent to which the strategy 
developed and implemented under subsection (a) improved behavioral and 
mental health outcomes associated with mental health conditions and 
substance abuse among Hispanic and Latino populations.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,000,000 for each of fiscal 
years 2023 through 2025.''.

SEC. 6073. STRENGTHENING MENTAL HEALTH SUPPORTS FOR BIPOC COMMUNITIES.

    (a) In General.--Section 1942(a) of the Public Health Service Act 
(42 U.S.C. 300x-52(a)) is amended--
            (1) in paragraph (1), by striking ``and'' at the end;
            (2) by redesignating paragraph (2) as paragraph (5); and
            (3) by inserting after paragraph (1) the following:
            ``(2) services provided by the State to adults with a 
        serious mental illness and children with a serious emotional 
        disturbance who are members of historically racial and ethnic 
        minority groups, including--
                    ``(A) the extent to which such services are 
                provided to such adults and children; and
                    ``(B) the outcomes experienced by such adults and 
                children as a result of the provision of such services, 
                including with respect to--
                            ``(i) diversions from hospitalization and 
                        criminal justice system involvement;
                            ``(ii) treatment for first episode 
                        psychosis or undefined psychosis;
                            ``(iii) reductions in suicide and increased 
                        utilization of appropriate treatments and 
                        interventions for suicidal ideation;
                            ``(iv) response through crisis services, 
                        including mobile crisis services;
                            ``(v) treatment of individuals who are 
                        experiencing homelessness or housing insecurity 
                        and individuals residing in rural communities; 
                        and
                            ``(vi) increased patient family and 
                        caregiver engagement and education on serious 
                        mental illness to reduce social stigma and 
                        promote healthy social support for patients;
            ``(3) any outreach by the State to, and the hiring of, 
        providers of mental health services from multiple disciplines 
        (such as a psychologist, psychiatrist, peer support provider, 
        or social worker) who are members of historically racial and 
        ethnic minority groups;
            ``(4) any outreach by the State to providers from multiple 
        disciplines of mental health services--
                    ``(A) to provide training on culturally effective, 
                culturally affirming, and linguistically competent 
                services; and
                    ``(B) to increase awareness of community-defined 
                practices by practitioners of historically racial and 
                ethnic minority groups; and''.
    (b) Applicability.--The amendments made by subsection (a) shall 
apply with respect to funding agreements entered into under section 
1911 or 1921 of the Public Health Service Act (42 U.S.C. 300x; 42 
U.S.C. 300x-21) on or after the date of the enactment of this Act.

SEC. 6074. STRONG SUPPORT FOR CHILDREN.

    (a) Data Analysis and Strategy Implementation To Prevent and 
Mitigate Childhood Trauma.--Title XXXI of the Public Health Service Act 
(42 U.S.C. 300kk) is amended by adding at the end the following:

``SEC. 3102. DATA ANALYSIS AND STRATEGY IMPLEMENTATION TO PREVENT AND 
              MITIGATE CHILDHOOD TRAUMA.

    ``(a) In General.--The Secretary shall establish a program--
            ``(1) to support the development and implementation of 
        programs that use data analysis methods to identify and 
        facilitate strategies for early intervention and prevention, in 
        order to prevent and mitigate childhood trauma and support 
        communities and families, including--
                    ``(A) improving connections through care 
                coordination;
                    ``(B) aligning community initiatives in targeted 
                areas of need; and
                    ``(C) expanding community capacity through cross-
                sector collaboration; and
            ``(2) to evaluate the effectiveness of these programs in 
        improving outcomes for children.
    ``(b) Grants.--The Secretary shall award grants to up to 5 eligible 
entities to carry out the activities described in subsection (a).
    ``(c) Use of Funds.--A grant for activities under this section 
shall be used to support the development and implementation of programs 
that use data analysis methods to identify and facilitate strategies 
for early intervention and prevention, in order to prevent and mitigate 
childhood trauma and support communities and families, including as 
follows:
            ``(1) Utilize data analysis methods to--
                    ``(A) identify specific geographic areas, such as 
                census tracts, with a high prevalence of adverse 
                childhood experiences and significant risk factors for 
                poor outcomes for children (such as increased risk of 
                experiencing adverse childhood experiences), including 
                areas with high rates of--
                            ``(i) poor public health outcomes including 
                        illness, disease, suicide, and mortality;
                            ``(ii) exclusionary discipline practices, 
                        including suspensions, expulsions, and 
                        referrals to law enforcement, as well as low 
                        graduation rates;
                            ``(iii) substance use disorders;
                            ``(iv) poverty;
                            ``(v) foster system involvement or 
                        referrals;
                            ``(vi) housing instability and 
                        homelessness;
                            ``(vii) food insecurity;
                            ``(viii) inequity, including disparities in 
                        income, wealth, employment, educational 
                        attainment, health care access, and public 
                        health outcomes, along lines of race, sex, 
                        sexuality and gender identity, ethnicity, or 
                        nationality;
                            ``(ix) incarceration rates; or
                            ``(x) other indicators of adversity as 
                        defined by the Secretary; and
                    ``(B) identify strategies to improve outcomes for 
                children aged 0 through 17 that build on strengths in 
                communities that could be further supported, 
                including--
                            ``(i) existing support networks for 
                        families; and
                            ``(ii) enhanced connections to community-
                        based organizations.
            ``(2) Implement strategies identified pursuant to paragraph 
        (1)(B) to facilitate outreach and involvement of children and 
        their caregivers in Federal, State, or local programs that 
        provide reparative, gender-responsive, culturally specific, and 
        trauma-informed prevention services, and for which children and 
        their caregivers are eligible, including--
                    ``(A) home visiting programs;
                    ``(B) training and education on parenting skills;
                    ``(C) substance use disorder prevention and 
                treatment that is voluntary and noncoercive;
                    ``(D) mental health supports and care that is 
                voluntary and noncoercive;
                    ``(E) family and intimate partner violence 
                prevention services;
                    ``(F) child advocacy center programming;
                    ``(G) economic and nutrition support services;
                    ``(H) housing support services, including emergency 
                and temporary shelter for those experiencing 
                homelessness and housing insecurity, as well as stable, 
                long-term housing;
                    ``(I) voluntary, noncoercive, gender-responsive, 
                and culturally specific mental health supports in 
                school and early childhood education center-based 
                settings;
                    ``(J) wraparound programs for transitioning youth 
                and youth currently in the foster system;
                    ``(K) programming to support the health and well-
                being of lesbian, gay, bisexual, transgender, and 
                intersex children and their families; and
                    ``(L) family resource center services.
    ``(d) Special Rules.--
            ``(1) Primary payer restriction.--The Secretary may not 
        award a grant under this section to an eligible entity for a 
        service if the service to be provided is available pursuant to 
        the State plan approved under title XIX of the Social Security 
        Act for the State in which the program funded by the grant is 
        being conducted unless the State and all eligible subdivisions 
        involved--
                    ``(A) will enter into agreements with public or 
                nonprofit private entities under which the entities 
                will provide the service; and
                    ``(B) demonstrate that the State and all eligible 
                subdivisions will ensure that the entities providing 
                the service--
                            ``(i) will seek payment for each such 
                        service rendered in accordance with the usual 
                        payment schedule under the State plan; and
                            ``(ii) the entities have entered into a 
                        participation agreement and are qualified to 
                        receive payments under such plan.
            ``(2) Implementation.--An eligible entity that receives a 
        grant under this section may use--
                    ``(A) not more than 25 percent of the amounts made 
                available through the grant for the first 24 months of 
                the grant period to utilize data analysis methods to--
                            ``(i) identify specific geographic areas 
                        where care coordination, prevention and early 
                        intervention, and facilitation services will be 
                        provided; and
                            ``(ii) identify support and intervention 
                        services to improve outcomes for children 
                        located in a geographic area identified under 
                        subsection (c)(1)(A); and
                    ``(B) not more than 10 percent of the grant in each 
                subsequent year to continue data analysis activities.
            ``(3) Administration.--An eligible entity that receives a 
        grant under this section may not use more than 5 percent of 
        amounts received through the grant for administration, 
        reporting, and program oversight functions, including the 
        development of systems to improve data collection and data 
        sharing for the purposes of improving services and the 
        provision of care.
            ``(4) Priority.--
                    ``(A) In general.--In awarding grants under this 
                section, the Secretary shall give priority, to the 
                extent practical, to eligible entities that use 
                community-based system dynamic modeling as the primary 
                data analysis method.
                    ``(B) System dynamic modeling defined.--The term 
                `system dynamic modeling' means a method of data 
                analysis and predictive modeling that includes--
                            ``(i) utilization of community-based 
                        participatory research methods for involving 
                        community in the process of understanding and 
                        changing systems and evaluating outcomes of 
                        grants;
                            ``(ii) consideration of a multitude of 
                        environmental risk factors and ascertainment of 
                        the significance of contributing community risk 
                        factors for purposes of identifying strategies 
                        to reduce adverse child outcomes, including--
                                    ``(I) maltreatment cases;
                                    ``(II) involvement with the 
                                juvenile criminal legal system or 
                                foster system;
                                    ``(III) exclusionary school 
                                discipline; or
                                    ``(IV) exposure to violence; and
                            ``(iii) identification of cross-sector 
                        responses involving reparative, trauma-
                        informed, culturally specific, gender-
                        responsive, and community-based organizations 
                        to reduce adverse child outcomes.
            ``(5) Subgrant.--
                    ``(A) In general.--An eligible entity that receives 
                a grant under this section shall use at least 25 
                percent of the total amount of the grant to make 
                subgrants to organizations that aide in implementing 
                the strategy identified under subsection (c)(1)(B) for 
                preventing and mitigating childhood trauma and 
                supporting communities and families.
                    ``(B) Eligibility.--To be eligible to receive a 
                subgrant under this paragraph, an organization shall 
                prepare and submit to the eligible entity an 
                application in such form, and containing such 
                information, as the eligible entity may require, 
                including evidence that the--
                            ``(i) needs of the population to be served 
                        are urgent and are not met by the services 
                        currently available in the geographic area; and
                            ``(ii) the organization has the capacity to 
                        provide the services listed in subsection 
                        (c)(2).
                    ``(C) Supplement, not supplant.--Subgrant funds 
                received pursuant to this paragraph by an organization 
                shall be used to supplement and not supplant State or 
                local funds provided to the partnership organization 
                for services listed in subsection (c)(2).
    ``(e) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application in such form, and containing such information, as the 
Secretary may require, to include the following:
            ``(1) A demonstration that--
                    ``(A) the applicant utilizes trauma-informed, 
                culturally specific, and gender-responsive practices, 
                including a demonstration of the extent to which the 
                applicant has trained staff in these practices;
                    ``(B) the applicant has the capacity to administer 
                the grant, including conducting all required data 
                analysis activities; and
                    ``(C) services will be provided to children and 
                families in an accessible, culturally relevant, and 
                linguistically specific manner consistent with local 
                needs.
            ``(2) A preliminary analysis of how the applicant will use 
        the grant to--
                    ``(A) identify the geographic area or areas to be 
                served using data analysis methods;
                    ``(B) utilize data analysis methods to identify 
                strategies to improve outcomes for children in the 
                geographic area;
                    ``(C) facilitate strategies identified through care 
                coordination efforts; and
                    ``(D) track data for evaluation of outcomes.
            ``(3) A detailed project plan for the use of the grant that 
        includes anticipated technical assistance needs.
            ``(4) Additional funding sources, including State and local 
        funds, supporting the prevention and mitigation of adverse 
        childhood experiences.
    ``(f) Grant Amount.--The amount of a grant under this section shall 
not exceed $9,500,000.
    ``(g) Period of a Grant.--The period of a grant under this section 
shall not exceed 7 years.
    ``(h) Service Provision Without Regard to Ability To Pay.--As a 
condition on receipt of a grant under this section, an eligible entity 
shall agree that any assistance provided to an individual through the 
grant will be provided without regard to--
            ``(1) the ability of the individual to pay for such 
        services;
            ``(2) the current or past health condition of the 
        individual to be served;
            ``(3) the immigration status of the individual to be 
        served;
            ``(4) the sexual orientation and gender identity of the 
        individual to be served; and
            ``(5) any prior involvement of the individual in the 
        criminal legal system.
    ``(i) Prohibitions.--In addition to any other prohibitions 
determined by the Secretary, an eligible entity may not use a grant 
under this section to--
            ``(1) use data analysis methods to inform individual case 
        decisions, including child removal or placement decisions, or 
        to target services at certain individuals or families;
            ``(2) require any individual or family to participate in 
        any service or program as a condition of receipt of a benefit 
        to which the individual or family is otherwise eligible;
            ``(3) increase the presence or funding of law enforcement 
        surveillance, involvement, or activity in implementing the 
        strategies identified under subsection (c)(1)(B); or
            ``(4) enable the practice of conversion therapy.
    ``(j) Evaluation.--
            ``(1) Data model evaluation.--Not later than 36 months 
        after the date of enactment of this section, the Assistant 
        Secretary for Planning and Evaluation of the Department of 
        Health and Human Services, in coordination with the grantees 
        receiving a grant under this section, shall complete an 
        evaluation of the effectiveness of the data model accuracy of 
        the grant program under this section to address each of the 
        following:
                    ``(A) Determining the effectiveness of the 
                grantees' use of data analysis methods to identify 
                geographic areas pursuant to subsection (c)(1).
                    ``(B) Examining the grantees' development and 
                utilization of data analysis methods.
                    ``(C) Examining the grantees' ability to 
                effectively utilize data analysis methods in future 
                prevention work.
                    ``(D) Establishing a method for rigorously 
                evaluating the activities of grantees and comparing the 
                reduction of child and family exposure to adverse 
                experiences in other communities with similar 
                demographics.
                    ``(E) Examining the grantees' utilization of 
                community-based system dynamics modeling methods and 
                other community engagement methods.
            ``(2) Program evaluation.--Not later than 6 years after the 
        date of enactment of this section, the Assistant Secretary for 
        Planning and Evaluation of the Department of Health and Human 
        Services, in coordination with eligible entities receiving 
        grants under this section, shall complete an evaluation of the 
        effectiveness of the grant program under this section.
            ``(3) Data collection.--
                    ``(A) In general.--The Assistant Secretary for 
                Planning and Evaluation of the Department of Health and 
                Human Services and each eligible entity receiving a 
                grant under this section shall collect any relevant 
                data necessary to complete the evaluations required by 
                paragraphs (1) and (2) to include--
                            ``(i) the activities funded by the grant 
                        under this section, including development and 
                        implementation data analysis methods;
                            ``(ii) the number of children and of 
                        families receiving coordination and 
                        facilitation of care and services; and
                            ``(iii) the effect of activities supported 
                        by the grant under this section on the local 
                        area serviced by the program, including such 
                        effects on--
                                    ``(I) children and adolescents' 
                                health and well-being;
                                    ``(II) the number of children who 
                                enter into or depart from foster 
                                services; and
                                    ``(III) homelessness and housing 
                                insecurity.
                    ``(B) Study.--
                            ``(i) In general.--Not later than 7 years 
                        after the date of enactment of this section, 
                        the Assistant Secretary for Planning and 
                        Evaluation of the Department of Health and 
                        Human Services shall--
                                    ``(I) complete a study on the 
                                results of the grant program under this 
                                section using the community-based 
                                participatory action research method, 
                                which focuses on social, structural, 
                                and physical environmental inequities 
                                through active involvement of community 
                                members, clients, organizational 
                                representatives, and researchers in all 
                                aspects of the research process; and
                                    ``(II) submit a report on the 
                                results of the study to the Congress.
                            ``(ii) Partners.--In conducting the study 
                        under clause (i), the Assistant Secretary for 
                        Planning and Evaluation of the Department of 
                        Health and Human Services shall ensure that 
                        partners and persons that have participated in 
                        the grant program under this section on every 
                        level, especially those such partners or 
                        persons receiving services and support through 
                        the program, have an opportunity to contribute 
                        their expertise to evaluating the strategy and 
                        outcomes.
    ``(k) Report.--Not later than three months after the completion of 
the evaluation required by subsection (j)(2), the Assistant Secretary 
for Planning and Evaluation of the Department of Health and Human 
Services shall submit to Congress and make available to the public on 
the internet website of the Department of Health and Human Services a 
report based upon the evaluation under subsection (j)(2), to include--
            ``(1) the impact of the program under this section on 
        homelessness and housing insecurity, substance use disorder and 
        drug deaths, incarceration, foster system involvement, and 
        other child and family outcomes as identified by the Assistant 
        Secretary for Planning and Evaluation of the Department of 
        Health and Human Services;
            ``(2) an analysis of which elements of the program should 
        be replicated and scaled by governmental or non-governmental 
        entities; and
            ``(3) such recommendations for legislation and 
        administrative action as the Secretary determines appropriate.
    ``(l) Definitions.--In this section:
            ``(1) The term `adverse childhood experience' means a 
        potentially traumatic experience that occurs in childhood and 
        can have a tremendous impact on the child's lifelong health and 
        opportunity outcomes, such as any of the following:
                    ``(A) Abuse, such as any of the following:
                            ``(i) Emotional and psychological abuse.
                            ``(ii) Physical abuse.
                            ``(iii) Sexual abuse.
                    ``(B) Household challenges such as any of the 
                following:
                            ``(i) A household member is treated 
                        violently.
                            ``(ii) A household member has a substance 
                        use disorder.
                            ``(iii) A household member has a mental 
                        health condition.
                            ``(iv) Parental separation or divorce.
                            ``(v) A household member is incarcerated, 
                        placed in immigrant detention, or has been 
                        deported.
                            ``(vi) A household member has a life-
                        threatening illness such as COVID-19.
                    ``(C) Neglect.
                    ``(D) Living in--
                            ``(i) impoverished communities that lack 
                        access to human services;
                            ``(ii) areas of high unemployment 
                        neighborhoods; or
                            ``(iii) communities experiencing de facto 
                        segregation.
                    ``(E) Experiencing food insecurity and poor 
                nutrition.
                    ``(F) Witnessing violence.
                    ``(G) Involvement with the foster system.
                    ``(H) Experiencing discrimination.
                    ``(I) Dealing with historical and ongoing traumas 
                due to systemic and interpersonal racism.
                    ``(J) Dealing with historical and ongoing traumas 
                regarding systemic and interpersonal sexism, 
                homophobia, biphobia, and transphobia.
                    ``(K) Dealing with the threat of deportation or 
                detention as a result of immigration status.
                    ``(L) The impacts of multigenerational poverty 
                resulting from limited educational and economic 
                opportunities.
                    ``(M) Living through natural disasters such as 
                earthquakes, forest fires, floods, or hurricanes.
            ``(2) The term `eligible entity' means a State or local 
        health department.
            ``(3) The term `practice of conversion therapy'--
                    ``(A) means any practice or treatment by any person 
                that seeks to change another individual's sexual 
                orientation or gender identity, including efforts to 
                change behaviors or gender expressions, or to eliminate 
                or reduce sexual or romantic attractions or feelings 
                toward individuals of the same gender, if such person 
                receives monetary compensation in exchange for any such 
                practice or treatment; and
                    ``(B) does not include any practice or treatment 
                that does not seek to change sexual orientation or 
                gender identity and--
                            ``(i) provides assistance to an individual 
                        undergoing a gender transition; or
                            ``(ii) provides acceptance, support, and 
                        understanding of a client or facilitation of a 
                        client's coping, social support, and identity 
                        exploration and development.
    ``(m) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section for the period of fiscal years 
2023 through 2030--
            ``(1) to carry out subsection (a)(1) through the award of 
        grants under subsection (b)--
                    ``(A) $47,500,000 for grants; and
                    ``(B) such sums as may be necessary for the 
                administrative costs of carrying out such subsection; 
                and
            ``(2) $7,500,000 to carry out the evaluation under 
        subsection (a)(2).''.
    (b) Care Coordination Grants.--Part E of title XII of the Public 
Health Service Act (42 U.S.C. 300d-51 et seq.) is amended by adding at 
the end the following new section:

``SEC. 1255. CARE COORDINATION GRANTS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to establish or expand trauma-informed care coordination 
services to support--
            ``(1) children aged 0 through 5 at risk of adverse 
        childhood experiences; and
            ``(2) their caregivers, including prenatal people of any 
        age.
    ``(b) Number of Grants.--Subject to the availability of 
appropriations, the Secretary shall award not fewer than 9 and not more 
than 40 grants under this section.
    ``(c) Amount of Grants.--Subject to the availability of 
appropriations, the amount of a grant under this section for a fiscal 
year shall be--
            ``(1) not less than $250,000; and
            ``(2) not more than $1,000,000.
    ``(d) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be a local government or Indian Tribe, 
acting through the public health department thereof if such government 
or Tribe has a public health department.
    ``(e) Priority.--
            ``(1) In general.--In awarding grants under this section, 
        the Secretary shall give priority to eligible entities 
        proposing to serve communities with a high need for trauma-
        informed care coordination services, as demonstrated by 
        indicators such as--
                    ``(A) pregnant people who face barriers to prenatal 
                care;
                    ``(B) mortality or morbidity of people giving birth 
                or infants;
                    ``(C) caretakers and parents who are living with a 
                mental health condition or substance use disorder;
                    ``(D) a high prevalence of community violence, 
                including domestic violence, as demonstrated by 
                instances of homicide and public health statistics, 
                including treatment of injury or trauma;
                    ``(E) high proportions of low-income children;
                    ``(F) a high prevalence of child fatalities or near 
                fatalities related to child abuse and neglect;
                    ``(G) significant disparities in health outcomes 
                for people giving birth and infants;
                    ``(H) a high rate of exclusionary discipline and 
                referrals to law enforcement; and
                    ``(I) a high rate of homelessness and housing 
                instability.
            ``(2) Data from tribal areas.--The Secretary, acting 
        through the Director of the Indian Health Service, shall 
        consult with Indian Tribes to establish criteria to measure 
        indicators of need, for purposes of paragraph (1), with respect 
        to Tribal areas.
    ``(f) Use of Funds.--
            ``(1) Required uses.--
                    ``(A) In general.--A grant received under this 
                section shall be used to establish or expand gender-
                responsive, culturally specific, trauma-informed care 
                coordination services, including by instituting and 
                conducting risk and needs assessments including--
                            ``(i) using strengths-based approaches 
                        focused on protective factors for children and 
                        their caregivers, including prenatal people of 
                        any age; and
                            ``(ii) inputting screening results into a 
                        centralized intake system to promote a single 
                        point of access system across providers and 
                        services.
                    ``(B) Training.--A grant received under this 
                section shall be used to ensure that individuals 
                employed through the grant funds, in whole or in part, 
                have received sufficient and up-to-date training on 
                trauma-informed care and strategies that are 
                reparative, culturally sensitive, gender-responsive, 
                and healing-centered.
            ``(2) Permissible uses.--A grant received under this 
        section may be used for any of the following:
                    ``(A) Employing care coordinators, case managers, 
                community health workers, certified infant mental 
                health specialists, and outreach and engagement 
                specialists to work with children and their caregivers, 
                including prenatal individuals, to prevent and respond 
                to adverse childhood experiences by connecting clients 
                with culturally specific, trauma-informed care 
                treatment services, including economic, social, food, 
                and housing supports.
                    ``(B) Providing training described in paragraph 
                (1)(B) to community health providers and community 
                partners.
                    ``(C) Expanding, enhancing, modifying, and 
                connecting the existing network of community programs 
                and services to achieve a more comprehensive and 
                coordinated system of care approach, including--
                            ``(i) developing local infrastructure to 
                        bolster and shape community support systems and 
                        map and build access to services in a 
                        coordinated and comprehensive way; and
                            ``(ii) creating infrastructure to conduct 
                        outreach to children and families, including 
                        those experiencing homelessness and housing 
                        instability, so they acquire access to the 
                        services and supports they need and the 
                        benefits to which they are entitled.
                    ``(D) Compiling information on resources (including 
                any referral services) available through community-
                based organizations and local, State, and Federal 
                agencies, such as--
                            ``(i) programs addressing social 
                        determinants of health, including--
                                    ``(I) emergency, temporary, and 
                                long-term housing;
                                    ``(II) programs that offer free or 
                                affordable and nutritious food;
                                    ``(III) vocational and workforce 
                                development; and
                                    ``(IV) transportation supports;
                            ``(ii) home visiting programs for new 
                        parents and their infants;
                            ``(iii) workforce development programs to 
                        support caregivers in skill building;
                            ``(iv) trauma-responsive, parenting skills-
                        building programs;
                            ``(v) the continuum of substance use 
                        prevention, intervention, and treatment 
                        programs and mental health support programs, 
                        including programs with trauma-informed, 
                        gender-responsive, and culturally specific 
                        counseling; and
                            ``(vi) childcare support and early 
                        childhood education, including Head Start and 
                        Early Head Start programs.
                    ``(E) Subject to subsection (g)(2), establishing or 
                updating a database that compiles data used to track 
                the effectiveness of the care coordination services 
                funded through the grant.
                    ``(F) Developing and implementing referral 
                partnership agreements with community-based 
                organizations, parent organizations, substance use 
                disorder treatment providers and facilities, housing 
                and shelter providers, health care providers, mental 
                health care providers, and Federal and State offices 
                and programs that implement practices to support 
                children ages 0 through 5 who are at risk of adverse 
                childhood experiences and their caregivers, including 
                prenatal people. Such practices shall include--
                            ``(i) a bilateral `warm handoff' system 
                        whereby a grantee understands the needs of the 
                        children and their families, and families are 
                        involved in addressing these needs; and
                            ``(ii) an active service connection whereby 
                        the children and families are each actively 
                        connected with a resource in a well-coordinated 
                        way that ensures availability and direct 
                        contact.
                    ``(G) Supporting cross-system planning and 
                collaboration among employees who may work in emergency 
                medical services, health care services, public health, 
                early childhood education, and substance use disorder 
                treatment and recovery support.
                    ``(H) Providing or subsidizing services to address 
                barriers that children, prenatal individuals, and 
                caregivers face to utilizing community resources and 
                services, such as by providing or subsidizing 
                transportation or childcare costs as applicable and 
                within reasonable amounts.
                    ``(I) Creating or expanding infrastructure and 
                investing in technology, including the provision of 
                communications technology and internet service to 
                children and their caregivers, to enable increased 
                telemedicine capabilities to reach participants.
            ``(3) Indian tribes.--In the case of an eligible entity 
        that is an Indian tribe, the Secretary may waive such 
        provisions of this subsection as the Secretary determines 
        appropriate.
            ``(4) Prohibitions.--In addition to any other prohibitions 
        determined by the Secretary, an eligible entity may not use a 
        grant under this section to--
                    ``(A) use data analysis methods to inform 
                individual case decisions, including child removal or 
                placement decisions, or to target services at certain 
                individuals or families;
                    ``(B) require any individual or family to 
                participate in any service or program as a condition of 
                receipt of a benefit to which the individual or family 
                is otherwise eligible; or
                    ``(C) increase the presence or funding of law 
                enforcement surveillance, involvement, or activity in 
                connection with trauma-informed care coordination 
                services supported pursuant to this section.
    ``(g) Requirements.--As a condition on receipt of a grant under 
this section, an eligible entity shall agree to each of the following 
funding conditions:
            ``(1) Restriction of funding allocation.--The eligible 
        entity will not use more than 30 percent of the funds made 
        available to the entity through the grant (for the total grant 
        period) to establish or update a database pursuant to 
        subsection (f)(2)(E).
            ``(2) Accessible setting.--
                    ``(A) In general.--The eligible entity will ensure 
                that all care coordination services provided through 
                the grant are provided in a setting that is accessible, 
                including through mobile settings, to--
                            ``(i) low-income or no-income individuals, 
                        including individuals experiencing homelessness 
                        or housing instability; and
                            ``(ii) individuals in rural areas.
                    ``(B) Community outreach.--In complying with 
                subparagraph (A), the eligible entity will ensure that 
                at least 50 percent of the care coordination services 
                provided through the grant occur in community settings 
                that are convenient to the children and caregivers who 
                are being served, such as homes, schools, and shelters, 
                whether for initial outreach or as part of long-term 
                care.
            ``(3) Supplement, not supplant.--The grant will be used to 
        supplement, not supplant other Federal, State, or local funds 
        available for care coordination services.
            ``(4) Confidentiality.--The eligible entity will maintain 
        the confidentiality of individuals receiving services through 
        the grant in a manner consistent with applicable law.
            ``(5) Partnering; risk stratification.--In providing care 
        coordination services through the grant, the eligible entity 
        will--
                    ``(A) partner with community-based organizations 
                with experience serving child populations prenatally 
                through age 5;
                    ``(B) coordinate with the local agency responsible 
                for administering the State plan approved under title 
                XIX of the Social Security Act; and
                    ``(C) employ risk stratification to develop 
                different effective models of care for different 
                populations based on their needs.
    ``(h) Application.--
            ``(1) In general.--To seek a grant under this section, an 
        eligible entity shall submit an application to the Secretary at 
        such time, in such manner, and containing such information, as 
        the Secretary may require.
            ``(2) Contents.--An application under paragraph (1) shall, 
        at a minimum, contain each of the following:
                    ``(A) Goals to be achieved through the grant, 
                including the activities that will be undertaken to 
                achieve those goals.
                    ``(B) The number of individuals likely to be served 
                through the grant, including demographic data on the 
                populations to be served.
                    ``(C) Existing programs and services that can be 
                used to significantly increase the proportion of 
                children and families who receive needed supports and 
                services.
                    ``(D) A plan for expanding, coordinating, or 
                modifying the existing network of programs and services 
                to meet the needs of children and families for 
                preventing and mitigating the traumatic impact of 
                adverse childhood experiences.
                    ``(E) A demonstration of the ability of the 
                eligible entity to reach the individuals to be served, 
                including by partnering with local stakeholders.
                    ``(F) An indication of how the personnel involved 
                are reflective of the communities to be served.
                    ``(G) A list of stakeholders with whom the entity 
                plans to partner or consult.
    ``(i) Reporting by Grantees.--Not later than 4 years after the date 
of enactment of this section, an eligible entity receiving a grant 
under this section shall submit to the Secretary a report on the 
activities funded through the grant. Such report shall include, at a 
minimum, a description of--
            ``(1) the number of individuals served through activities 
        funded through the grant, including demographics as applicable;
            ``(2) the number of referrals made through the grant and 
        the rate of such referrals successfully linked or closed;
            ``(3) a qualitative analysis or number of collaborative 
        partnerships with other organizations in carrying out the 
        activities funded through the grant;
            ``(4) the number of services provided to individuals 
        through the grant;
            ``(5) aggregated and de-identified outcomes experienced by 
        individuals served through the grant such as--
                    ``(A) the rate of successful service connections;
                    ``(B) any increases in development of protective 
                factors for children;
                    ``(C) any increase in development of protective 
                factors for the caregivers;
                    ``(D) any mitigation of the negative outcomes 
                associated with adverse childhood experiences or 
                decreased likelihood of children experiencing an 
                adverse childhood experience as evidenced by--
                            ``(i) decreased presence of law enforcement 
                        or other punitive State surveillance in the 
                        community;
                            ``(ii) a parent completing substance use 
                        treatment;
                            ``(iii) a parent receiving voluntary 
                        treatment for mental health-related conditions;
                            ``(iv) a family entering into or 
                        maintaining a stable housing situation;
                            ``(v) a family achieving or maintaining 
                        economic security;
                            ``(vi) a parent achieving or maintaining 
                        job stability; or
                            ``(vii) a child meeting developmental 
                        markers for school readiness; and
                    ``(E) reports of satisfaction with the coordination 
                of care by people served; and
            ``(6) any other information required by the Secretary.
    ``(j) Convening Participants for Sharing Lessons Learned.--After 
the period of all grants awarded under this section has concluded, the 
Assistant Secretary for Planning and Evaluation of the Department of 
Health and Human Services shall provide an in-person or online 
opportunity for persons participating in the programs funded through 
this section to share with each other--
            ``(1) lessons learned;
            ``(2) challenges experienced; and
            ``(3) ideas for next steps and solutions.
    ``(k) Compiling Findings and Conclusions.--After providing the 
opportunity required by subsection (j), the Secretary shall--
            ``(1) compile the findings and conclusions of grantees 
        under this section on the provision of care coordination 
        services described in subsection (a);
            ``(2) submit a report on such findings and conclusions to 
        the appropriate congressional committees; and
            ``(3) make such report publicly available.
    ``(l) Definitions.--In this section:
            ``(1) Adverse childhood experience.--The term `adverse 
        childhood experience' means a potentially traumatic experience 
        that occurs in childhood and can have a tremendous impact on 
        the child's lifelong health and opportunity outcomes, such as 
        any of the following:
                    ``(A) Abuse, such as any of the following:
                            ``(i) Emotional and psychological abuse.
                            ``(ii) Physical abuse.
                            ``(iii) Sexual abuse.
                    ``(B) Household challenges such as any of the 
                following:
                            ``(i) A household member is treated 
                        violently.
                            ``(ii) A household member has a substance 
                        use disorder.
                            ``(iii) A household member has a mental 
                        health condition.
                            ``(iv) Parental separation or divorce.
                            ``(v) A household member is incarcerated, 
                        placed in immigrant detention, or has been 
                        deported.
                            ``(vi) A household member has a life-
                        threatening illness such as COVID-19.
                    ``(C) Neglect.
                    ``(D) Living in--
                            ``(i) impoverished communities that lack 
                        access to human services;
                            ``(ii) areas of high unemployment 
                        neighborhoods; or
                            ``(iii) communities experiencing de facto 
                        segregation.
                    ``(E) Experiencing food insecurity and poor 
                nutrition.
                    ``(F) Witnessing violence.
                    ``(G) Involvement with the foster system.
                    ``(H) Experiencing discrimination.
                    ``(I) Dealing with historical and ongoing traumas 
                due to systemic and interpersonal racism.
                    ``(J) Dealing with historical and ongoing traumas 
                regarding systemic and interpersonal sexism, 
                homophobia, biphobia, and transphobia.
                    ``(K) Dealing with the threat of deportation or 
                detention as a result of immigration status.
                    ``(L) The impacts of multigenerational poverty 
                resulting from limited educational and economic 
                opportunities.
                    ``(M) Living through natural disasters such as 
                earthquakes, forest fires, floods, or hurricanes.
            ``(2) Care coordination.--The term `care coordination' 
        means an active, ongoing process that--
                    ``(A) assists children ages 0 through 5 at risk of, 
                or who have experienced, an adverse childhood 
                experience, and their caregivers, including prenatal 
                people of any age, to identify, access, and use 
                community resources and services;
                    ``(B) is client-centered and comprehensive of the 
                services a child or caregiver may need;
                    ``(C) ensures a closed loop referral by obtaining 
                feedback from the families served; and
                    ``(D) works across systems and services to promote 
                collaboration to effectively meet the needs of 
                community members.
            ``(3) Indian tribe.--The term `Indian Tribe' has the 
        meaning given such term in section 4 of the Indian Self-
        Determination and Education Assistance Act.
            ``(4) Protective factors.--The term `protective factors' 
        refers to any supportive element in a child or caretaker's life 
        that helps the child or caretaker to withstand trauma such as a 
        stable school environment or supportive peer relationships.
    ``(m) Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there is 
        authorized to be appropriated $15,000,000 for each of the 5 
        fiscal years following the fiscal year in which this section is 
        enacted.
            ``(2) Grants to indian tribes.--Of the amount made 
        available to carry out this section for a fiscal year, the 
        Secretary shall use not less than 10 percent of such amount for 
        grants to eligible entities that are Indian tribes.
            ``(3) Administrative expenses.--Of the amount made 
        available to carry out this section for a fiscal year, the 
        Secretary may use not more than 15 percent of such amount for 
        administrative expenses, including the expenses of the 
        Assistant Secretary for Planning and Evaluation of the 
        Department of Health and Human Services for compiling and 
        reporting information.
            ``(4) Technical assistance.--Of the amount made available 
        to carry out this section for a fiscal year, the Secretary may 
        reserve up to 5 percent of such amount to provide technical 
        assistance to eligible entities in preparing and submitting 
        applications under this section.''.

SEC. 6075. IMPROVING ACCESS TO MENTAL HEALTH.

    (a) Access to Clinical Social Workers.--Section 1833(a)(1)(F)(ii) 
of the Social Security Act (42 U.S.C. 1395l(a)(1)(F)(ii)) is amended by 
striking ``75 percent of the amount determined for payment of a 
psychologist under clause (L)'' and inserting ``85 percent of the fee 
schedule amount provided under section 1848''.
    (b) Access to Clinical Social Worker Services Provided to Residents 
of Skilled Nursing Facilities.--
            (1) In general.--Section 1888(e)(2)(A)(ii) of the Social 
        Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by 
        inserting ``clinical social worker services,'' after 
        ``qualified psychologist services,''.
            (2) Conforming amendment.--Section 1861(hh)(2) of the 
        Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by 
        striking ``and other than services furnished to an inpatient of 
        a skilled nursing facility which the facility is required to 
        provide as a requirement for participation''.
    (c) Access to the Complete Set of Clinical Social Worker 
Services.--Section 1861(hh)(2) of the Social Security Act (42 U.S.C. 
1395x(hh)(2)) is further amended by striking ``for the diagnosis and 
treatment of mental illnesses (other than services'' and inserting 
``(including services for the diagnosis and treatment of mental 
illnesses or services for health and behavior assessment and 
intervention (identified as of January 1, 2021, by HCPCS codes 96150 
through 96161 (and any succeeding codes)), but not including 
services''.
    (d) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2022.

SEC. 6076. MENTAL HEALTH IN SCHOOLS EXCELLENCE PROGRAM.

    (a) Program To Establish Public-Private Contributions To Increase 
the Available Workforce of School-Based Mental Health Service 
Providers.--
            (1) Program authorized.--The Secretary shall carry out a 
        program under which eligible graduate institutions may enter 
        into an agreement with the Secretary to cover a portion of the 
        cost of attendance of a participating student, which 
        contributions shall be matched by equivalent contributions 
        towards such cost of attendance by the Secretary.
            (2) Designation of program.--The program under this 
        subsection shall be known as the ``Mental Health in Schools 
        Excellence Program''.
            (3) Agreements.--The Secretary shall enter into an 
        agreement with each eligible graduate institution seeking to 
        participate in the program under this section. Each agreement 
        shall specify the following:
                    (A) The manner (whether by direct grant, 
                scholarship, or otherwise) in which the eligible 
                graduate institution will contribute to the cost of 
                attendance of a participating student.
                    (B) The maximum amount of the contribution to be 
                made by the eligible graduate institution with respect 
                to any particular participating student in any given 
                academic year.
                    (C) The maximum number of individuals for whom the 
                eligible graduate institution will make contributions 
                in any given academic year.
                    (D) That the eligible graduate institution, in 
                selecting participating students to receive assistance 
                under the program, shall prioritize the participating 
                students described in paragraph (4)(B).
                    (E) Such other matters as the Secretary and the 
                eligible graduate institution determine appropriate.
            (4) Outreach.--The Secretary shall--
                    (A) make publicly available and periodically update 
                on the internet website of the Department of Education 
                a list of the eligible graduate institutions 
                participating in the program under this subsection that 
                shall specify, for each such graduate institution, 
                appropriate information on the agreement between the 
                Secretary and such college or university under 
                paragraph (3); and
                    (B) conduct outreach about the program under this 
                section to participating students who, as 
                undergraduates--
                            (i) received a Federal Pell Grant under 
                        section 401 of the Higher Education Act of 1965 
                        (20 U.S.C. 1070a); or
                            (ii) attended an institution listed in 
                        section 371(a) of the Higher Education Act of 
                        1965 (20 U.S.C. 1067q(a)).
            (5) Matching contributions.--The Secretary may provide a 
        contribution of up to 50 percent of the cost of attendance of a 
        participating student if the eligible graduate institution at 
        which such student is enrolled enters into an agreement under 
        paragraph (3) with the Secretary to match such contribution.
    (b) Definitions.--In this section:
            (1) Cost of attendance.--The term ``cost of attendance'' 
        has the meaning given the term in section 472 of the Higher 
        Education Act of 1965 (20 U.S.C. 1087ll).
            (2) Eligible graduate institution.--The term ``eligible 
        graduate institution'' means an institution of higher education 
        that offers a program of study that leads to a graduate 
        degree--
                    (A) in school psychology that is accredited or 
                approved by the National Association of School 
                Psychologists' Program Accreditation Board or the 
                Commission on Accreditation of the American 
                Psychological Association and that prepares students in 
                such program for the State licensing or certification 
                examination in school psychology at the specialist 
                level;
                    (B) in an accredited school counseling program that 
                prepares students in such program for the State 
                licensing or certification examination in school 
                counseling;
                    (C) in school social work that is accredited by the 
                Council on Social Work Education and that prepares 
                students in such program for the State licensing or 
                certification examination in school social work;
                    (D) in another school-based mental health field 
                that prepares students in such program for the State 
                licensing or certification examination in such field, 
                if applicable; or
                    (E) in any combination of study described in 
                subparagraphs (A) through (D).
            (3) Institution of higher education.--The term 
        ``institution of higher education'' has the meaning given such 
        term in section 101 of the Higher Education Act of 1965 (20 
        U.S.C. 1001), but excludes any institution of higher education 
        described in section 102(a)(1)(C) of such Act.
            (4) Participating student.--The term ``participating 
        student'' means an individual who is enrolled in a graduate 
        degree program in a school-based mental health field at a 
        participating eligible graduate institution.
            (5) School-based mental health field.--The term ``school-
        based mental health field'' means each of the following fields:
                    (A) School counseling.
                    (B) School social work.
                    (C) School psychology.
                    (D) Any other field of study that leads to 
                employment as a school-based mental health services 
                provider, as determined by the Secretary.
            (6) School-based mental health services provider.--The term 
        ``school-based mental health services provider'' has the 
        meaning given the term in section 4102 of the Elementary and 
        Secondary Education Act of 1965 (20 U.S.C. 7112).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Education.

SEC. 6077. SCHOOL SOCIAL WORKERS IMPROVING STUDENT SUCCESS.

    (a) School Social Worker Grants.--
            (1) Purposes.--The purpose of this section is to assist 
        States and local educational agencies in hiring additional 
        school social workers in order to increase access to mental 
        health and other student support services to students in 
        elementary and secondary schools in the United States to the 
        minimum ratios recommended by the National Association of 
        Social Workers, the School Social Work Association of America, 
        and the American Council for School Social Work of one school 
        social worker for every 250 students, and one school social 
        worker for every 50 students when a social worker is providing 
        services to students with intensive needs.
            (2) ESEA amendment.--Subpart 4 of part F of title IV of the 
        Elementary and Secondary Education Act of 1965 (10 U.S.C. 7271 
        et seq.) is amended by adding at the end the following new 
        section:

``SEC. 4645. GRANTS FOR SCHOOL SOCIAL WORKERS.

    ``(a) Grants Authorized.--
            ``(1) In general.--From the amounts appropriated under 
        subsection (g), the Secretary shall award grants to high-need 
        local educational agencies to enable such agencies to retain 
        school social workers employed by such agencies or to hire 
        additional school social workers.
            ``(2) Duration.--A grant awarded under this section shall 
        be awarded for a period not to exceed 4 years.
            ``(3) Supplement, not supplant.--Funds made available under 
        this section shall be used to supplement, and not to supplant, 
        other Federal, State, or local funds used for hiring and 
        retaining school social workers.
    ``(b) Application.--
            ``(1) In general.--To be eligible to receive a grant under 
        this section, a high-need local educational agency shall submit 
        to the Secretary an application at such time, in such manner, 
        and containing such information as the Secretary may require.
            ``(2) Contents.--An application submitted under paragraph 
        (1) shall include an assurance that each school social worker 
        who receives assistance under the grant will provide the 
        services described in subsection (d), and a description of the 
        specific services to be provided by such social worker.
    ``(c) Use of Funds.--A high-need local educational agency receiving 
a grant under this section--
            ``(1) shall use the grant--
                    ``(A) to achieve a ratio of not less than 1 school 
                social worker for every 250 students served by the 
                agency, by--
                            ``(i) retaining school social workers 
                        employed by such agency; or
                            ``(ii)(I) employing additional school 
                        social workers; or
                            ``(II) hiring contractors to serve as 
                        school social workers only in a case in which--
                                    ``(aa) the local educational agency 
                                demonstrates to the Secretary that the 
                                agency--
                                            ``(AA) has not been able to 
                                        employ a sufficient number of 
                                        school social workers under 
                                        subclause (I) to achieve such 
                                        ratio despite strong and 
                                        continuing efforts to recruit 
                                        and employ school social 
                                        workers; and
                                            ``(BB) hiring contractors 
                                        is the only viable option to 
                                        ensure students have adequate 
                                        access to school social work 
                                        services; and
                                    ``(bb) each such contractor meets 
                                the requirements of subparagraphs (A) 
                                and (B) of subsection (h)(2); and
                    ``(B) to ensure that each school social worker who 
                receives assistance under such grant provides the 
                services described in subsection (d); and
            ``(2) may use the grant to reimburse school social workers 
        who receive assistance under such grant for--
                    ``(A) in the case of a school served by the agency 
                in which the majority of students are higher risk 
                students, to hire or retain additional school social 
                workers in accordance with clauses (i) and (ii) of 
                paragraph (1)(A) to achieve a ratio of not less than 1 
                school social worker for every 50 students;
                    ``(B) travel expenses incurred during home visits 
                and other school-related trips;
                    ``(C) any additional expenses incurred by such 
                social workers in rendering any service described in 
                subsection (d); and
                    ``(D) the cost of clinical social work supervision 
                for such social workers.
    ``(d) Responsibilities of a School Social Worker.--A school social 
worker who receives assistance under a grant under this section shall 
provide the following services:
            ``(1) Identifying high-need students in each school that 
        the social worker serves, and targeting services provided at 
        the school to such students.
            ``(2) Providing students in each school that the school 
        social worker serves, social work services to promote school 
        engagement and improve academic outcomes, including--
                    ``(A) counseling and crisis intervention;
                    ``(B) trauma-informed services;
                    ``(C) evidence-based educational, behavioral, and 
                mental health services (such as implementing multi-
                tiered programs and practices, monitoring progress, and 
                evaluating service effectiveness);
                    ``(D) addressing the social and emotional learning 
                needs of students;
                    ``(E) promoting a school climate and culture 
                conducive to student learning and teaching excellence 
                (such as promoting effective school policies and 
                administrative procedures, enhancing the professional 
                capacity of school personnel, and facilitating 
                engagement between student, family, school, and 
                community);
                    ``(F) providing access to school-based and 
                community based resources (such as promoting a 
                continuum of services, mobilizing resources and 
                promoting assets, and providing leadership, 
                interdisciplinary collaboration, systems coordination, 
                professional consultation, and connecting students and 
                families to resource systems);
                    ``(G) working with students, families, schools, and 
                communities to address barriers to educational 
                attainment (such as homelessness and housing 
                insecurity, lack of transportation, food insecurity, 
                equity, social justice issues, access to quality 
                education, and school, family, and community risk 
                factors);
                    ``(H) providing assistance to schools and teachers 
                to design social-emotional, educational, behavioral, 
                and mental health interventions;
                    ``(I) case management activities to coordinate the 
                delivery of and access to the appropriate social work 
                services to the highest-need students;
                    ``(J) home visits to meet the family of students in 
                need of social work services in the home environment;
                    ``(K) supervising or coordinating district level 
                school social work services; and
                    ``(L) other services the Secretary determines, in 
                partnership with students, educators, and community 
                member voices are necessary to be carried out by such a 
                social worker.
    ``(e) Grant Renewal.--
            ``(1) In general.--A grant awarded under this section may 
        be renewed for additional periods with the same duration as the 
        original grant period.
            ``(2) Continuing eligibility application.--To be eligible 
        for a renewal under this section a high-need local educational 
        agency shall submit to the Secretary, for each renewal, a 
        report on the progress of such agency in retaining and hiring 
        school social workers to achieve the ratio of not less than 1 
        school social worker for every 250 students served by the 
        agency, and shall include--
                    ``(A) a description of the staffing expansion of 
                school social workers funded through the original grant 
                received under this section; and
                    ``(B) a description of the work conducted by such 
                social workers for higher risk students.
    ``(f) Technical Assistance.--
            ``(1) In general.--The Secretary shall provide technical 
        assistance to high-need local educational agencies, including 
        such agencies that do not have adequate staff, in applying for 
        grants under this section.
            ``(2) Extension of application period.--The Secretary shall 
        extend any application period for a grant under this section 
        for any high-need local educational agency that--
                    ``(A) submits to the Secretary a written 
                notification of the intent to apply for a grant under 
                this section before requesting technical assistance 
                under paragraph (1); and
                    ``(B) after submitting the notification under 
                paragraph (1), requests such technical assistance.
    ``(g) Authorization for Appropriations.--There is authorized to be 
appropriated to carry out this section, $100,000,000 for each of fiscal 
years 2023 through 2027.
    ``(h) Definitions.--In this section:
            ``(1) High-need local educational agency.--The term `high-
        need local educational agency' has the meaning given the term 
        in section 200 of the Higher Education Act of 1965 (20 U.S.C. 
        1021).
            ``(2) School social worker.--The term `school social 
        worker' means an individual who--
                    ``(A) has a graduate degree in social work from a 
                social work program that is accredited by the Council 
                on Social Work Education; and
                    ``(B) meets all other State and local credentialing 
                requirements for practicing as a social worker in an 
                elementary school or secondary school.''.
    (b) National Technical Assistance Center for School Social Work.--
            (1) In general.--The Secretary of Education, acting through 
        the Assistant Secretary, shall establish an evaluation, 
        documentation, dissemination, and technical assistance resource 
        center to provide appropriate information, training, and 
        technical assistance to States, political subdivisions of 
        States, federally recognized Indian Tribes, Tribal 
        organizations, institutions of higher education, State and 
        local educational agencies, and individual students and 
        educators with respect to hiring and retaining school social 
        workers at elementary schools and secondary schools served by 
        local educational agencies.
            (2) Responsibilities of the center.--The center established 
        under paragraph (1) shall conduct activities for the purpose 
        of--
                    (A) developing and continuing statewide or Tribal 
                strategies for improving the effectiveness of the 
                school social work workforce;
                    (B) studying the costs and effectiveness of school 
                social work programs at institutions of higher 
                education to identify areas of improvement and provide 
                information on relevant issues of importance to State, 
                Tribal, and national policymakers;
                    (C) working with Federal agencies and other State, 
                Tribal, and national stakeholders to collect, evaluate, 
                and disseminate data regarding school social work 
                ratios, outcomes and best practices of school-based 
                mental health services, and impact of expanding the 
                number of school social workers within elementary 
                schools and secondary schools; and
                    (D) establishing partnerships among National, 
                State, Tribal, and local governments, and local 
                educational agencies, institutions of higher education, 
                non-profit organizations, and State and national trade 
                associations for the purposes of--
                            (i) data collection and dissemination;
                            (ii) establishing a school social work 
                        workforce development program;
                            (iii) documenting the success of school 
                        social work methods on a national level; and
                            (iv) conducting other activities determined 
                        appropriate by the Secretary.
            (3) Definitions.--In this subsection:
                    (A) ESEA terms.--Except as otherwise provided, any 
                term used in this subsection that is defined in section 
                8101 of the Elementary and Secondary Education Act of 
                1965 (20 U.S.C. 7801) shall have the meaning given that 
                term in such section.
                    (B) School social worker.--The term ``school social 
                worker'' has the meaning given the term in section 
                4645(h) of the Elementary and Secondary Education Act 
                of 1965, as added by subsection (a).

SEC. 6078. OPIOID GRANTS TO SUPPORT CAREGIVERS, KINSHIP CARE FAMILIES, 
              AND KINSHIP CAREGIVERS.

    (a) Opioid Grants.--Section 1003(b)(2) of the 21st Century Cures 
Act (42 U.S.C. 290ee-3 note) is amended--
            (1) by redesignating subparagraph (E) as subparagraph (F); 
        and
            (2) by inserting after subparagraph (D) the following:
                    ``(E) Supporting opioid abuse prevention and 
                treatment services within a State provided by State and 
                local agencies for children and caregivers, kinship 
                care families, and kinship caregivers through--
                            ``(i) workforce recruitment and training;
                            ``(ii) health care services (including such 
                        services described in subparagraph (D)); and
                            ``(iii) foster and adoptive parent 
                        recruitment and training.''.
    (b) Definitions.--Section 1003 of the 21st Century Cures Act (42 
U.S.C. 290ee-3 note) is amended--
            (1) by redesignating subsections (h), (i), and (j) as 
        subsections (i), (j), and (k), respectively; and
            (2) by inserting after subsection (g) the following:
    ``(h) Definitions.--In this section:
            ``(1) The term `kinship care family' means a family with a 
        kinship caregiver.
            ``(2) The term `kinship caregiver' means a relative of a 
        child by blood, marriage, or adoption, who--
                    ``(A) lives with the child;
                    ``(B) is the primary caregiver of the child because 
                the biological or adoptive parent of the child is 
                unable or unwilling to serve as the primary caregiver 
                of the child; and
                    ``(C) has a legal relationship to the child or is 
                raising the child informally.''.
    (c) Authorization of Appropriations.--Section 1003(i) of the 21st 
Century Cures Act (42 U.S.C. 290ee-3 note), as redesignated, is amended 
by inserting ``, and $255,000,000 for each of fiscal years 2022 through 
2026'' after ``2021''.
    (d) Set Aside.--Section 1003(j) of the 21st Century Cures Act (42 
U.S.C. 290ee-3 note), as redesignated, is amended--
            (1) by striking ``, and up to'' and inserting ``, up to''; 
        and
            (2) by inserting before the period at the end ``, and 1 
        percent of such amount for such fiscal year shall be made 
        available to carry out subsection (b)(2)(E)''.

SEC. 6079. ADVANCING STUDENT SERVICES IN SCHOOLS TODAY ACT (ASSIST 
              ACT).

    (a) Program To Increase Mental Health and Substance Use Disorder 
Care Providers in Schools and School-Based Health Centers.--Subpart I 
of part D of title III of the Public Health Service Act (42 U.S.C. 254b 
et seq.) is amended by adding at the end the following:

``SEC. 330O. PROGRAM TO INCREASE MENTAL HEALTH AND SUBSTANCE USE 
              DISORDER CARE PROVIDERS IN SCHOOLS AND SCHOOL-BASED 
              HEALTH CENTERS.

    ``(a) In General.--Not later than 3 months after the date of 
enactment of this section, the Secretary, in consultation with the 
Secretary of Education, shall award grants, contracts, or cooperative 
agreements to eligible entities to increase the number of mental health 
and substance use disorder care providers in schools and health centers 
served by such entities.
    ``(b) Application.--An eligible entity seeking an award under this 
section shall submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary may 
require, including a description of--
            ``(1) the mental health and substance use disorder needs of 
        the student population served by the eligible entity; and
            ``(2) with respect to the student population served by the 
        eligible entity, how the eligible entity will ensure that the 
        mental health and substance use disorder care providers 
        supported by the eligible entity, and the services administered 
        by such providers, are culturally competent and linguistically 
        appropriate.
    ``(c) Reporting.--
            ``(1) Eligible entity reporting.--Eligible entities 
        receiving an award under this section shall submit an annual 
        report to the Secretary accompanied by such information as the 
        Secretary may require, including--
                    ``(A) the number of mental health and substance use 
                disorder care providers working at the schools or 
                health centers served by the eligible entity, and the 
                number of such providers supported through the award;
                    ``(B) the types of services provided by the mental 
                health and substance use disorder care providers and 
                the efficacy of such services;
                    ``(C) the practices used by the schools or health 
                centers served by the eligible entity to recruit and 
                retain mental health and substance use disorder care 
                providers; and
                    ``(D) the rates of retention of mental health and 
                substance use disorder care providers at the school or 
                health center.
            ``(2) Secretary.--Not later than 18 months after the date 
        of enactment of this section, and annually thereafter, the 
        Secretary shall submit to Congress a report on the 
        effectiveness of the awards under this section.
    ``(d) Definitions.--In this section:
            ``(1) Eligible entity.--The term `eligible entity' means--
                    ``(A) a local educational agency, as defined in 
                section 8101 of the Elementary and Secondary Education 
                Act of 1965;
                    ``(B) an institution of higher education (as 
                defined in section 101 of the Higher Education Act of 
                1965);
                    ``(C) a school operated by the Bureau of Indian 
                Affairs; or
                    ``(D) a school-based health center, as defined in 
                section 399Z-1(a)(3).
            ``(2) Mental health and substance use disorder care 
        provider.--The term `behavioral health care provider' means an 
        individual who is licensed to provide mental and behavioral 
        health services, including--
                    ``(A) a school counselor;
                    ``(B) a school psychologist or any other 
                psychologist;
                    ``(C) a psychiatrist who specializes in child or 
                adolescent psychiatry;
                    ``(D) a school social worker; and
                    ``(E) other providers, as the Secretary determines 
                appropriate.''.
    (b) Increasing the Applicable FMAP for State Expenditures 
Attributable to Certain Behavioral Health Services.--Section 1905 of 
the Social Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (b), by striking ``and (ii)'' and 
        inserting ``(ii), and (jj)''; and
            (2) by adding at the end the following new subsection:
    ``(jj)(1) Notwithstanding any preceding provision of this section, 
with respect to State expenditures for medical assistance consisting of 
services provided by a behavioral care provider and furnished at a 
school (as defined in section 330O(d) of the Public Health Service Act) 
or at a school-based health center (as defined in section 399Z-1(a)(3) 
of such Act) on or after the date that is 3 months after the date of 
the enactment of this subsection, the Federal medical assistance 
percentage otherwise determined under subsection (b) shall, subject to 
paragraph (2), be equal to 90 percent.
    ``(2) Paragraph (1) shall not apply in the case of State 
expenditures described in such paragraph if application of such 
paragraph would result in a lower Federal medical assistance percentage 
for such expenditures than would otherwise apply without application of 
such paragraph.''.

          TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES

                           Subtitle A--Cancer

SEC. 7001. LUNG CANCER MORTALITY REDUCTION.

    (a) Findings.--Congress makes the following findings:
            (1) Lung cancer is the leading cause of cancer death for 
        both men and women, accounting for 25 percent of all cancer 
        deaths.
            (2) Since the National Cancer Act of 1971 (Public Law 92-
        218; 85 Stat. 778), coordinated and comprehensive research has 
        raised the 5-year survival rates for breast cancer to 90 
        percent, for prostate cancer to 99 percent, and for colon 
        cancer to 64 percent.
            (3) The 5-year survival rate for lung cancer is still only 
        18 percent, and a similar coordinated and comprehensive 
        research effort is required to achieve increases in lung cancer 
        survivability rates.
            (4) Sixty percent of lung cancer cases are now diagnosed in 
        nonsmokers or former smokers.
            (5) Two-thirds of nonsmokers diagnosed with lung cancer are 
        women.
            (6) Certain minority populations, such as African-American 
        males, have disproportionately high rates of lung cancer 
        incidence and mortality, despite their smoking rate being 
        similar to other racial groups.
            (7) Members of the Baby Boomer Generation are entering 
        their 60s, the most common age at which people develop lung 
        cancer.
            (8) Tobacco addiction and exposure to other lung cancer 
        carcinogens such as Agent Orange and other herbicides and 
        battlefield emissions are serious problems among military 
        personnel and war veterans.
            (9) Significant and rapid improvements in lung cancer 
        mortality can be expected through greater use and access to 
        lung cancer screening tests for at-risk individuals.
            (10) Recent research has shown that screening with low-dose 
        computed tomography scan reduced lung cancer death mortality by 
        20 percent for those with a high risk of lung cancer through 
        early detection. The Centers for Medicare & Medicaid Services 
        supports annual lung cancer screening for high-risk patients 
        with low-dose computed tomography.
            (11) Additional strategies are necessary to further enhance 
        the existing tests and therapies available to diagnose and 
        treat lung cancer in the future.
            (12) The August 2001 Report of the Lung Cancer Progress 
        Review Group of the National Cancer Institute stated that 
        funding for lung cancer research was ``far below the levels 
        characterized for other common malignancies and far out of 
        proportion to its massive health impact''.
            (13) The Report of the Lung Cancer Progress Review Group 
        identified as its ``highest priority'' the creation of 
        integrated, multidisciplinary, multi-institutional research 
        consortia organized around the problem of lung cancer rather 
        than around specific research disciplines.
            (14) The United States must enhance its response to the 
        issues raised in the Report of the Lung Cancer Progress Review 
        Group, and this can be accomplished through the establishment 
        of a coordinated effort designed to reduce the lung cancer 
        mortality rate by 50 percent by 2020 and targeted funding to 
        support this coordinated effort.
    (b) Sense of Congress Concerning Investment in Lung Cancer 
Research.--It is the sense of the Congress that--
            (1) lung cancer mortality reduction should be made a 
        national public health priority; and
            (2) a comprehensive mortality reduction program coordinated 
        by the Secretary of Health and Human Services is justified and 
        necessary to adequately address and reduce lung cancer 
        mortality.
    (c) Lung Cancer Mortality Reduction Program.--
            (1) In general.--Subpart 1 of part C of title IV of the 
        Public Health Service Act (42 U.S.C. 285 et seq.) is amended by 
        adding at the end the following:

``SEC. 417H. LUNG CANCER MORTALITY REDUCTION PROGRAM.

    ``(a) In General.--Not later than 6 months after the date of the 
enactment of the Health Equity and Accountability Act of 2022, the 
Secretary, in consultation with the Secretary of Defense, the Secretary 
of Veterans Affairs, the Director of the National Institutes of Health, 
the Director of the Centers for Disease Control and Prevention, the 
Commissioner of Food and Drugs, the Administrator of the Centers for 
Medicare & Medicaid Services, the Director of the National Institute on 
Minority Health and Health Disparities, the Administrator of the 
Environmental Protection Agency, and other members of the Lung Cancer 
Advisory Board established under section 7001 of the Health Equity and 
Accountability Act of 2022, shall implement a comprehensive program, to 
be known as the Lung Cancer Mortality Reduction Program, to achieve a 
reduction of at least 25 percent in the mortality rate of lung cancer 
by 2027.
    ``(b) Requirements.--The Program shall include at least the 
following:
            ``(1) With respect to the National Institutes of Health--
                    ``(A) a strategic review and prioritization by the 
                National Cancer Institute of research grants to achieve 
                the goal specified in subsection (a);
                    ``(B) the provision of funds to enable the Airway 
                Biology and Disease Branch of the National Heart, Lung, 
                and Blood Institute to expand its research programs to 
                include predispositions to lung cancer, the 
                interrelationship between lung cancer and other 
                pulmonary and cardiac disease, and the diagnosis and 
                treatment of such diseases;
                    ``(C) the provision of funds to enable the National 
                Institute of Biomedical Imaging and Bioengineering to 
                expedite the development of computer-assisted 
                diagnostic, surgical, treatment, and drug-testing 
                innovations to reduce lung cancer mortality, such as 
                through expansion of the Institute's Quantum Grant 
                Program and Image-Guided Interventions program; and
                    ``(D) the provision of funds to enable the National 
                Institute of Environmental Health Sciences to implement 
                research programs relative to the lung cancer 
                incidence.
            ``(2) With respect to the Food and Drug Administration--
                    ``(A) activities under section 529B of the Federal 
                Food, Drug, and Cosmetic Act; and
                    ``(B) activities under section 561 of the Federal 
                Food, Drug, and Cosmetic Act to expand access to 
                investigational drugs and devices for the diagnosis, 
                monitoring, or treatment of lung cancer.
            ``(3) With respect to the Centers for Disease Control and 
        Prevention, the establishment of an early disease research and 
        management program under section 1511.
            ``(4) With respect to the Agency for Healthcare Research 
        and Quality, the conduct of a biannual review of lung cancer 
        screening, diagnostic, and treatment protocols, and the 
        issuance of updated guidelines.
            ``(5) The promotion (including education) of lung cancer 
        screening within minority and rural populations and the study 
        of the effectiveness of efforts to increase such screening.
            ``(6) The cooperation and coordination of all minority and 
        health disparity programs within the Department of Health and 
        Human Services to ensure that all aspects of the Lung Cancer 
        Mortality Reduction Program under this section adequately 
        address the burden of lung cancer on minority and rural 
        populations.
            ``(7) The cooperation and coordination of all tobacco 
        control and cessation programs within agencies of the 
        Department of Health and Human Services to achieve the goals of 
        the Lung Cancer Mortality Reduction Program under this section 
        with particular emphasis on the coordination of drug and other 
        cessation treatments with early detection protocols.''.
            (2) Federal food, drug, and cosmetic act.--Subchapter B of 
        chapter V of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 360aaa et seq.) is amended by adding at the end the 
        following:

``SEC. 529B. DRUGS RELATING TO LUNG CANCER.

    ``(a) In General.--The provisions of this subchapter shall apply to 
a drug described in subsection (b) to the same extent and in the same 
manner as such provisions apply to a drug for a rare disease or 
condition (as defined in section 526).
    ``(b) Qualified Drugs.--A drug described in this subsection is--
            ``(1) a chemoprevention drug for precancerous conditions of 
        the lung;
            ``(2) a drug for targeted therapeutic treatments, including 
        any vaccine, for lung cancer; or
            ``(3) a drug to curtail or prevent nicotine addiction.
    ``(c) Board.--The Board established under section 7001 of the 
Health Equity and Accountability Act of 2022 shall monitor the program 
implemented under this section.''.
            (3) Access to unapproved therapies.--Section 561(e) of the 
        Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is 
        amended by inserting before the period the following: ``and 
        shall include expanding access to drugs under section 529B, 
        with substantial consideration being given to whether the 
        totality of information available to the Secretary regarding 
        the safety and effectiveness of an investigational drug, as 
        compared to the risk of morbidity and death from the disease, 
        indicates that a patient may obtain more benefit than risk if 
        treated with the drug''.
            (4) CDC.--Title XV of the Public Health Service Act (42 
        U.S.C. 300k et seq.) is amended by adding at the end the 
        following:

``SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT PROGRAM.

    ``The Secretary shall establish and implement an early disease 
research and management program targeted at the high incidence and 
mortality rates of lung cancer among minority and low-income 
populations.''.
    (d) Department of Defense and the Department of Veterans Affairs.--
The Secretary of Defense and the Secretary of Veterans Affairs, each in 
coordination with the Secretary of Health and Human Services, shall 
engage--
            (1) in the implementation within the Department of Defense 
        and the Department of Veterans Affairs of an early detection 
        and disease management research program for military personnel 
        and veterans whose smoking history and exposure to carcinogens 
        during active duty service has increased their risk for lung 
        cancer; and
            (2) in the implementation of coordinated care programs for 
        military personnel and veterans diagnosed with lung cancer.
    (e) Lung Cancer Advisory Board.--
            (1) In general.--The Secretary of Health and Human Services 
        shall convene a Lung Cancer Advisory Board (referred to in this 
        section as the ``Board'')--
                    (A) to monitor the programs established under this 
                section (and the amendments made by this section); and
                    (B) to provide annual reports to the Congress 
                concerning benchmarks, expenditures, lung cancer 
                statistics, and the public health impact of such 
                programs.
            (2) Composition.--The Board shall be comprised of--
                    (A) the Secretary of Health and Human Services;
                    (B) the Secretary of Defense;
                    (C) the Secretary of Veterans Affairs; and
                    (D) 2 representatives each from the fields of 
                clinical medicine focused on lung cancer, lung cancer 
                research, imaging, drug development, and lung cancer 
                advocacy, to be appointed by the Secretary of Health 
                and Human Services.
    (f) Authorization of Appropriations.--
            (1) In general.--To carry out this section (and the 
        amendments made by this section), there are authorized to be 
        appropriated $75,000,000 for fiscal year 2023 and such sums as 
        may be necessary for each of fiscal years 2024 through 2026.
            (2) Lung cancer mortality reduction program.--The amounts 
        appropriated under paragraph (1) shall be allocated as follows:
                    (A) $25,000,000 for fiscal year 2023, and such sums 
                as may be necessary for each of fiscal years 2024 
                through 2026, for the activities described in section 
                417H(b)(1)(B) of the Public Health Service Act, as 
                added by subsection (d);
                    (B) $25,000,000 for fiscal year 2023, and such sums 
                as may be necessary for each of fiscal years 2024 
                through 2026, for the activities described in section 
                417H(b)(1)(C) of the Public Health Service Act;
                    (C) $10,000,000 for fiscal year 2023, and such sums 
                as may be necessary for each of fiscal years 2024 
                through 2026, for the activities described in section 
                417H(b)(1)(D) of the Public Health Service Act; and
                    (D) $15,000,000 for fiscal year 2023, and such sums 
                as may be necessary for each of fiscal years 2024 
                through 2026, for the activities described in section 
                417H(b)(3) of the Public Health Service Act.

SEC. 7002. EXPANDING PROSTATE CANCER RESEARCH, OUTREACH, SCREENING, 
              TESTING, ACCESS, AND TREATMENT EFFECTIVENESS.

    (a) Findings.--Congress makes the following findings:
            (1) Prostate cancer is the second leading cause of cancer 
        death among men.
            (2) In 2020, an estimated 191,930 individuals in the United 
        States will be diagnosed with prostate cancer and approximately 
        33,330 will die from the disease.
            (3) Roughly 2,000,000 to 3,000,000 people in the United 
        States are living with a diagnosis of prostate cancer and its 
        consequences.
            (4) Although prostate cancer generally affects older 
        individuals, younger men are also at risk for the disease, and 
        when prostate cancer appears in early middle age, it frequently 
        takes on a more aggressive form.
            (5) There are significant racial and ethnic disparities 
        that demand attention, for example, African Americans have 
        prostate cancer mortality rates that are more than double those 
        in the White population.
            (6) Underserved rural populations have higher rates of 
        mortality compared to their urban counterparts, and innovative 
        and cost-efficient methods to improve rural access to high-
        quality care should take advantage of advances in telehealth to 
        diagnose and treat prostate cancer when appropriate.
            (7) Certain populations of veterans may have nearly twice 
        the incidence of prostate cancer as the general population of 
        the United States.
            (8) Urologists may constitute the specialists who diagnose 
        and treat the vast majority of prostate cancer patients.
            (9) Although much basic and translational research has been 
        completed and much is currently known, there are still many 
        unanswered questions, such as the extent to which known 
        disparities are attributable to disease etiology, access to 
        care, or education and awareness in the community.
            (10) Causes of prostate cancer are not known. There is not 
        good information regarding how to differentiate accurately, 
        early on, between aggressive and indolent forms of the disease. 
        As a result, there is significant overtreatment in prostate 
        cancer. There are no treatments that can durably arrest growth 
        or cure prostate cancer once it has metastasized.
            (11) A significant proportion of cases may be clinically 
        indolent and ``overdiagnosed'', resulting in significant 
        overtreatment. More accurate tests will allow men and their 
        families to face less physical, psychological, financial, and 
        emotional trauma, and billions of dollars could be saved in 
        private and public health care systems.
            (12) Prostate cancer research and health care programs 
        across Federal agencies should be coordinated to improve 
        accountability and actively encourage the translation of 
        research into practice and to identify and implement best 
        practices in order to foster an integrated and consistent focus 
        on effective prevention, diagnosis, and treatment of the 
        disease.
    (b) Prostate Cancer Coordination and Education.--
            (1) Interagency prostate cancer coordination and education 
        task force.--Not later than 180 days after the date of the 
        enactment of this Act, the Secretary of Veterans Affairs, in 
        cooperation with the Secretary of Defense and the Secretary of 
        Health and Human Services, shall establish an Interagency 
        Prostate Cancer Coordination and Education Task Force (in this 
        section referred to as the ``Prostate Cancer Task Force'').
            (2) Duties.--The Prostate Cancer Task Force shall--
                    (A) develop a summary of advances in prostate 
                cancer research supported or conducted by Federal 
                agencies relevant to the diagnosis, prevention, and 
                treatment of prostate cancer, including psychosocial 
                impairments related to prostate cancer treatment, and 
                compile a list of best practices that warrant broader 
                adoption in health care programs;
                    (B) consider establishing, and advocating for, a 
                guidance to enable physicians to allow screening of men 
                who are age 74 or older, on a case-by-case basis, 
                taking into account quality of life and family history 
                of prostate cancer;
                    (C) share and coordinate information on research 
                and health care program activities by the Federal 
                Government, including activities related to--
                            (i) determining how to improve research and 
                        health care programs, including psychosocial 
                        impairments related to prostate cancer 
                        treatment;
                            (ii) identifying any gaps in the overall 
                        research inventory and in health care programs;
                            (iii) identifying opportunities to promote 
                        translation of research into practice; and
                            (iv) maximizing the effects of Federal 
                        Government efforts by identifying opportunities 
                        for collaboration and leveraging of resources 
                        in research and health care programs that serve 
                        individuals who are susceptible to or diagnosed 
                        with prostate cancer;
                    (D) develop a comprehensive interagency strategy 
                and advise relevant Federal agencies in the 
                solicitation of proposals for collaborative, 
                multidisciplinary research and health care programs, 
                including proposals to evaluate factors that may be 
                related to the etiology of prostate cancer, that 
                would--
                            (i) result in innovative approaches to 
                        study emerging scientific opportunities or 
                        eliminate knowledge gaps in research to improve 
                        the prostate cancer research portfolio of the 
                        Federal Government; and
                            (ii) outline key research questions, 
                        methodologies, and knowledge gaps;
                    (E) develop a coordinated message related to 
                screening and treatment for prostate cancer to be 
                reflected in educational and beneficiary materials for 
                Federal health programs as such materials are updated; 
                and
                    (F) not later than 2 years after the date of the 
                establishment of the Prostate Cancer Task Force, submit 
                to the expert advisory panels appointed under paragraph 
                (4) to be reviewed and returned within 30 days, and 
                then within 90 days submitted to Congress, 
                recommendations--
                            (i) regarding any appropriate changes to 
                        research and health care programs, including 
                        recommendations to improve the research 
                        portfolio of the Department of Veterans 
                        Affairs, the Department of Defense, the 
                        National Institutes of Health, and other 
                        Federal agencies to ensure that scientifically 
                        based strategic planning is implemented in 
                        support of research and health care program 
                        priorities;
                            (ii) designed to ensure that the research 
                        and health care programs and activities of the 
                        Department of Veterans Affairs, the Department 
                        of Defense, the Department of Health and Human 
                        Services, and other Federal agencies are free 
                        of unnecessary duplication;
                            (iii) regarding public participation in 
                        decisions relating to prostate cancer research 
                        and health care programs to increase the 
                        involvement of patient advocates, community 
                        organizations, and medical associations 
                        representing a broad geographical area;
                            (iv) on how to best disseminate information 
                        on prostate cancer research and progress 
                        achieved by health care programs;
                            (v) about how to expand partnerships 
                        between public entities, including Federal 
                        agencies, and private entities to encourage 
                        collaborative, cross-cutting research and 
                        health care delivery;
                            (vi) assessing any cost savings and 
                        efficiencies realized through the efforts 
                        identified in, and supported through, this 
                        subsection and recommending expansion of those 
                        efforts that have proved most promising while 
                        also ensuring against any conflicts in 
                        directives in law;
                            (vii) identifying key priority action items 
                        from among the recommendations; and
                            (viii) with respect to the level of funding 
                        needed by each agency to implement the 
                        recommendations contained in the report.
            (3) Members of the prostate cancer task force.--The 
        Prostate Cancer Task Force shall be comprised of 
        representatives from such Federal agencies as the head of each 
        such applicable agency determines necessary, so as to 
        coordinate a uniform message relating to prostate cancer 
        screening and treatment where appropriate, including 
        representatives of each of the following:
                    (A) The Department of Veterans Affairs, including 
                representatives of each relevant program area of the 
                Department of Veterans Affairs.
                    (B) The Prostate Cancer Research Program of the 
                Congressionally Directed Medical Research Program of 
                the Department of Defense.
                    (C) The Department of Health and Human Services, 
                including, at a minimum, representatives of each of the 
                following:
                            (i) The National Institutes of Health.
                            (ii) National research institutes and 
                        centers, including the National Cancer 
                        Institute, the National Institute of Allergy 
                        and Infectious Diseases, and the Office of 
                        Minority Health.
                            (iii) The Centers for Medicare & Medicaid 
                        Services.
                            (iv) The Food and Drug Administration.
                            (v) The Centers for Disease Control and 
                        Prevention.
                            (vi) The Agency for Healthcare Research and 
                        Quality.
                            (vii) The Health Resources and Services 
                        Administration.
            (4) Appointing expert advisory panels.--The Prostate Cancer 
        Task Force shall appoint expert advisory panels, as the task 
        force determines appropriate, to provide input and concurrence 
        from--
                    (A) individuals and organizations from the medical, 
                prostate cancer patient and advocate, research, and 
                delivery communities with expertise in prostate cancer 
                diagnosis, treatment, and research, including 
                practicing urologists, primary care providers, and 
                others; and
                    (B) individuals with expertise in education and 
                outreach to underserved populations affected by 
                prostate cancer.
            (5) Meetings.--The Prostate Cancer Task Force shall convene 
        not less frequently than twice each year, or more frequently as 
        the Secretary of Veterans Affairs determines to be appropriate.
            (6) Federal advisory committee act.--The Federal Advisory 
        Committee Act (5 U.S.C. App.) shall apply to the Prostate 
        Cancer Task Force.
            (7) Sunset date.--The Prostate Cancer Task Force shall 
        terminate on September 30, 2025.
    (c) Prostate Cancer Research.--
            (1) Research coordination program.--
                    (A) In general.--The Secretary of Veterans Affairs, 
                in coordination with the Secretary of Defense and the 
                Secretary of Health and Human Services, shall establish 
                and carry out a program to coordinate and intensify 
                prostate cancer research.
                    (B) Elements.--The program established under 
                subparagraph (A) shall--
                            (i) develop advances in diagnostic and 
                        prognostic methods and tests, including 
                        biomarkers and an improved prostate cancer 
                        screening blood test, including improvements or 
                        alternatives to the prostate specific antigen 
                        test and additional tests to distinguish 
                        indolent from aggressive disease;
                            (ii) develop a better understanding of the 
                        etiology of the disease (including an analysis 
                        of lifestyle factors proven to be involved in 
                        higher rates of prostate cancer, such as 
                        obesity and diet, and in different ethnic, 
                        racial, and socioeconomic groups, such as the 
                        African-American, Latino or Hispanic, and 
                        American Indian populations and men with a 
                        family history of prostate cancer) to improve 
                        prevention efforts;
                            (iii) expand basic research into prostate 
                        cancer, including studies of fundamental 
                        molecular and cellular mechanisms;
                            (iv) identify and provide clinical testing 
                        of novel agents for the prevention and 
                        treatment of prostate cancer;
                            (v) establish clinical registries for 
                        prostate cancer;
                            (vi) use the National Institute of 
                        Biomedical Imaging and Bioengineering and the 
                        National Cancer Institute for assessment of 
                        appropriate imaging modalities; and
                            (vii) address such other matters relating 
                        to prostate cancer research as may be 
                        identified by the Federal agencies 
                        participating in the program under this 
                        subsection.
                    (C) Underserved minority grant program.--In 
                carrying out the program established under subparagraph 
                (A), the Secretary shall--
                            (i) award grants to eligible entities to 
                        carry out components of the research outlined 
                        in subparagraph (B);
                            (ii) integrate and build upon existing 
                        knowledge gained from comparative effectiveness 
                        research; and
                            (iii) recognize and address--
                                    (I) the racial and ethnic 
                                disparities in the incidence and 
                                mortality rates of prostate cancer and 
                                men with a family history of prostate 
                                cancer;
                                    (II) any barriers in access to care 
                                and participation in clinical trials 
                                that are specific to racial, ethnic, 
                                and other underserved minorities and 
                                men with a family history of prostate 
                                cancer;
                                    (III) outreach and educational 
                                efforts to raise awareness among the 
                                populations described in subclause 
                                (II); and
                                    (IV) appropriate access and 
                                utilization of imaging modalities.
            (2) Prostate cancer advisory board.--
                    (A) In general.--There is established in the Office 
                of the Chief Scientist of the Food and Drug 
                Administration a Prostate Cancer Scientific Advisory 
                Board.
                    (B) Duties.--The board established under 
                subparagraph (A) shall be responsible for accelerating 
                real-time sharing of the latest research data and 
                accelerating movement of new medicines for the 
                treatment of prostate cancer to patients.
    (d) Telehealth and Rural Access Pilot Projects.--
            (1) Establishment of pilot projects.--
                    (A) In general.--The Secretary of Veterans Affairs, 
                in cooperation with the Secretary of Defense and the 
                Secretary of Health and Human Services (referred to in 
                this subsection collectively as the ``Secretaries'') 
                shall establish 4-year telehealth pilot projects for 
                the purpose of analyzing the clinical outcomes and 
                cost-effectiveness associated with telehealth services 
                in a variety of geographic areas that contain high 
                proportions of medically underserved populations, 
                including African Americans, Latinos or Hispanics, 
                American Indians or Alaska Natives, and those in rural 
                areas.
                    (B) Efficient and effective care.--Pilot projects 
                established under subparagraph (A) shall promote 
                efficient use of specialist care through better 
                coordination of primary care and physician extender 
                teams in underserved areas and more effectively employ 
                tumor boards to better counsel patients.
            (2) Eligible entities.--
                    (A) In general.--The Secretaries shall select 
                eligible entities to participate in the pilot projects 
                established under this subsection.
                    (B) Priority.--In selecting eligible entities to 
                participate in the pilot projects under this 
                subsection, the Secretaries shall give priority to 
                entities located in medically underserved areas, 
                particularly those that include African Americans, 
                Latinos and Hispanics, and facilities of the Indian 
                Health Service, including facilities operated by the 
                Indian Health Service, tribally operated facilities, 
                and Urban Indian Clinics, and those in rural areas.
            (3) Evaluation.--The Secretaries shall, through the pilot 
        projects, evaluate--
                    (A) the effective and economic delivery of care in 
                diagnosing and treating prostate cancer with the use of 
                telehealth services in medically underserved and Tribal 
                areas including collaborative uses of health 
                professionals and integration of the range of 
                telehealth and other technologies;
                    (B) the effectiveness of improving the capacity of 
                nonmedical providers and nonspecialized medical 
                providers to provide health services for prostate 
                cancer in medically underserved and Tribal areas, 
                including the exploration of innovative medical home 
                models with collaboration between urologists, other 
                relevant medical specialists, including oncologists, 
                radiologists, and primary care teams, and coordination 
                of care through the efficient use of primary care teams 
                and physician extenders; and
                    (C) the effectiveness of using telehealth services 
                to provide prostate cancer treatment in medically 
                underserved areas, including the use of tumor boards to 
                facilitate better patient counseling.
            (4) Report.--Not later than 1 year after the completion of 
        the pilot projects under this subsection, the Secretaries shall 
        submit to Congress a report describing the outcomes of such 
        pilot projects, including any cost savings and efficiencies 
        realized, and providing recommendations, if any, for expanding 
        the use of telehealth services.
    (e) Education and Awareness.--
            (1) Campaign.--
                    (A) In general.--The Secretary of Veterans Affairs 
                shall develop a national education campaign for 
                prostate cancer.
                    (B) Elements.--The campaign developed under 
                subparagraph (A) shall involve the use of written 
                educational materials and public service announcements 
                consistent with the findings of the Prostate Cancer 
                Task Force under subsection (c) that are intended to 
                encourage men to seek prostate cancer screening when 
                appropriate.
            (2) Racial disparities and the population of men with a 
        family history of prostate cancer.--In developing the campaign 
        under paragraph (1), the Secretary shall ensure that 
        educational materials and public service announcements used in 
        the campaign are more readily available in communities 
        experiencing racial disparities in the incidence and mortality 
        rates of prostate cancer and to men of any race classification 
        with a family history of prostate cancer.
            (3) Grants.--In carrying out the campaign under this 
        subsection, the Secretary shall award grants to nonprofit 
        private entities to enable such entities to test alternative 
        outreach and education strategies.
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section for the period of fiscal years 
2023 through 2027 an amount equal to the amount of savings for the 
Federal Government projected to be achieved over such period by 
implementation of this section.

SEC. 7003. PROSTATE RESEARCH, IMAGING, AND MEN'S EDUCATION (PRIME).

    (a) Findings.--Congress makes the following findings:
            (1) Prostate cancer has reached epidemic proportions, 
        particularly among African-American men, and strikes and kills 
        men in numbers comparable to the number of women who lose their 
        lives from breast cancer.
            (2) Life-saving breakthroughs in screening, diagnosis, and 
        treatment of breast cancer resulted from the development of 
        advanced imaging technologies led by the Federal Government.
            (3) Men should have accurate and affordable prostate cancer 
        screening exams and minimally invasive treatment tools, similar 
        to what women have for breast cancer.
            (4) While it is important for men to take advantage of 
        current prostate cancer screening techniques, a recent NCI-
        funded study demonstrated that the most common available 
        methods of detecting prostate cancer (PSA blood test and 
        physical exams) are not foolproof, causing numerous false 
        alarms and false reassurances.
            (5) The absence of advanced imaging technologies for 
        prostate cancer causes the lack of accurate information 
        critical for clinical decisions, resulting in missed cancers 
        and lost lives, as well as unnecessary and costly medical 
        procedures, with related complications.
            (6) With prostate imaging tools, men and their families 
        would face less physical, psychological, financial, and 
        emotional trauma and billions of dollars could be saved in 
        private and public health care systems.
    (b) Research and Development of Prostate Cancer Imaging 
Technologies.--
            (1) Expansion of research.--The Secretary of Health and 
        Human Services (referred to in this section as the 
        ``Secretary''), acting through the Director of the National 
        Institutes of Health and the Administrator of the Health 
        Resources and Services Administration, and in consultation with 
        the Secretary of Defense, shall carry out a program to expand 
        and intensify research to develop innovative advanced imaging 
        technologies for prostate cancer detection, diagnosis, and 
        treatment comparable to state-of-the-art mammography 
        technologies.
            (2) Early stage research.--In implementing the program 
        under paragraph (1), the Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall carry out a grant program to encourage 
        the early stages of research in prostate imaging to develop and 
        implement new ideas, proof of concepts, and pilot studies for 
        high-risk technologic innovation in prostate cancer imaging 
        that would have a high potential impact for improving patient 
        care, including individualized care, quality of life, and cost-
        effectiveness.
            (3) Large scale later stage research.--In implementing the 
        program under paragraph (1), the Secretary, acting through the 
        Director of the National Institutes of Health, shall utilize 
        the National Institute of Biomedical Imaging and Bioengineering 
        and the National Cancer Institute for advanced stages of 
        research in prostate imaging, including technology development 
        and clinical trials for projects determined by the Secretary to 
        have demonstrated promising preliminary results and proof of 
        concept.
            (4) Interdisciplinary private-public partnerships.--In 
        developing the program under paragraph (1), the Secretary, 
        acting through the Administrator of the Health Resources and 
        Services Administration, shall establish interdisciplinary 
        private-public partnerships to develop and implement research 
        strategies for expedited innovation in imaging and image-guided 
        treatment and to conduct such research.
            (5) Racial disparities.--In developing the program under 
        paragraph (1), the Secretary shall recognize and address--
                    (A) the racial disparities in the incidences of 
                prostate cancer and mortality rates with respect to 
                such disease; and
                    (B) any barriers in access to care and 
                participation in clinical trials that are specific to 
                racial minorities.
            (6) Authorization of appropriations.--
                    (A) In general.--Subject to subparagraph (B), there 
                is authorized to be appropriated to carry out this 
                subsection, $100,000,000 for each of fiscal years 2023 
                through 2027.
                    (B) Specific allocations.--Of the amount authorized 
                to be appropriated under subparagraph (A) for each of 
                the fiscal years described in such subparagraph--
                            (i) no less than 10 percent may be used to 
                        carry out the grant program under paragraph 
                        (2); and
                            (ii) no more than 1 percent may be used to 
                        carry out paragraph (4).
    (c) Public Awareness and Education Campaign.--
            (1) National campaign.--The Secretary shall carry out a 
        national campaign to increase the awareness and knowledge of 
        individuals in the United States with respect to the need for 
        prostate cancer screening and for improved detection 
        technologies.
            (2) Requirements.--The national campaign conducted under 
        this subsection shall include--
                    (A) roles for the Health Resources Services 
                Administration, the Office of Minority Health of the 
                Department of Health and Human Services, the Centers 
                for Disease Control and Prevention, and the Office of 
                Minority Health and Health Equity of the Centers for 
                Disease Control and Prevention; and
                    (B) the development and distribution of written 
                educational materials, and the development and placing 
                of public service announcements, that are intended to 
                encourage men to seek prostate cancer screening and to 
                create awareness of the need for improved imaging 
                technologies for prostate cancer screening and 
                diagnosis, including in vitro blood testing and imaging 
                technologies.
            (3) Racial disparities.--In developing the national 
        campaign under paragraph (1), the Secretary shall recognize and 
        address--
                    (A) the racial disparities in the incidences of 
                prostate cancer and mortality rates with respect to 
                such disease; and
                    (B) any barriers in access to care and 
                participation in clinical trials that are specific to 
                racial minorities.
            (4) Grants.--The Secretary shall establish a program to 
        award grants to nonprofit private entities to enable such 
        entities to test alternative outreach and education strategies 
        to increase the awareness and knowledge of individuals in the 
        United States with respect to the need for prostate cancer 
        screening and improved imaging technologies.
            (5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection $10,000,000 for 
        each of fiscal years 2023 through 2027.
    (d) Improving Prostate Cancer Screening Blood Tests.--
            (1) In general.--The Secretary, in coordination with the 
        Secretary of Defense, shall support research to develop an 
        improved prostate cancer screening blood test using in-vitro 
        detection.
            (2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection, $20,000,000 
        for each of fiscal years 2023 through 2027.
    (e) Reporting and Compliance.--
            (1) Report and strategy.--Not later than 12 months after 
        the date of the enactment of this Act, the Secretary shall 
        submit to Congress a report that details the strategy of the 
        Secretary for implementing the requirements of this section and 
        the status of such efforts.
            (2) Full compliance.--Not later than 36 months after the 
        date of the enactment of this Act, and annually thereafter, the 
        Secretary shall submit to Congress a report that--
                    (A) describes the research and development and 
                public awareness and education campaigns funded under 
                this section;
                    (B) provides evidence that projects involving high-
                risk, high impact technologic innovation, proof of 
                concept, and pilot studies are prioritized;
                    (C) provides evidence that the Secretary recognizes 
                and addresses any barriers in access to care and 
                participation in clinical trials that are specific to 
                racial minorities in the implementation of this 
                section;
                    (D) contains assurances that all the other 
                provisions of this section are fully implemented; and
                    (E) certifies compliance with the provisions of 
                this section, or in the case of a Federal agency that 
                has not complied with any of such provisions, an 
                explanation as to such failure to comply.

SEC. 7004. PROSTATE CANCER DETECTION RESEARCH AND EDUCATION.

    (a) Plan To Develop and Validate a Test or Tests for Prostate 
Cancer.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary''), acting 
        through the Director of the National Institutes of Health, 
        shall establish an advisory council on prostate cancer 
        (referred to in this section as the ``advisory council'') to 
        draft a plan for the development and validation of an accurate 
        test or tests, such as biomarkers or imaging, to detect and 
        diagnose prostate cancer.
            (2) Advisory council.--
                    (A) Membership.--
                            (i) Federal members.--The advisory council 
                        shall be comprised of the following experts:
                                    (I) A designee of the Centers for 
                                Disease Control and Prevention.
                                    (II) A designee of the Centers for 
                                Medicare & Medicaid Services.
                                    (III) A designee of the Office of 
                                the Director of the National Cancer 
                                Institute.
                                    (IV) A designee of the Director of 
                                the Department of Defense 
                                Congressionally Directed Medical 
                                Research Programs.
                                    (V) A designee of the Director of 
                                the National Institute of Biomedical 
                                Imaging and Bioengineering.
                                    (VI) A designee of the Director of 
                                the National Institute of General 
                                Medical Sciences.
                                    (VII) A designee of the Director of 
                                the National Institute on Minority 
                                Health and Health Disparities.
                                    (VIII) A designee of the Director 
                                of the National Institutes of Health.
                                    (IX) A designee of the Commissioner 
                                of Food Drugs.
                                    (X) A designee of the Director of 
                                the Agency for Healthcare Research and 
                                Quality.
                                    (XI) A designee of the Director of 
                                the Telemedicine and Advanced 
                                Technology Research Center of the 
                                Department of Defense.
                            (ii) Non-federal members.--In addition to 
                        the members described in clause (i), the 
                        advisory council shall include 8 expert members 
                        from outside the Federal Government to be 
                        appointed by the Secretary, which shall 
                        include--
                                    (I) 2 prostate cancer patient 
                                advocates;
                                    (II) 2 health care providers with a 
                                range of expertise and experience in 
                                prostate cancer; and
                                    (III) 4 leading researchers with 
                                prostate cancer-related expertise in a 
                                range of clinical disciplines.
                    (B) Meetings.--The advisory council shall meet 
                quarterly and such meetings shall be open to the 
                public.
                    (C) Advice.--The advisory council shall advise the 
                Secretary, or the Secretary's designee.
                    (D) Annual report.--Not later than 1 year after the 
                date of enactment of this Act, the advisory council 
                shall provide to the Secretary, or the Secretary's 
                designee, and Congress--
                            (i) an initial evaluation of all federally 
                        funded efforts in prostate cancer research 
                        relating to the development and validation of 
                        an accurate test or tests to detect and 
                        diagnose prostate cancer;
                            (ii) a plan for the development and 
                        validation of a reliable test or tests for the 
                        detection and accurate diagnosis of prostate 
                        cancer; and
                            (iii) a set of standards for prostate 
                        cancer screening, developed in coordination 
                        with the United States Preventive Services Task 
                        Force, to ensure that any tools for screening, 
                        detection, and diagnosis developed in 
                        accordance with the plan under clause (ii) will 
                        meet the requirements of the Task Force for 
                        recommendation as a proven preventive or 
                        diagnostic service.
                    (E) Termination.--The advisory council shall 
                terminate on December 31, 2026.
            (3) Funding.--Notwithstanding any other provision of law, 
        the Secretary may make available $1,000,000, from any 
        unobligated amounts appropriated to the National Institutes of 
        Health, for each of fiscal years 2023 through 2027 to carry out 
        this subsection.
    (b) Coordination and Intensification of Prostate Cancer Research.--
            (1) In general.--The Director of the National Institutes of 
        Health, in consultation with the Secretary of Defense, shall 
        coordinate and intensify research in accordance with the plan 
        provided under subsection (a)(2)(D)(ii), with particular 
        attention provided to leveraging existing research to develop 
        and validate a test or tests, such as biomarkers or imaging, to 
        detect and accurately diagnose prostate cancer in order to 
        improve quality of life for millions of individuals in the 
        United States, and decrease health care system costs.
            (2) Funding.--Notwithstanding any other provision of law, 
        the Secretary may make available $30,000,000, from any 
        unobligated amounts appropriated to the National Institutes of 
        Health, for each of fiscal years 2024 through 2028 to carry out 
        this subsection.

SEC. 7005. NATIONAL PROSTATE CANCER COUNCIL.

    (a) National Prostate Cancer Council.--
            (1) Establishment.--There is established in the Office of 
        the Secretary of Health and Human Services (referred to in this 
        section as the ``Secretary'') the National Prostate Cancer 
        Council on Screening, Early Detection, Assessment, and 
        Monitoring of Prostate Cancer (referred to in this section as 
        the ``Council'').
            (2) Purpose of the council.--The Council shall--
                    (A) develop and implement a national strategic plan 
                for the accelerated creation, advancement, and testing 
                of diagnostic tools to improve screening, early 
                detection, assessment, and monitoring of prostate 
                cancer, including--
                            (i) early detection of aggressive prostate 
                        cancer to save lives;
                            (ii) monitoring of tumor response to 
                        treatment, including recurrence and 
                        progression; and
                            (iii) accurate assessment and surveillance 
                        of indolent disease to reduce unnecessary 
                        biopsies and treatment;
                    (B) provide information and coordination of 
                prostate cancer research and services across all 
                Federal agencies;
                    (C) review diagnostic tools and their overall 
                effectiveness at screening, detecting, assessing, and 
                monitoring of prostate cancer;
                    (D) evaluate all programs in prostate cancer that 
                are in existence on the date of enactment of this Act, 
                including Federal budget requests and approvals and 
                public-private partnerships;
                    (E) submit an annual report to the Secretary and 
                Congress on the creation and implementation of the 
                national strategic plan under subparagraph (A); and
                    (F) ensure the inclusion of men at high-risk for 
                prostate cancer, including men from minority ethnic and 
                racial populations and men who are least likely to 
                receive care, in clinical, research, and service 
                efforts, with the purpose of decreasing health 
                disparities.
            (3) Membership.--
                    (A) Federal members.--The Council shall be led by 
                the Secretary or the Secretary's designee and comprised 
                of the following experts:
                            (i) Two representatives of the National 
                        Institutes of Health, including 1 
                        representative of the National Institute of 
                        Biomedical Imaging and Bioengineering and 1 
                        representative of the National Cancer 
                        Institute.
                            (ii) A representative of the Centers for 
                        Disease Control and Prevention.
                            (iii) A representative of the Centers for 
                        Medicare & Medicaid Services.
                            (iv) A designee of the Director of the 
                        Department of Defense Congressionally Directed 
                        Medical Research Programs.
                            (v) A designee of the Director of the 
                        Office of Minority Health.
                            (vi) A representative of the Food and Drug 
                        Administration.
                            (vii) A representative of the Agency for 
                        Healthcare Research and Quality.
                    (B) Non-federal members.--In addition to the 
                members described in subparagraph (A), the Council 
                shall include 14 expert members from outside the 
                Federal Government, which shall include--
                            (i) 6 prostate cancer patient advocates, 
                        including--
                                    (I) 2 patient-survivors;
                                    (II) 2 caregivers of prostate 
                                cancer patients; and
                                    (III) 2 representatives from 
                                national prostate cancer disease 
                                organizations that fund research or 
                                have demonstrated experience in 
                                providing assistance to patients, 
                                families, and medical professionals, 
                                including information on health care 
                                options, education, and referral; and
                            (ii) 8 health care stakeholders with 
                        specific expertise in prostate cancer research 
                        in the critical areas of clinical expertise, 
                        including medical oncology, radiology, 
                        radiation oncology, urology, and pathology.
            (4) Meetings.--The Council shall meet quarterly and 
        meetings shall be open to the public.
            (5) Advice.--The Council shall advise the Secretary, or the 
        Secretary's designee.
            (6) Annual report.--The Council shall submit annual 
        reports, beginning not later than 1 year after the date of 
        enactment of this Act, to the Secretary or the Secretary's 
        designee and to Congress. The annual report shall include--
                    (A) in the first year--
                            (i) an evaluation of all federally funded 
                        efforts in prostate cancer research and gaps 
                        relating to the development and validation of 
                        diagnostic tools for prostate cancer; and
                            (ii) recommendations for priority actions 
                        to expand, eliminate, coordinate, or condense 
                        programs based on the performance, mission, and 
                        purpose of the programs; and
                    (B) annually thereafter for 5 years--
                            (i) an outline for the development and 
                        implementation of a national research plan for 
                        creation and validation of accurate diagnostic 
                        tools to improve prostate cancer care in 
                        accordance with paragraph (1);
                            (ii) roles for the National Cancer 
                        Institute, National Institute on Minority 
                        Health and Health Disparities, and the Office 
                        of Minority Health of the Department of Health 
                        and Human Services;
                            (iii) an analysis of the disparities in the 
                        incidence and mortality rates of prostate 
                        cancer in men at high risk of the disease, 
                        including individuals with family history, 
                        increasing age, or African-American heritage; 
                        and
                            (iv) a review of the progress towards the 
                        realization of the proposed strategic plan.
            (7) Termination.--The Council shall terminate on December 
        31, 2027.

SEC. 7006. IMPROVED MEDICAID COVERAGE FOR CERTAIN BREAST AND CERVICAL 
              CANCER PATIENTS IN THE TERRITORIES.

    (a) Elimination of Funding Limitations.--Section 1108(g)(4) of the 
Social Security Act (42 U.S.C. 1308(g)(4)) is amended--
            (1) by striking ``paragraphs (1), (2), (3), and (4) of''; 
        and
            (2) by adding at the end the following: ``With respect to 
        fiscal years beginning with fiscal year 2023, payment for 
        medical assistance for individuals who are eligible for such 
        assistance only on the basis of section 
        1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in 
        applying subsection (f) (as increased in accordance with this 
        subsection) to Puerto Rico, the Virgin Islands, Guam, the 
        Northern Mariana Islands, or American Samoa for such fiscal 
        year.''.
    (b) Application of Enhanced FMAP for Highest State.--Section 
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the 
end the following: ``Notwithstanding the first sentence of this 
subsection, with respect to medical assistance described in clause (4) 
of such sentence that is furnished in Puerto Rico, the Virgin Islands, 
Guam, the Northern Mariana Islands, or American Samoa in a fiscal year, 
the Federal medical assistance percentage is equal to the highest such 
percentage applied under such clause for such fiscal year for any of 
the 50 States or the District of Columbia that provides such medical 
assistance for any portion of such fiscal year.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to payment for medical assistance for items and services 
furnished on or after October 1, 2023.

SEC. 7007. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC AND 
              RACIAL MINORITIES.

    (a) Demonstration.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary'') shall 
        conduct demonstration projects for the purpose of developing 
        models and evaluating methods that--
                    (A) improve the quality of items and services 
                provided to target individuals in order to facilitate 
                reduced disparities in early detection and treatment of 
                cancer;
                    (B) improve clinical outcomes, satisfaction, 
                quality of life, appropriate use of items and services 
                covered under the Medicare program under title XVIII of 
                the Social Security Act (42 U.S.C. 1395 et seq.), and 
                referral patterns with respect to target individuals 
                with cancer;
                    (C) eliminate disparities in the rate of preventive 
                cancer screening measures, such as Pap smears, prostate 
                cancer screenings, colon and colorectal cancer 
                screenings, breast cancer screenings, and computed 
                tomography scans, for lung cancer among target 
                individuals;
                    (D) promote collaboration with community-based 
                organizations to ensure cultural competency of health 
                care professionals and linguistic access for target 
                individuals who are persons with limited English 
                proficiency; and
                    (E) encourage the incorporation of community health 
                workers to increase the efficiency and appropriateness 
                of cancer screening programs.
            (2) Community health worker defined.--In this section, the 
        term ``community health worker'' includes a community health 
        advocate, a lay health worker, a community health 
        representative, a peer health promoter, a community health 
        outreach worker, and a promotore de salud, who promotes health 
        or nutrition within the community in which the individual 
        resides.
            (3) Target individual defined.--In this section, the term 
        ``target individual'' means an individual of a racial and 
        ethnic minority group, as defined in section 1707(g)(1) of the 
        Public Health Service Act (42 U.S.C. 300u-6(g)(1)), who is 
        entitled to benefits under part A, and enrolled under part B, 
        of title XVIII of the Social Security Act.
    (b) Program Design.--
            (1) Initial design.--Not later than 1 year after the date 
        of the enactment of this Act, the Secretary shall evaluate best 
        practices in the private sector, community programs, and 
        academic research of methods that reduce disparities among 
        individuals of racial and ethnic minority groups in the 
        prevention and treatment of cancer and shall design the 
        demonstration projects based on such evaluation.
            (2) Number and project areas.--Not later than 2 years after 
        the date of the enactment of this Act, the Secretary shall 
        implement at least 9 demonstration projects, including the 
        following:
                    (A) Two projects, each of which shall target 
                different ethnic subpopulations, for each of the 4 
                following major racial and ethnic minority groups:
                            (i) American Indians and Alaska Natives, 
                        Eskimos, and Aleuts.
                            (ii) Asian Americans.
                            (iii) Blacks and African Americans.
                            (iv) Latinos and Hispanics.
                            (v) Native Hawaiians and other Pacific 
                        Islanders.
                    (B) One project within the Pacific Islands or 
                United States insular areas.
                    (C) At least one project in a rural area.
                    (D) At least one project in an inner-city area.
            (3) Expansion of projects; implementation of demonstration 
        project results.--The Secretary shall continue the existing 
        demonstration projects and may expand the number of 
        demonstration projects if the initial report under subsection 
        (c) contains an evaluation that demonstration projects--
                    (A) reduce expenditures under the Medicare program 
                under title XVIII of the Social Security Act (42 U.S.C. 
                1395 et seq.); or
                    (B) do not increase expenditures under such 
                Medicare program and reduce racial and ethnic health 
                disparities in the quality of health care services 
                provided to target individuals and increase 
                satisfaction of Medicare beneficiaries and health care 
                providers.
    (c) Report to Congress.--
            (1) In general.--Not later than 2 years after the date the 
        Secretary implements the initial demonstration projects, and 
        biannually thereafter, the Secretary shall submit to Congress a 
        report regarding the demonstration projects.
            (2) Content of report.--Each report under paragraph (1) 
        shall include the following:
                    (A) A description of the demonstration projects.
                    (B) An evaluation of--
                            (i) the cost-effectiveness of the 
                        demonstration projects;
                            (ii) the quality of the health care 
                        services provided to target individuals under 
                        the demonstration projects; and
                            (iii) beneficiary and health care provider 
                        satisfaction under the demonstration projects.
                    (C) Any other information regarding the 
                demonstration projects that the Secretary determines to 
                be appropriate.
    (d) Waiver Authority.--The Secretary shall waive compliance with 
the requirements of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) to such extent and for such period as the Secretary 
determines is necessary to conduct demonstration projects.

SEC. 7008. REDUCING CANCER DISPARITIES WITHIN MEDICARE.

    (a) Development of Measures of Disparities in Quality of Cancer 
Care.--
            (1) Development of measures.--The Secretary of Health and 
        Human Services (in this section referred to as the 
        ``Secretary'') shall enter into an agreement with an entity 
        that specializes in developing quality measures for cancer care 
        under which the entity shall develop a uniform set of measures 
        to evaluate disparities in the quality of cancer care and 
        annually update such set of measures.
            (2) Measures to be included.--Such set of measures shall 
        include, with respect to the treatment of cancer, measures of 
        patient outcomes, the process for delivering medical care 
        related to such treatment, patient counseling and engagement in 
        decision-making, patient experience of care, resource use, and 
        practice capabilities, such as care coordination.
    (b) Establishment of Reporting Process.--
            (1) In general.--The Secretary shall establish a reporting 
        process that requires and provides for a method for health care 
        providers specified under paragraph (2) to submit to the 
        Secretary and make public data on the performance of such 
        providers during each reporting period through use of the 
        measures developed pursuant to subsection (a). Such data shall 
        be submitted in a form and manner and at a time specified by 
        the Secretary.
            (2) Specification of providers to report on measures.--The 
        Secretary shall specify the classes of Medicare providers of 
        services and suppliers, including hospitals, cancer centers, 
        physicians, primary care providers, and specialty providers, 
        that will be required under such process to publicly report on 
        the measures specified under subsection (a).
            (3) Assessment of changes.--Under such reporting process, 
        the Secretary shall establish a format that assesses changes in 
        both the absolute and relative disparities in cancer care over 
        time. These measures shall be presented in an easily 
        comprehensible format, such as those presented in the final 
        publications relating to Healthy People 2010 or the National 
        Healthcare Disparities Report.
            (4) Initial implementation.--The Secretary shall implement 
        the reporting process under this subsection for reporting 
        periods beginning not later than 6 months after the date that 
        measures are first established under subsection (a).

  Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention

SEC. 7051. VIRAL HEPATITIS AND LIVER CANCER CONTROL AND PREVENTION.

    (a) Short Title.--This section may be cited as the ``Viral 
Hepatitis and Liver Cancer Control and Prevention Act of 2022''.
    (b) Findings.--Congress finds the following:
            (1) In the United States, nearly 5,000,000 persons are 
        living with the hepatitis B virus (referred to in this section 
        as ``HBV'') or the hepatitis C virus (referred to in this 
        section as ``HCV'').
            (2) The Centers for Disease Control and Prevention 
        (referred to in this section as the ``CDC''), has recognized 
        HCV as the Nation's most common chronic bloodborne virus 
        infection and HBV as the deadliest vaccine-preventable disease.
            (3) HBV is transmitted through contact with infectious 
        blood, semen, or other bodily fluids and is 100 times more 
        infectious than HIV. HCV is transmitted by contact with 
        infectious blood, particularly through percutaneous exposures 
        (such as puncture through the skin).
            (4) In the United States, chronic HBV and HCV are the most 
        common causes of liver cancer, the second deadliest and fastest 
        growing cancer in this country. These viruses are the most 
        common cause of chronic liver disease, liver cirrhosis, and the 
        most common indications for liver transplantation. In 2019, 
        nearly 16,000 deaths per year in the United States were 
        attributed to chronic HBV and HCV. Chronic HCV is also a 
        leading cause of death in Americans living with HIV/AIDS, many 
        of those living with HIV/AIDS are coinfected with chronic HBV, 
        chronic HCV, or both.
            (5) The CDC estimates that in 2019, 57,500 people in the 
        United States were newly infected with HCV and 20,700 people in 
        the United States were newly infected with HBV. These estimates 
        could be much higher due to many reasons, including lack of 
        screening education and awareness, and perceived 
        marginalization of the populations at risk.
            (6) The CDC reported a 374 percent increase in hepatitis C 
        cases from 2010 to 2017, stemming from the opioid, heroin, and 
        overdose epidemics affecting communities nationwide. From 2014 
        to 2015, the number of reported cases of acute hepatitis B 
        infection in the United States rose for the first time since 
        2006, increasing by 20.7 percent, which is also largely 
        attributable to the opioid epidemic.
            (7) HBV and HCV disproportionately affect certain 
        populations in the United States. Although representing only 
        about 6 percent of the population, Asian Americans and Pacific 
        Islanders account for half of all chronic HBV cases in the 
        United States. Baby boomers (those born between 1945 and 1965) 
        account for approximately 75 percent of domestic chronic HCV 
        cases. In addition, African Americans, Latinos, and American 
        Indian and Native Alaskans are among the groups which have 
        disproportionately high rates of HBV or HCV infections in the 
        United States.
            (8) Liver cancer is a leading cause of cancer death among 
        the Asian American and Pacific Islander community. Asian and 
        Pacific Islander men and women are more than twice as likely to 
        develop liver cancer compared to the non-Hispanic White 
        population. The higher incidence rate of liver cancer is 
        partially explained by higher incidence rates of hepatitis B 
        and diabetes, which are comorbidities shown to increase an 
        individual's risk of developing liver cancer.
            (9) Chronic HBV and chronic HCV usually do not cause 
        symptoms early in the course of the disease, but after many 
        years of a clinically ``silent'' phase, CDC estimates show more 
        than 33 percent of infected individuals will develop cirrhosis, 
        end-stage liver disease, or liver cancer. Since most 
        individuals with chronic HBV, HCV, or both are unaware of their 
        infection, they do not know to take precautions to prevent the 
        spread of their infection and can unknowingly exacerbate their 
        own disease progression. For those chronically infected with 
        HBV or HCV, regular monitoring can lead to the early detection 
        of liver cancer at a stage where a treatment is still possible.
            (10) For both chronic HBV and chronic HCV, behavioral 
        changes and appropriate medical care can slow disease 
        progression if diagnosis is made early. Early diagnosis, which 
        is determined through simple blood tests, can reduce the risk 
        of transmission and disease progression through education and 
        vaccination of household members and other susceptible persons 
        at risk.
            (11) Treatment for chronic HCV can eradicate the disease in 
        approximately 90 percent of those currently treated. While 
        there is no cure for chronic HBV, available treatments can 
        effectively suppress viral replication in the overwhelming 
        majority of those treated, thereby reducing the risk of 
        transmission and progression to liver scarring or liver cancer.
            (12) The annual health care costs attributable to HBV and 
        HCV in the United States are significant. For HBV, it is 
        estimated to be approximately $2,500,000,000 ($2,000 per 
        infected person). In 2000, the lifetime cost of HBV, before the 
        availability of most current therapies, was approximately 
        $80,000 per chronically infected person, totaling more than 
        $100,000,000,000. For HCV, medical costs for patients are 
        expected to increase from $30,000,000,000 in 2009 to over 
        $85,000,000,000 in 2024. Avoiding these costs by screening and 
        diagnosing individuals earlier, and connecting them to 
        appropriate treatment and care, will save lives and critical 
        health care dollars. Currently, without a comprehensive 
        screening, testing, and diagnosis program, most patients are 
        diagnosed too late when they need a liver transplant costing at 
        least $314,000 for uncomplicated cases or when they have liver 
        cancer or end-stage liver disease which costs $30,980 to 
        $110,576 per hospital admission. As health care costs continue 
        to grow, it is critical that the Federal Government invests in 
        effective mechanisms to avoid documented cost drivers.
            (13) In 2021, the Department of Health and Human Services 
        released its ``Viral Hepatitis National Strategic Plan: A 
        Roadmap for Elimination for the United States, 2021-2025'' 
        (referred to in this section as the ``HHS Strategic Plan''). In 
        March 2017, the National Academies of Sciences, Engineering, 
        and Medicine released a report entitled, ``A National Strategy 
        for the Elimination of Hepatitis B and C: Phase Two Report'' 
        (referred to in this section as the ``NAS report''), 
        recommending specific actions to eliminate viral hepatitis as 
        public health problems in the United States by 2030.
            (14) According to the NAS report, chronic HBV and HCV 
        infections cause substantial morbidity and mortality despite 
        being preventable and treatable. Deficiencies in the 
        implementation of established guidelines for the prevention, 
        diagnosis, and medical management of chronic HBV and HCV 
        infections perpetuate personal and economic burdens. Existing 
        grants are not sufficient for the scale of the health burden 
        presented by HBV and HCV.
            (15) Screening and testing for HBV and HCV is aligned with 
        the goals of Healthy People 2030 to increase immunization 
        rates, reduce rates of infectious diseases, and improve health 
        for people with chronic infections. Awareness of disease and 
        access to prevention and treatment remain essential components 
        for reducing infectious disease transmission.
            (16) Federal support is necessary to increase knowledge and 
        awareness of HBV and HCV and to assist State and local 
        prevention and control efforts in reducing the morbidity and 
        mortality of these epidemics.
            (17) The Secretary of Health and Human Services has the 
        discretion to carry out this section (including the amendments 
        made by this section) directly and through whichever of the 
        agencies of the Public Health Service the Secretary determines 
        to be appropriate, which may (in the Secretary's discretion) 
        include the Centers for Disease Control and Prevention, the 
        Health Resources and Services Administration, the Substance 
        Abuse and Mental Health Services Administration, the National 
        Institutes of Health (including the National Institute on 
        Minority Health and Health Disparities), and other agencies of 
        such Service.
    (c) Biennial Assessment of HHS Hepatitis B and Hepatitis C 
Prevention, Education, Research, and Medical Management Plan.--Title 
III of the Public Health Service Act (42 U.S.C. 241 et seq.) is further 
amended--
            (1) by striking section 317N (42 U.S.C. 247b-15); and
            (2) by adding after part V the following:

   ``PART W--BIENNIAL ASSESSMENT OF HHS HEPATITIS B AND HEPATITIS C 
      PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PLAN

``SEC. 399OO. BIENNIAL UPDATE OF THE PLAN.

    ``(a) In General.--The Secretary shall conduct a biennial 
assessment of the Secretary's plan for the prevention, control, and 
medical management of, and education and research relating to, 
hepatitis B and hepatitis C, for the purposes of--
            ``(1) incorporating into such plan new knowledge or 
        observations relating to hepatitis B and hepatitis C (such as 
        knowledge and observations that may be derived from clinical, 
        laboratory, and epidemiological research and disease detection, 
        prevention, and surveillance outcomes);
            ``(2) addressing gaps in the coverage or effectiveness of 
        the plan; and
            ``(3) evaluating and, if appropriate, updating 
        recommendations, guidelines, or educational materials of the 
        Centers for Disease Control and Prevention or the National 
        Institutes of Health for health care providers or the public on 
        viral hepatitis in order to be consistent with the plan.
    ``(b) Publication of Notice of Assessments.--Not later than October 
1 of the first even-numbered year beginning after the date of the 
enactment of this part, and October 1 of each even-numbered year 
thereafter, the Secretary shall publish in the Federal Register a 
notice of the results of the assessments conducted under subsection 
(a). Such notice shall include--
            ``(1) a description of any revisions to the plan referred 
        to in subsection (a) as a result of the assessment;
            ``(2) an explanation of the basis for any such revisions, 
        including the ways in which such revisions can reasonably be 
        expected to further promote the original goals and objectives 
        of the plan; and
            ``(3) in the case of a determination by the Secretary that 
        the plan does not need revision, an explanation of the basis 
        for such determination.

``SEC. 399OO-1. ELEMENTS OF PROGRAM.

    ``(a) Education and Awareness Programs.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention, 
the Administrator of the Health Resources and Services Administration, 
and the Assistant Secretary for Mental Health and Substance Use, and in 
accordance with the plan referred to in section 399OO(a), shall 
implement programs to increase awareness and enhance knowledge and 
understanding of hepatitis B and hepatitis C. Such programs shall 
include--
            ``(1) the conduct of culturally and linguistically 
        appropriate health education in primary and secondary schools, 
        college campuses, public awareness campaigns, and community 
        outreach activities (especially to the ethnic communities with 
        high rates of chronic hepatitis B and chronic hepatitis C and 
        other high-risk groups) to promote public awareness and 
        knowledge about the value of hepatitis A and hepatitis B 
        immunization; risk factors, transmission, and prevention of 
        hepatitis B and hepatitis C; the value of screening for the 
        early detection of hepatitis B and hepatitis C; and options 
        available for the treatment of chronic hepatitis B and chronic 
        hepatitis C;
            ``(2) the promotion of immunization programs that increase 
        awareness and access to hepatitis A and hepatitis B vaccines 
        for susceptible adults and children;
            ``(3) the training of health care professionals regarding 
        the importance of vaccinating individuals infected with 
        hepatitis C and individuals who are at risk for hepatitis C 
        infection against hepatitis A and hepatitis B;
            ``(4) the training of health care professionals regarding 
        the importance of vaccinating individuals chronically infected 
        with hepatitis B and individuals who are at risk for chronic 
        hepatitis B infection against the hepatitis A virus;
            ``(5) the training of health care professionals and health 
        educators to make them aware of the high rates of chronic 
        hepatitis B and chronic hepatitis C in certain adult ethnic 
        populations, and the importance of prevention, detection, and 
        medical management of hepatitis B and hepatitis C and of liver 
        cancer screening;
            ``(6) the development and distribution of health education 
        curricula (including information relating to the special needs 
        of individuals infected with or at risk of hepatitis B and 
        hepatitis C, such as the importance of prevention and early 
        intervention, regular monitoring, the recognition of 
        psychosocial needs, appropriate treatment, and liver cancer 
        screening) for individuals providing hepatitis B and hepatitis 
        C counseling; and
            ``(7) support for the implementation of the curricula 
        described in paragraph (6) by State and local public health 
        agencies.
    ``(b) Immunization, Prevention, and Control Programs.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall support the integration of activities described in 
        paragraph (3) into existing clinical and public health programs 
        at State, local, territorial, and Tribal levels (including 
        community health clinics, programs for the prevention and 
        treatment of HIV/AIDS, sexually transmitted infections, and 
        substance abuse, and programs for individuals in correctional 
        settings).
            ``(2) Coordination of development of federal screening 
        guidelines.--
                    ``(A) References.--For purposes of this subsection, 
                the term `CDC Director' means the Director of the 
                Centers for Disease Control and Prevention, and the 
                term `AHRQ Director' means the Director of the Agency 
                for Healthcare Research and Quality.
                    ``(B) Agency for healthcare research and quality.--
                Due to the rapidly evolving standard of care associated 
                with diagnosing and treating viral hepatitis infection, 
                the AHRQ Director shall convene the Preventive Services 
                Task Force under section 915(a) to review its 
                recommendation for screening for HBV and HCV infection 
                every 3 years.
            ``(3) Activities.--
                    ``(A) Voluntary testing programs.--
                            ``(i) In general.--The Secretary shall 
                        establish a mechanism by which to support and 
                        promote the development of State, local, 
                        territorial, and Tribal voluntary hepatitis B 
                        and hepatitis C testing programs to screen the 
                        high-prevalence populations to aid in the early 
                        identification of chronically infected 
                        individuals.
                            ``(ii) Confidentiality of the test 
                        results.--The Secretary shall prohibit the use 
                        of the results of a hepatitis B or hepatitis C 
                        test conducted by a testing program developed 
                        or supported under this subparagraph for any of 
                        the following:
                                    ``(I) Issues relating to health 
                                insurance.
                                    ``(II) To screen or determine 
                                suitability for employment.
                                    ``(III) To discharge a person from 
                                employment.
                    ``(B) Counseling regarding viral hepatitis.--The 
                Secretary shall support State, local, territorial, and 
                Tribal programs in a wide variety of settings, 
                including those providing primary and specialty health 
                care services in nonprofit private and public sectors, 
                to--
                            ``(i) provide individuals with ongoing risk 
                        factors for hepatitis B and hepatitis C 
                        infection with client-centered education and 
                        counseling which concentrates on--
                                    ``(I) promoting testing of 
                                individuals that have been exposed to 
                                their blood, family members, and their 
                                sexual partners; and
                                    ``(II) changing behaviors that 
                                place individuals at risk for 
                                infection;
                            ``(ii) provide individuals chronically 
                        infected with hepatitis B or hepatitis C with 
                        education, health information, and counseling 
                        to reduce their risk of--
                                    ``(I) dying from end-stage liver 
                                disease and liver cancer; and
                                    ``(II) transmitting viral hepatitis 
                                to others; and
                            ``(iii) provide people chronically infected 
                        with hepatitis B or hepatitis C who are 
                        pregnant or of childbearing age with culturally 
                        and linguistically appropriate health 
                        information, such as how to prevent hepatitis B 
                        perinatal infection, and to alleviate fears 
                        associated with pregnancy or raising a family.
                    ``(C) Immunization.--The Secretary shall support 
                State, local, territorial, and Tribal efforts to expand 
                the current vaccination programs to protect every child 
                in the Nation and all susceptible adults, particularly 
                those infected with hepatitis C and high-prevalence 
                ethnic populations and other high-risk groups, from the 
                risks of acute and chronic hepatitis B infection by--
                            ``(i) ensuring continued funding for 
                        hepatitis B vaccination for all children 18 
                        years of age or younger through the Vaccines 
                        for Children program;
                            ``(ii) ensuring that the recommendations of 
                        the Advisory Committee on Immunization 
                        Practices of the Centers for Disease Control 
                        and Prevention are followed regarding hepatitis 
                        B vaccination for infants, children, and 
                        adults;
                            ``(iii) requiring proof of hepatitis B 
                        vaccination for entry into public or private 
                        daycare, preschool, elementary school, 
                        secondary school, and institutions of higher 
                        education;
                            ``(iv) expanding the availability of 
                        hepatitis B vaccination for all adults to 
                        protect them from becoming acutely or 
                        chronically infected, including ethnic and 
                        other populations with high prevalence rates of 
                        chronic hepatitis B infection;
                            ``(v) expanding the availability of 
                        hepatitis B vaccination for all adults, 
                        particularly those of reproductive age (women 
                        and men less than 45 years of age), to protect 
                        them from the risk of hepatitis B infection;
                            ``(vi) ensuring the vaccination of 
                        individuals infected, or at risk for infection, 
                        with hepatitis C against hepatitis A, hepatitis 
                        B, and other infectious diseases, as 
                        appropriate, for which such individuals may be 
                        at increased risk; and
                            ``(vii) ensuring the vaccination of 
                        individuals infected, or at risk for infection, 
                        with hepatitis B against hepatitis A virus and 
                        other infectious diseases, as appropriate, for 
                        which such individuals may be at increased 
                        risk.
                    ``(D) Medical referral.--The Secretary shall 
                support State, local, territorial, and Tribal programs 
                that support--
                            ``(i) referral of persons chronically 
                        infected with hepatitis B or hepatitis C--
                                    ``(I) for medical evaluation to 
                                determine the appropriateness for 
                                antiviral treatment to reduce the risk 
                                of progression to cirrhosis and liver 
                                cancer; and
                                    ``(II) for ongoing medical 
                                management including regular monitoring 
                                of liver function and screening for 
                                liver cancer; and
                            ``(ii) referral of persons infected with 
                        acute or chronic hepatitis B infection or acute 
                        or chronic hepatitis C infection for drug and 
                        alcohol abuse treatment where appropriate.
            ``(4) Increased support for adult viral hepatitis 
        prevention coordinators.--The Secretary, acting through the CDC 
        Director, shall provide increased support to adult viral 
        hepatitis prevention coordinators in State, local, territorial, 
        and Tribal health departments in order to enhance the 
        additional management, networking, and technical expertise 
        needed to ensure successful integration of hepatitis B and 
        hepatitis C prevention and control activities into existing 
        public health programs.
    ``(c) Epidemiological Surveillance.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall support the establishment and maintenance of a national 
        chronic and acute hepatitis B and hepatitis C surveillance 
        program, in order to identify--
                    ``(A) trends in the incidence of acute and chronic 
                hepatitis B and acute and chronic hepatitis C;
                    ``(B) trends in the prevalence of acute and chronic 
                hepatitis B and acute and chronic hepatitis C infection 
                among groups that may be disproportionately affected; 
                and
                    ``(C) trends in liver cancer and end-stage liver 
                disease incidence and deaths, caused by chronic 
                hepatitis B and chronic hepatitis C in the high-risk 
                ethnic populations.
            ``(2) Seroprevalence and liver cancer studies.--The 
        Secretary, acting through the Director of the Centers for 
        Disease Control and Prevention, shall prepare a report 
        outlining the population-based seroprevalence studies currently 
        underway, future planned studies, the criteria involved in 
        determining which seroprevalence studies to conduct, defer, or 
        suspend, and the scope of those studies, the economic and 
        clinical impact of hepatitis B and hepatitis C, and the impact 
        of chronic hepatitis B and chronic hepatitis C infections on 
        the quality of life. Not later than one year after the date of 
        the enactment of this part, the Secretary shall submit the 
        report to the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Energy and Commerce 
        of the House of Representatives.
            ``(3) Confidentiality.--The Secretary shall not disclose 
        any individually identifiable information identified under 
        paragraph (1) or derived through studies under paragraph (2).
    ``(d) Research.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, the Director of the 
National Cancer Institute, and the Director of the National Institutes 
of Health, shall--
            ``(1) conduct epidemiologic and community-based research to 
        develop, implement, and evaluate best practices for hepatitis B 
        and hepatitis C prevention especially in the ethnic populations 
        with high rates of chronic hepatitis B and chronic hepatitis C 
        and other high-risk groups;
            ``(2) conduct research on hepatitis B and hepatitis C 
        natural history, pathophysiology, improved treatments and 
        prevention (such as the hepatitis C vaccine), and noninvasive 
        tests that help to predict the risk of progression to liver 
        cirrhosis and liver cancer;
            ``(3) conduct research that will lead to better noninvasive 
        or blood tests to screen for liver cancer, and more effective 
        treatments of liver cancer caused by chronic hepatitis B and 
        chronic hepatitis C; and
            ``(4) conduct research comparing the effectiveness of 
        screening, diagnostic, management, and treatment approaches for 
        chronic hepatitis B, chronic hepatitis C, and liver cancer in 
        the affected communities.
    ``(e) Underserved and Disproportionately Affected Populations.--In 
carrying out this section, the Secretary shall provide expanded support 
for individuals with limited access to health education, testing, and 
health care services and groups that may be disproportionately affected 
by hepatitis B and hepatitis C.
    ``(f) Evaluation of Program.--The Secretary shall develop 
benchmarks for evaluating the effectiveness of the programs and 
activities conducted under this section and make determinations as to 
whether such benchmarks have been achieved.

``SEC. 399OO-2. GRANTS.

    ``(a) In General.--The Secretary may award grants to, or enter into 
contracts or cooperative agreements with, States, political 
subdivisions of States, territories, Indian Tribes, or nonprofit 
entities that have special expertise relating to hepatitis B, hepatitis 
C, or both, to carry out activities under this part.
    ``(b) Application.--To be eligible for a grant, contract, or 
cooperative agreement under subsection (a), an entity shall prepare and 
submit to the Secretary an application at such time, in such manner, 
and containing such information as the Secretary may require.

``SEC. 399OO-3. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated to carry out this part 
$90,000,000 for fiscal year 2023, $90,000,000 for fiscal year 2023, 
$110,000,000 for fiscal year 2024, $130,000,000 for fiscal year 2025, 
and $150,000,000 for fiscal year 2026.''.

SEC. 7052. LIVER CANCER AND DISEASE PREVENTION, AWARENESS, AND PATIENT 
              TRACKING GRANTS.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end the following 
new section:

``SEC. 330Q. LIVER CANCER AND DISEASE PREVENTION, AWARENESS, AND 
              PATIENT TRACKING GRANTS.

    ``(a) Prevention Initiative Grant Program.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        award grants and enter into cooperative agreements with 
        entities for the purpose of expanding and supporting--
                    ``(A) prevention activities (including providing 
                screenings, vaccinations, or other preventative 
                interventions) for conditions known to increase an 
                individual's risk of developing a major liver disease, 
                such as liver cancer, hepatitis B, hepatitis C, 
                nonalcoholic fatty liver disease, nonalcoholic 
                steatohepatitis, and cirrhosis of the liver;
                    ``(B) activities relating to detection and 
                provision of guidance for individuals at high risk for 
                contracting liver cancer and other liver diseases; and
                    ``(C) viral hepatitis surveillance to provide for 
                timely and accurate information regarding progress to 
                eliminate viral hepatitis.
            ``(2) Report.--An entity that receives a grant or 
        cooperative agreement under paragraph (1) shall submit to the 
        Secretary, at a time specified by the Secretary, a report 
        describing each activity carried out pursuant to such paragraph 
        and evaluating the effectiveness of such activity in promoting 
        prevention and treatment of liver cancer and other liver 
        diseases.
            ``(3) Authorization of appropriations.--For purposes of 
        carrying out this subsection, there is authorized to be 
        appropriated $90,000,000 for each of fiscal years 2023 through 
        2027.
    ``(b) Awareness Initiative Grant Program.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        award grants to eligible entities for the purpose of raising 
        awareness for liver cancer and other liver diseases, which may 
        include the production, dissemination, and distribution of 
        informational materials targeted towards communities and 
        populations with a higher risk for developing liver cancer and 
        other liver diseases.
            ``(2) Eligible entities.--To be eligible to receive a grant 
        under paragraph (1), an entity shall submit to the Secretary an 
        application, at such time, in such manner, and containing such 
        information as the Secretary may require, including a 
        description of how the entity, in disseminating information on 
        liver cancer and other liver diseases pursuant to paragraph 
        (1), will--
                    ``(A) with respect to any community or population, 
                consult with members of such community or population 
                and provide such information in a manner that is 
                culturally and linguistically appropriate for such 
                community or population;
                    ``(B) highlight the range of preventative measures 
                and treatments available for liver cancer and other 
                liver diseases;
                    ``(C) integrate information on available hepatitis 
                B and hepatitis C testing programs into any liver 
                cancer presentations carried out by the entity; and
                    ``(D) address communities and populations with a 
                higher risk for contracting liver cancer and other 
                liver diseases.
            ``(3) Preference.--In awarding grants under paragraph (1), 
        the Secretary shall give preference to entities that--
                    ``(A) work with a Federally qualified health 
                center;
                    ``(B) are community-based organizations; or
                    ``(C) serve communities and populations with a 
                higher risk for contracting liver cancer and other 
                liver diseases.
            ``(4) Report.--An entity that receives a grant under 
        paragraph (1) shall submit to the Secretary, at a time 
        specified by the Secretary, a report describing each activity 
        carried out pursuant to such paragraph and evaluating the 
        effectiveness of such activity in raising awareness for liver 
        cancer and other liver diseases.
            ``(5) Authorization of appropriations.--For purposes of 
        carrying out this subsection, there is authorized to be 
        appropriated $10,000,000 for each of fiscal years 2023 through 
        2027.''.

           Subtitle C--Acquired Bone Marrow Failure Diseases

SEC. 7101. ACQUIRED BONE MARROW FAILURE DISEASES.

    (a) Short Title.--This section may be cited as the ``Bone Marrow 
Failure Disease Research and Treatment Act of 2020''.
    (b) Findings.--The Congress finds the following:
            (1) Between 20,000 and 30,000 people in the United States 
        are diagnosed each year with myelodysplastic syndromes, 
        aplastic anemia, paroxysmal nocturnal hemoglobinuria, and other 
        acquired bone marrow failure diseases.
            (2) Acquired bone marrow failure diseases have a 
        debilitating and often fatal impact on those diagnosed with 
        these diseases.
            (3) While some treatments for acquired bone marrow failure 
        diseases can prolong and improve the quality of patients' 
        lives, there is no single cure for these diseases.
            (4) The prevalence of acquired bone marrow failure diseases 
        in the United States will continue to grow as the general 
        public ages.
            (5) Evidence exists suggesting that acquired bone marrow 
        failure diseases occur more often in minority populations, 
        particularly in Asian-American and Latino or Hispanic 
        populations.
            (6) The National Heart, Lung, and Blood Institute and the 
        National Cancer Institute have conducted important research 
        into the causes of and treatments for acquired bone marrow 
        failure diseases.
            (7) The National Marrow Donor Program Registry has made 
        significant contributions to the fight against bone marrow 
        failure diseases by connecting millions of potential marrow 
        donors with individuals and families suffering from these 
        conditions.
            (8) Despite these advances, a more comprehensive Federal 
        strategic effort among numerous Federal agencies is needed to 
        discover a cure for acquired bone marrow failure disorders.
            (9) Greater Federal surveillance of acquired bone marrow 
        failure diseases is needed to gain a better understanding of 
        the causes of acquired bone marrow failure diseases.
            (10) The Federal Government should increase its research 
        support for and engage with public and private organizations in 
        developing a comprehensive approach to combat and cure acquired 
        bone marrow failure diseases.
    (c) National Acquired Bone Marrow Failure Disease Registry.--Title 
III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended 
by inserting after section 317U (42 U.S.C. 247b-23) the following:

``SEC. 317V. NATIONAL ACQUIRED BONE MARROW FAILURE DISEASE REGISTRY.

    ``(a) Establishment of Registry.--
            ``(1) In general.--Not later than 6 months after the date 
        of the enactment of this section, the Secretary, acting through 
        the Director of the Centers for Disease Control and Prevention, 
        shall--
                    ``(A) develop a system to collect data on acquired 
                bone marrow failure diseases; and
                    ``(B) establish and maintain a national and 
                publicly available registry, to be known as the 
                National Acquired Bone Marrow Failure Disease Registry, 
                in accordance with paragraph (3).
            ``(2) Recommendations of advisory committee.--In carrying 
        out this subsection, the Secretary shall take into 
        consideration the recommendations of the Advisory Committee on 
        Acquired Bone Marrow Failure Diseases established under 
        subsection (b).
            ``(3) Purposes of registry.--The National Acquired Bone 
        Marrow Failure Disease Registry shall--
                    ``(A) identify the incidence and prevalence of 
                acquired bone marrow failure diseases in the United 
                States;
                    ``(B) be used to collect and store data on acquired 
                bone marrow failure diseases, including data 
                concerning--
                            ``(i) the age, race or ethnicity, general 
                        geographic location, sex, and family history of 
                        individuals who are diagnosed with acquired 
                        bone marrow failure diseases, and any other 
                        characteristics of such individuals determined 
                        appropriate by the Secretary;
                            ``(ii) the genetic and environmental 
                        factors that may be associated with developing 
                        acquired bone marrow failure diseases;
                            ``(iii) treatment approaches for dealing 
                        with acquired bone marrow failure diseases;
                            ``(iv) outcomes for individuals treated for 
                        acquired bone marrow failure diseases, 
                        including outcomes for recipients of stem cell 
                        therapeutic products as contained in the 
                        database established pursuant to section 379A; 
                        and
                            ``(v) any other factors pertaining to 
                        acquired bone marrow failure diseases 
                        determined appropriate by the Secretary; and
                    ``(C) be made available--
                            ``(i) to the general public; and
                            ``(ii) to researchers to facilitate further 
                        research into the causes of, and treatments 
                        for, acquired bone marrow failure diseases in 
                        accordance with standard practices of the 
                        Centers for Disease Control and Prevention.
    ``(b) Advisory Committee.--
            ``(1) Establishment.--Not later than 6 months after the 
        date of the enactment of this section, the Secretary, acting 
        through the Director of the Centers for Disease Control and 
        Prevention, shall establish an advisory committee, to be known 
        as the Advisory Committee on Acquired Bone Marrow Failure 
        Diseases.
            ``(2) Members.--The members of the Advisory Committee on 
        Acquired Bone Marrow Failure Diseases shall be appointed by the 
        Secretary, acting through the Director of the Centers for 
        Disease Control and Prevention, and shall include at least one 
        representative from each of the following:
                    ``(A) A national patient advocacy organization with 
                experience advocating on behalf of patients suffering 
                from acquired bone marrow failure diseases.
                    ``(B) The National Institutes of Health, including 
                at least one representative from each of--
                            ``(i) the National Cancer Institute;
                            ``(ii) the National Heart, Lung, and Blood 
                        Institute; and
                            ``(iii) the Office of Rare Diseases.
                    ``(C) The Centers for Disease Control and 
                Prevention.
                    ``(D) Clinicians with experience in--
                            ``(i) diagnosing or treating acquired bone 
                        marrow failure diseases; or
                            ``(ii) medical data registries.
                    ``(E) Epidemiologists who have experience with data 
                registries.
                    ``(F) Publicly or privately funded researchers who 
                have experience researching acquired bone marrow 
                failure diseases.
                    ``(G) The entity operating the C.W. Bill Young Cell 
                Transplantation Program established pursuant to section 
                379 and the entity operating the C.W. Bill Young Cell 
                Transplantation Program Outcomes Database.
            ``(3) Responsibilities.--The Advisory Committee on Acquired 
        Bone Marrow Failure Diseases shall provide recommendations to 
        the Secretary on the establishment and maintenance of the 
        National Acquired Bone Marrow Failure Disease Registry, 
        including recommendations on the collection, maintenance, and 
        dissemination of data.
            ``(4) Public availability.--The Secretary shall make the 
        recommendations of the Advisory Committee on Acquired Bone 
        Marrow Failure Disease publicly available.
    ``(c) Grants.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, may award grants to, and 
enter into contracts and cooperative agreements with, public or private 
nonprofit entities for the management of, as well as the collection, 
analysis, and reporting of data to be included in, the National 
Acquired Bone Marrow Failure Disease Registry.
    ``(d) Definition.--In this section, the term `acquired bone marrow 
failure disease' means--
            ``(1) myelodysplastic syndromes;
            ``(2) aplastic anemia;
            ``(3) paroxysmal nocturnal hemoglobinuria;
            ``(4) pure red cell aplasia;
            ``(5) acute myeloid leukemia that has progressed from 
        myelodysplastic syndromes; or
            ``(6) large granular lymphocytic leukemia.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $3,000,000 for each of fiscal 
years 2023 through 2027.''.
    (d) Pilot Studies Through the Agency for Toxic Substances and 
Disease Registry.--
            (1) Pilot studies.--The Secretary of Health and Human 
        Services, acting through the Director of the Agency for Toxic 
        Substances and Disease Registry, shall conduct pilot studies to 
        determine which environmental factors, including exposure to 
        toxins, may cause acquired bone marrow failure diseases.
            (2) Collaboration with the radiation injury treatment 
        network.--In carrying out the directives of this section, the 
        Secretary of Health and Human Services may collaborate with the 
        Radiation Injury Treatment Network of the C.W. Bill Young Cell 
        Transplantation Program established pursuant to section 379 of 
        the Public Health Service Act (42 U.S.C. 274k) to--
                    (A) augment data for the pilot studies authorized 
                by this section;
                    (B) access technical assistance that may be 
                provided by the Radiation Injury Treatment Network; or
                    (C) perform joint research projects.
            (3) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this section $1,000,000 for 
        each of fiscal years 2023 through 2027.
    (e) Minority-Focused Programs on Acquired Bone Marrow Failure 
Diseases.--Title XVII of the Public Health Service Act (42 U.S.C. 300u 
et seq.) is amended by inserting after section 1707A the following:

``SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE MARROW FAILURE 
              DISEASE.

    ``(a) Information and Referral Services.--
            ``(1) In general.--Not later than 6 months after the date 
        of the enactment of this section, the Secretary, acting through 
        the Deputy Assistant Secretary for Minority Health, shall 
        establish and coordinate outreach and informational programs 
        targeted to minority populations affected by acquired bone 
        marrow failure diseases.
            ``(2) Program requirements.--Minority-focused outreach and 
        informational programs authorized by this section at the 
        National Minority Health Resource Center supported under 
        section 1707(b)(8) (including by means of the Center's website, 
        through appropriate locations such as the Center's knowledge 
        center, and through appropriate programs such as the Center's 
        resource persons network) and through minority health 
        consultants located at each Department of Health and Human 
        Services regional office--
                    ``(A) shall make information about treatment 
                options and clinical trials for acquired bone marrow 
                failure diseases publicly available; and
                    ``(B) shall provide referral services for treatment 
                options and clinical trials.
    ``(b) Hispanic and Asian-American and Pacific Islander Outreach.--
            ``(1) In general.--The Secretary, acting through the Deputy 
        Assistant Secretary for Minority Health, shall undertake a 
        coordinated outreach effort to connect Hispanic, Asian-
        American, and Pacific Islander communities with comprehensive 
        services focused on treatment of, and information about, 
        acquired bone marrow failure diseases.
            ``(2) Collaboration.--In carrying out this subsection, the 
        Secretary may collaborate with public health agencies, 
        nonprofit organizations, community groups, and online entities 
        to disseminate information about treatment options and clinical 
        trials for acquired bone marrow failure diseases.
    ``(c) Grants and Cooperative Agreements.--
            ``(1) In general.--Not later than 6 months after the date 
        of the enactment of this section, the Secretary, acting through 
        the Deputy Assistant Secretary for Minority Health, shall award 
        grants to, or enter into cooperative agreements with, entities 
        to perform research on acquired bone marrow failure diseases.
            ``(2) Requirement.--Grants and cooperative agreements 
        authorized by this subsection shall be awarded or entered into 
        on a competitive, peer-reviewed basis.
            ``(3) Scope of research.--Research funded under this 
        section shall examine factors affecting the incidence of 
        acquired bone marrow failure diseases in minority populations.
    ``(d) Definition.--In this section, the term `acquired bone marrow 
failure disease' has the meaning given to such term in section 317V(d).
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,000,000 for each of fiscal 
years 2023 through 2027''.
    (f) Diagnosis and Quality of Care for Acquired Bone Marrow Failure 
Diseases.--
            (1) Grants.--The Secretary of Health and Human Services, 
        acting through the Director of the Agency for Healthcare 
        Research and Quality, shall award grants to entities to improve 
        diagnostic practices and quality of care with respect to 
        patients with acquired bone marrow failure diseases.
            (2) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this section $2,000,000 for 
        each of fiscal years 2023 through 2027.
    (g) Definition.--In this section, the term ``acquired bone marrow 
failure disease'' has the meaning given such term in section 317V(d) of 
the Public Health Service Act, as added by subsection (c).

Subtitle D--Cardiovascular Disease, Chronic Disease, Obesity, and Other 
                             Disease Issues

SEC. 7151. GUIDELINES FOR DISEASE SCREENING FOR MINORITY PATIENTS.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary''), acting through the 
Director of the Agency for Healthcare Research and Quality, shall 
convene a series of meetings to develop guidelines for disease 
screening for minority patient populations that have a higher than 
average risk for many chronic diseases and cancers.
    (b) Participants.--In convening meetings under subsection (a), the 
Secretary shall ensure that meeting participants include 
representatives of--
            (1) professional societies and associations;
            (2) minority health organizations;
            (3) health care researchers and providers, including those 
        with expertise in minority health;
            (4) Federal health agencies, including the Office of 
        Minority Health, the National Institute on Minority Health and 
        Health Disparities, and the National Institutes of Health; and
            (5) other experts as the Secretary determines appropriate.
    (c) Diseases.--Screening guidelines for minority populations shall 
be developed as appropriate under subsection (a) for--
            (1) hypertension;
            (2) hypercholesterolemia;
            (3) diabetes;
            (4) cardiovascular disease;
            (5) cancers, including breast, prostate, colon, cervical, 
        and lung cancer;
            (6) other pulmonary problems including sleep apnea;
            (7) asthma;
            (8) kidney diseases;
            (9) eye diseases and disorders, including glaucoma;
            (10) HIV/AIDS and sexually transmitted infections;
            (11) uterine fibroids;
            (12) autoimmune diseases, including lupus;
            (13) mental health conditions;
            (14) dental health conditions and oral diseases, including 
        oral cancer;
            (15) environmental and related health illnesses and 
        conditions;
            (16) sickle cell disease and sickle cell trait;
            (17) violence and injury prevention and control;
            (18) genetic and related conditions;
            (19) heart disease and stroke;
            (20) tuberculosis;
            (21) chronic obstructive pulmonary disease;
            (22) musculoskeletal diseases, arthritis, and obesity; and
            (23) other diseases determined appropriate by the 
        Secretary.
    (d) Dissemination.--Not later than 2 years after the date of 
enactment of this Act, the Secretary shall publish and disseminate to 
health care provider organizations the guidelines developed under 
subsection (a).
    (e) 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 2023 through 2027.

SEC. 7152. CDC WISEWOMAN SCREENING PROGRAM.

    Section 1509 of the Public Health Service Act (42 U.S.C. 300n-4a) 
is amended--
            (1) in subsection (a)--
                    (A) by striking the heading and inserting ``In 
                General.--''; and
                    (B) in the matter preceding paragraph (1), by 
                striking ``may make grants'' and all that follows 
                through ``purpose'' and inserting the following: ``may 
                make grants to such States for the purpose''; and
            (2) in subsection (d)(1), by striking ``there are 
        authorized'' and all that follows through the period and 
        inserting ``there are authorized to be appropriated $23,000,000 
        for fiscal year 2023, $25,300,000 for fiscal year 2024, 
        $27,800,000 for fiscal year 2025, $30,800,000 for fiscal year 
        2026, and $34,000,000 for fiscal year 2027.''.

SEC. 7153. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399V-7. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.

    ``Not later than September 30, 2023, and annually thereafter, the 
Secretary shall prepare and submit to Congress a report on the quality 
of and access to care for women and minorities with heart disease, 
stroke, and other cardiovascular diseases. The report shall contain 
recommendations for eliminating disparities in, and improving the 
treatment of, heart disease, stroke, and other cardiovascular diseases 
in women, racial and ethnic minorities, those for whom English is not 
their primary language, and individuals with disabilities.''.

SEC. 7154. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN 
              MEDICAID, CHIP, AND PRIVATE HEALTH INSURANCE.

    (a) Requiring Medicaid Coverage of Counseling and Pharmacotherapy 
for Cessation of Tobacco Use and Temporary Enhanced FMAP for Coverage 
of Tobacco Cessation Services.--Section 1905 of the Social Security Act 
(42 U.S.C. 1396d) is amended--
            (1) by amending subsection (a)(4)(D) to read as follows:
                    ``(D) counseling and pharmacotherapy for cessation 
                of tobacco use by individuals who are eligible under 
                the State plan (as defined in subsection (bb)); and'';
            (2) in subsection (b), by inserting ``(bb)(2),'' after 
        ``(aa),''; and
            (3) by striking subsection (bb) and inserting the 
        following:
    ``(bb) Counseling and Pharmacotherapy for Cessation of Tobacco 
Use.--
            ``(1) In general.--For purposes of this title, the term 
        `counseling and pharmacotherapy for cessation of tobacco use by 
        individuals who are eligible under the State plan' means 
        diagnostic, therapy, and counseling services and 
        pharmacotherapy (including the coverage of prescription and 
        nonprescription tobacco cessation agents approved by the Food 
        and Drug Administration) for the cessation of tobacco use by 
        individuals who use tobacco products or who are being treated 
        for tobacco use that is furnished--
                    ``(A) by or under the supervision of a physician; 
                or
                    ``(B) by any other health care professional who--
                            ``(i) is legally authorized to furnish such 
                        services under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the services are furnished; 
                        and
                            ``(ii) is authorized to receive payment for 
                        other services under this title or is 
                        designated by the Secretary for this purpose;
                which is recommended in the guideline entitled, 
                `Treating Tobacco Use and Dependence: 2008 Update: A 
                Clinical Practice Guideline' published by the Public 
                Health Service in May 2008 (or any subsequent 
                modification of such guideline) or is recommended for 
                the cessation of tobacco use by the United States 
                Preventive Services Task Force or any additional 
                intervention approved by the Food and Drug 
                Administration as safe and effective in helping smokers 
                quit.
            ``(2) Temporary enhanced fmap for coverage of tobacco 
        cessation services.--Notwithstanding subsection (b), for 
        calendar quarters occurring during the period beginning on the 
        date of the enactment of this paragraph and ending 2 years 
        after the last day of the emergency period described in section 
        1135(g)(1)(B), the Federal medical assistance percentage with 
        respect to amounts expended by a State for medical assistance 
        for counseling and pharmacotherapy for cessation of tobacco use 
        by individuals who are eligible under the State plan (as 
        defined in paragraph (1)) shall be equal to 100 percent.''.
    (b) No Cost Sharing.--
            (1) In general.--Subsections (a)(2) and (b)(2) of section 
        1916 of the Social Security Act (42 U.S.C. 1396o) are each 
        amended--
                    (A) in subparagraph (B), by striking ``, and 
                counseling'' and all that follows through ``section 
                1905(bb)(2)(A)'';
                    (B) by adjusting the left margins of subparagraphs 
                (H) and (I) so as to align with the left margin of 
                subparagraph (G);
                    (C) in subparagraph (H), by striking ``or'' at the 
                end;
                    (D) in subparagraph (I), by striking ``; and'' and 
                inserting ``; or''; and
                    (E) by adding at the end the following new 
                subparagraph:
                    ``(J) counseling and pharmacotherapy for cessation 
                of tobacco use by individuals who are eligible under 
                the State plan (as defined in section 1905(bb)) and 
                covered outpatient drugs (as defined in subsection 
                (k)(2) of section 1927 and including nonprescription 
                drugs described in subsection (d)(2) of such section) 
                that are prescribed for purposes of promoting tobacco 
                cessation in accordance with the guideline specified in 
                section 1905(bb); and''.
            (2) Application to alternative cost sharing.--Section 
        1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o-
        1(b)(3)(B)) is amended--
                    (A) in clause (iii), by striking ``, and counseling 
                and pharmacotherapy for cessation of tobacco use by 
                pregnant women (as defined in section 1905(bb))'';
                    (B) by adjusting the left margins of clauses (xii) 
                and (xiii) so as to align with the left margin of 
                clause (xi); and
                    (C) by adding at the end the following new clause:
                            ``(xiv) Counseling and pharmacotherapy for 
                        cessation of tobacco use by individuals who are 
                        eligible under the State plan (as defined in 
                        section 1905(bb)) and covered outpatient drugs 
                        (as defined in subsection (k)(2) of section 
                        1927 and including nonprescription drugs 
                        described in subsection (d)(2) of such section) 
                        that are prescribed for purposes of promoting 
                        tobacco cessation in accordance with the 
                        guideline specified in section 1905(bb).''.
    (c) Exception From Optional Restriction Under Medicaid Prescription 
Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42 
U.S.C. 1396r-8(d)(2)(F)) is amended to read as follows:
                    ``(F) Nonprescription drugs, except, when 
                recommended in accordance with the guideline referred 
                to in section 1905(bb), agents approved by the Food and 
                Drug Administration under the over-the-counter 
                monograph process for purposes of promoting tobacco 
                cessation.''.
    (d) State Monitoring and Promoting of Comprehensive Tobacco 
Cessation Services Under Medicaid.--Section 1902(a) of the Social 
Security Act (42 U.S.C. 1396a(a)) is amended--
            (1) in paragraph (86), by striking ``and'' at the end;
            (2) in paragraph (87), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (87) the following new 
        paragraph:
            ``(88) provide for the State to monitor and promote the use 
        of comprehensive tobacco cessation services under the State 
        plan (including conducting an outreach campaign to increase 
        awareness of the benefits of using such services) among--
                    ``(A) individuals entitled to medical assistance 
                under the State plan who use tobacco products; and
                    ``(B) clinicians and others who provide services to 
                individuals entitled to medical assistance under the 
                State plan.''.
    (e) Federal Reimbursement for Outreach Campaign.--Section 1903(a) 
of the Social Security Act (42 U.S.C. 1396b(a)) is amended--
            (1) in paragraph (6)(B), by striking ``plus'' at the end;
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``; plus''; and
            (3) by inserting after paragraph (7) the following new 
        paragraph:
            ``(8) with respect to the development, implementation, and 
        evaluation of an outreach campaign to--
                    ``(A) increase awareness of comprehensive tobacco 
                cessation services covered in the State plan among--
                            ``(i) individuals who are likely to be 
                        eligible for medical assistance under the State 
                        plan; and
                            ``(ii) clinicians and others who provide 
                        services to individuals who are likely to be 
                        eligible for medical assistance under the State 
                        plan; and
                    ``(B) increase awareness of the benefits of using 
                comprehensive tobacco cessation services covered in the 
                State plan among--
                            ``(i) individuals who are likely to be 
                        eligible for medical assistance under the State 
                        plan; and
                            ``(ii) clinicians and others who provide 
                        services to individuals who are likely to be 
                        eligible for medical assistance under the State 
                        plan about the benefits of using comprehensive 
                        tobacco cessation services;
                for calendar quarters occurring during the period 
                beginning on the date of the enactment of this 
                paragraph and ending on 2 years after the last day of 
                the emergency period described in section 
                1135(g)(1)(B), an amount equal to 100 percent of the 
                sums expended during each quarter which are 
                attributable to such development, implementation, and 
                evaluation, and for calendar quarters succeeding such 
                period, an amount equal to Federal medical assistance 
                percentage determined under section 1905(b) of the sums 
                expended during each quarter which are so 
                attributable.''.
    (f) No Prior Authorization for Tobacco Cessation Drugs Under 
Medicaid.--Section 1927(d) of the Social Security Act (42 U.S.C. 1396r-
8(d)) is amended--
            (1) in paragraph (1)(A), by striking ``A State'' and 
        inserting ``Subject to paragraph (8), a State''; and
            (2) by adding at the end the following new paragraph:
            ``(8) No prior authorization programs for tobacco cessation 
        drugs.--A State plan may not require, as a condition of 
        coverage or payment for a covered outpatient drug, the approval 
        of an agent to promote smoking cessation (including agents 
        approved by the Food and Drug Administration) or tobacco 
        cessation.''.
    (g) Exclusion of Enhanced Payments From Territorial Caps.--
Notwithstanding any other provision of law, for purposes of section 
1108 of the Social Security Act (42 U.S.C. 1308), with respect to any 
additional amount paid to a territory as a result of the application of 
section 1905(bb)(2) of the Social Security Act (42 U.S.C. 
1396d(bb)(2))--
            (1) the limitation on payments to territories under 
        subsections (f) and (g) of such section 1108 shall not apply to 
        such additional amounts; and
            (2) such additional amounts shall be disregarded in 
        applying such subsections.
    (h) Requiring CHIP Coverage of Counseling and Pharmacotherapy for 
Cessation of Tobacco Use.--
            (1) In general.--Section 2103(c)(2) of the Social Security 
        Act (42 U.S.C. 1397cc(c)(2)) is amended by adding at the end 
        the following new subparagraph:
                    ``(D) Counseling and pharmacotherapy for cessation 
                of tobacco use by individuals who are eligible under 
                the State child health plan.''.
            (2) Counseling and pharmacotherapy for cessation of tobacco 
        use defined.--Section 2110(c) of the Social Security Act (42 
        U.S.C. 1397jj(c)) is amended by adding at the end the following 
        new paragraph:
            ``(10) Counseling and pharmacotherapy for cessation of 
        tobacco use.--The term `counseling and pharmacotherapy for 
        cessation of tobacco use' means diagnostic, therapy, and 
        counseling services and pharmacotherapy (including the coverage 
        of prescription and nonprescription tobacco cessation agents 
        approved by the Food and Drug Administration) for the cessation 
        of tobacco use by individuals who use tobacco products or who 
        are being treated for tobacco use that are furnished--
                    ``(A) by or under the supervision of a physician; 
                or
                    ``(B) by any other health care professional who--
                            ``(i) is legally authorized to furnish such 
                        services under State law (or the State 
                        regulatory mechanism provided by State law) of 
                        the State in which the services are furnished; 
                        and
                            ``(ii) is authorized to receive payment for 
                        other services under this title or is 
                        designated by the Secretary for this purpose;
                which is recommended in the guideline entitled, 
                `Treating Tobacco Use and Dependence: 2008 Update: A 
                Clinical Practice Guideline' published by the Public 
                Health Service in May 2008 (or any subsequent 
                modification of such guideline) or is recommended for 
                the cessation of tobacco use by the United States 
                Preventive Services Task Force or any additional 
                intervention approved by the Food and Drug 
                Administration as safe and effective in helping smokers 
                quit.''.
    (i) No Cost Sharing.--Section 2103(e) of the Social Security Act 
(42 U.S.C. 1397cc(e)) is amended by adding at the end the following new 
paragraph:
            ``(5) No cost sharing on benefits for counseling and 
        pharmacotherapy for cessation of tobacco use.--The State child 
        health plan may not impose deductibles, coinsurance, or other 
        cost sharing with respect to benefits for counseling and 
        pharmacotherapy for cessation of tobacco use (as defined in 
        section 2110(c)(10)) and prescription drugs that are covered 
        under a State child health plan that are prescribed for 
        purposes of promoting tobacco cessation in accordance with the 
        guideline specified in section 2110(c)(10)(B).''.
    (j) Exception From Optional Restriction Under CHIP Prescription 
Drug Coverage.--Section 2103 of the Social Security Act (42 U.S.C. 
1397cc) is amended by adding at the end the following new subsection:
    ``(g) Exception From Optional Restriction Under CHIP Prescription 
Drug Coverage.--The State child health plan may exclude or otherwise 
restrict nonprescription drugs, except, in the case of--
            ``(1) pregnant women when recommended in accordance with 
        the guideline specified in section 2110(c)(10)(B), agents 
        approved by the Food and Drug Administration under the over-
        the-counter monograph process for purposes of promoting tobacco 
        cessation; and
            ``(2) individuals who are eligible under the State child 
        health plan when recommended in accordance with the Guideline 
        referred to in section 2110(c)(10)(B), agents approved by the 
        Food and Drug Administration under the over-the-counter 
        monograph process for purposes of promoting tobacco 
        cessation.''.
    (k) State Monitoring and Promoting of Comprehensive Tobacco 
Cessation Services Under CHIP.--Section 2102 of the Social Security Act 
(42 U.S.C. 1397bb) is amended by adding at the end the following new 
subsection:
    ``(d) State Monitoring and Promoting of Comprehensive Tobacco 
Cessation Services Under CHIP.--A State child health plan shall include 
a description of the procedures to be used by the State to monitor and 
promote the use of comprehensive tobacco cessation services under the 
State plan (including conducting an outreach campaign to increase 
awareness of the benefits of using such services) among--
            ``(1) individuals entitled to medical assistance under the 
        State child health plan who use tobacco products; and
            ``(2) clinicians and others who provide services to 
        individuals entitled to medical assistance under the State 
        child health plan.''.
    (l) Federal Reimbursement for CHIP Coverage and Outreach 
Campaign.--
            (1) In general.--Section 2105(a) of the Social Security Act 
        (42 U.S.C. 1397ee(a)) is amended by adding at the end the 
        following new paragraph:
            ``(5) Federal reimbursement for chip coverage of 
        comprehensive tobacco cessation services and outreach 
        campaign.--In addition to the payments made under paragraph (1) 
        for calendar quarters occurring during the period beginning on 
        the date of the enactment of this paragraph and ending on 2 
        years after the last day of the emergency period described in 
        section 1135(g)(1)(B), the Secretary shall pay--
                    ``(A) an amount equal to 100 percent of the sums 
                expended during each quarter which are attributable to 
                the cost of furnishing counseling and pharmacotherapy 
                for cessation of tobacco use by individuals who are 
                eligible under the State child health plan (net of any 
                payments made to the State under paragraph (1) with 
                respect to such counseling and pharmacotherapy); plus
                    ``(B) an amount equal to 100 percent of the sums 
                expended during each quarter which are attributable to 
                the development, implementation, and evaluation of an 
                outreach campaign to--
                            ``(i) increase awareness of comprehensive 
                        tobacco cessation services covered in the State 
                        child health plan among--
                                    ``(I) individuals who are likely to 
                                be eligible for medical assistance 
                                under the State child health plan; and
                                    ``(II) clinicians and others who 
                                provide services to individuals who are 
                                likely to be eligible for medical 
                                assistance under the State child health 
                                plan; and
                            ``(ii) increase awareness of the benefits 
                        of using comprehensive tobacco cessation 
                        services covered in the State child health plan 
                        among--
                                    ``(I) individuals who are likely to 
                                be eligible for medical assistance 
                                under the State child health plan; and
                                    ``(II) clinicians and others who 
                                provide services to individuals who are 
                                likely to be eligible for medical 
                                assistance under the State child health 
                                plan about the benefits of using 
                                comprehensive tobacco cessation 
                                services.''.
            (2) Adjustment of chip allotments.--Section 2104(m) of the 
        Social Security Act (42 U.S.C. 1397dd(m)) is amended--
                    (A) in paragraph (2)(B), by striking ``and (12)'' 
                and inserting ``(12), and (13)''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(13) Adjusting allotments to account for federal payments 
        for chip coverage of comprehensive tobacco cessation services 
        and outreach campaign.--If a State (including the District of 
        Columbia and each commonwealth and territory) receives a 
        payment for a fiscal year under section 2105(a)(5), the 
        allotment determined for the State for such fiscal year shall 
        be increased by the amount of such payment.''.
    (m) No Prior Authorization for Tobacco Cessation Drugs Under 
CHIP.--Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as 
amended by subsection (h), is further amended--
            (1) in subsection (c)(2)(A), by inserting ``(in accordance 
        with subsection (h))'' after ``Coverage of prescription 
        drugs''; and
            (2) by adding at the end the following new subsection:
    ``(h) No Prior Authorization Programs for Tobacco Cessation 
Drugs.--A State child health plan may not require, as a condition of 
coverage or payment for a prescription drugs, the approval of an agent 
to promote smoking cessation (including agents approved by the Food and 
Drug Administration) or tobacco cessation.''.
    (n) Comprehensive Coverage of Tobacco Cessation Coverage in Private 
Health Insurance.--Section 2713 of the Public Health Service Act (42 
U.S.C. 300gg-13) is amended by adding at the end the following:
    ``(d) No Prior Authorization.--A group health plan and a health 
insurance issuer offering group or individual health insurance coverage 
shall not impose any prior authorization requirement for tobacco 
cessation counseling and pharmacotherapy that has in effect a rating of 
`A' or `B' in the current recommendations of the United States 
Preventive Services Task Force.''.
    (o) Rule of Construction.--None of the amendments made by this 
section shall be construed to limit coverage of any counseling or 
pharmacotherapy for individuals under 18 years of age.
    (p) Effective Date.--The amendments made by this section shall take 
effect on the first day of the first fiscal year that begins on or 
after the date of enactment of this Act.

SEC. 7155. CLINICAL RESEARCH FUNDING FOR ORAL HEALTH.

    (a) In General.--The Secretary of Health and Human Services shall 
expand and intensify the conduct and support of the research activities 
of the National Institutes of Health and the National Institute of 
Dental and Craniofacial Research to improve the oral health of the 
population through the prevention and management of oral diseases and 
conditions.
    (b) Included Research Activities.--Research activities under 
subsection (a) shall include--
            (1) comparative effectiveness research and clinical disease 
        management research addressing early childhood caries and oral 
        cancer; and
            (2) awarding of grants and contracts to support the 
        training and development of health services researchers, 
        comparative effectiveness researchers, and clinical researchers 
        whose research improves the oral health of the population.

SEC. 7156. GUIDE ON EVIDENCE-BASED STRATEGIES FOR PUBLIC HEALTH 
              DEPARTMENT OBESITY PREVENTION PROGRAMS.

    (a) Development and Dissemination of an Evidence-Based Strategies 
Guide.--The Secretary of Health and Human Services (referred to in this 
section as the ``Secretary''), acting through the Director of the 
Centers for Disease Control and Prevention, not later than 2 years 
after the date of enactment of this Act, shall--
            (1) develop a guide on evidence-based strategies for State, 
        territorial, and local health departments to use to build and 
        maintain effective obesity prevention and reduction programs, 
        and, in consultation with stakeholders that have expertise in 
        Tribal health, a guide on such evidence-based strategies with 
        respect to Indian Tribes and Tribal organizations for such 
        Indian Tribes and Tribal organizations to use for such purpose, 
        both of which guides shall--
                    (A) describe an integrated program structure for 
                implementing interventions proven to be effective in 
                preventing and reducing the incidence of obesity; and
                    (B) recommend--
                            (i) optimal resources, including staffing 
                        and infrastructure, for promoting nutrition and 
                        obesity prevention and reduction; and
                            (ii) strategies for effective obesity 
                        prevention programs for State and local health 
                        departments, Indian Tribes, and Tribal 
                        organizations, including strategies related 
                        to--
                                    (I) the application of evidence-
                                based and evidence-informed practices 
                                to prevent and reduce obesity rates;
                                    (II) the development, 
                                implementation, and evaluation of 
                                obesity prevention and reduction 
                                strategies for specific communities and 
                                populations;
                                    (III) demonstrated knowledge of 
                                obesity prevention practices that 
                                reduce associated preventable diseases, 
                                health conditions, death, and health 
                                care costs;
                                    (IV) best practices for the 
                                coordination of efforts to prevent and 
                                reduce obesity and related chronic 
                                diseases;
                                    (V) addressing the underlying risk 
                                factors and social determinants of 
                                health that impact obesity rates; and
                                    (VI) interdisciplinary coordination 
                                between relevant public health 
                                officials specializing in fields such 
                                as nutrition, physical activity, 
                                epidemiology, communications, and 
                                policy implementation, and 
                                collaboration between public health 
                                officials and community-based 
                                organizations; and
            (2) disseminate the guides and current research, evidence-
        based practices, tools, and educational materials related to 
        obesity prevention, consistent with the guides, to State and 
        local health departments, Indian Tribes, and Tribal 
        organizations.
    (b) Technical Assistance.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
provide technical assistance to State and local health departments, 
Indian Tribes, and Tribal organizations to support such health 
departments in implementing the guides developed under subsection 
(a)(1).
    (c) Indian Tribes; Tribal Organizations.--In this section, the 
terms ``Indian Tribe'' and ``Tribal organization'' have the meanings 
given the terms ``Indian tribe'' and ``tribal organization'', 
respectively, in section 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5304).

SEC. 7157. STEPHANIE TUBBS JONES UTERINE FIBROID RESEARCH AND EDUCATION 
              ACT.

    (a) Research With Respect to Uterine Fibroids.--
            (1) Research.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary'') shall 
        expand, intensify, and coordinate programs for the conduct and 
        support of research with respect to uterine fibroids.
            (2) Administration and coordination.--The Secretary shall 
        carry out the conduct and support of research pursuant to 
        paragraph (1), in coordination with the appropriate institutes, 
        offices, and centers of the National Institutes of Health and 
        any other relevant Federal agency, as determined by the 
        Director.
            (3) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there are authorized to be 
        appropriated $30,000,000 for each of fiscal years 2022 through 
        2026.
    (b) Research With Respect to Medicaid Coverage of Uterine Fibroids 
Treatment.--
            (1) Research.--The Secretary (or the Secretary's designee) 
        shall establish a research database, or expand an existing 
        research database, to collect data on services furnished to 
        individuals diagnosed with uterine fibroids under a State plan 
        (or a waiver of such a plan) under the Medicaid program under 
        title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
        or under a State child health plan (or a waiver of such a plan) 
        under the Children's Health Insurance Program under title XXI 
        of such Act (42 U.S.C. 1397aa et seq.) for the treatment of 
        such fibroids for purposes of assessing the frequency at which 
        such individuals are furnished such services.
            (2) Report.--
                    (A) In general.--Not later than the date that is 
                two years after the date of the enactment of this Act, 
                the Secretary shall submit to Congress a report on the 
                amount of Federal and State expenditures with respect 
                to services furnished for the treatment of uterine 
                fibroids under State plans (or waivers of such plans) 
                under the Medicaid program under such title XIX and 
                State child health plans (or waivers of such plans) 
                under the Children's Health Insurance Program under 
                such title XXI.
                    (B) Coordination.--The Secretary shall coordinate 
                the development and submission of the report required 
                under subparagraph (A) with any other relevant Federal 
                agency, as determined by the Secretary.
    (c) Education and Dissemination of Information With Respect to 
Uterine Fibroids.--
            (1) Uterine fibroids public education program.--The 
        Secretary shall develop and disseminate to the public 
        information regarding uterine fibroids, including information 
        on--
                    (A) the awareness, incidence, and prevalence of 
                uterine fibroids among individuals, including all 
                minority individuals;
                    (B) the elevated risk for minority individuals to 
                develop uterine fibroids; and
                    (C) the availability, as medically appropriate, of 
                the range of treatment options for symptomatic uterine 
                fibroids, including non-hysterectomy treatments and 
                procedures.
            (2) Dissemination of information.--The Secretary may 
        disseminate information under paragraph (1) directly or through 
        arrangements with intra-agency initiatives, nonprofit 
        organizations, consumer groups, institutions of higher 
        education (as defined in section 101 of the Higher Education 
        Act of 1965 (20 U.S.C. 1001)), or Federal, State, or local 
        public private partnerships.
            (3) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there are authorized to be 
        appropriated such sums as may be necessary for each of fiscal 
        years 2022 through 2026.

                          Subtitle E--HIV/AIDS

SEC. 7201. STATEMENT OF POLICY.

    It is the policy of the United States to achieve an AIDS-free 
generation, and to--
            (1) expand access to lifesaving antiretroviral therapy for 
        people living with HIV and immediately link people to 
        continuous and coordinated high-quality care when they learn 
        they are living with HIV;
            (2) expand targeted efforts to prevent HIV infection using 
        a combination of effective, evidence-based approaches, 
        including routine HIV screening, and universal access to HIV 
        prevention tools, including preexposure prophylaxis, in 
        communities disproportionately impacted by HIV, particularly 
        communities of color;
            (3) ensure laws, policies, and regulations do not impede 
        access to prevention, treatment, and care for people living 
        with HIV or disproportionately impacted by HIV;
            (4) accelerate research for more efficacious HIV prevention 
        and treatments tools, a cure, and a vaccine; and
            (5) respect the human rights and dignity of persons living 
        with HIV.

SEC. 7202. FINDINGS.

    The Congress finds the following:
            (1) Over 1,100,000 people are estimated to be living with 
        HIV in the United States according to the Centers for Disease 
        Control and Prevention, 14 percent of whom are unaware they are 
        living with HIV.
            (2) The Centers for Disease Control and Prevention 
        estimates that, in 2019, there were approximately 34,800 people 
        newly diagnosed with HIV. New HIV infections declined 8 percent 
        from 37,800 in 2015, after a period of general stability. From 
        2015 to 2019, new infections among young gay and bisexual men 
        (ages 13 to 24) dropped 33 percent overall, with declines in 
        young men of all races, but African Americans, Hispanics, and 
        Latinos continue to be severely and disproportionately 
        affected.
            (3) HIV disproportionately affects certain populations in 
        the United States. Though Blacks/African Americans represent 
        approximately 13 percent of the population, they account for 
        almost half (44 percent) of all people living with HIV in the 
        United States. Black/African-American men who have sex with men 
        account for 26 percent of all new HIV infections and have 
        remained stable from 2010 to 2019.
            (4) Disparities continue to exist among Latinos and 
        Hispanics; in 2019, Latinos and Hispanics made up 18 percent of 
        the United States population and 30 percent of new infections.
            (5) Though the rate of new infections among American 
        Indians and Alaska Natives (referred to in this section as 
        ``AI/AN'') is proportional to their population size, from 2015 
        to 2019, the annual number of HIV diagnoses increased among 
        American Indians and Alaska Natives.
            (6) Asian Americans account for about 2 percent of new HIV 
        infections, but in 2013, 22 percent were undiagnosed, the 
        highest rate of undiagnosed HIV among any race or ethnicity. 
        Between 2010 and 2016, the number of Asian Americans receiving 
        an HIV diagnosis increased by 42 percent.
            (7) The latest data from the Centers for Disease Control 
        and Prevention indicates that new infections among women 
        remained stable for women in 2019.
            (8) The history of HIV shows that culturally relevant and 
        gender-responsive supportive services, including psychosocial 
        support, treatment literacy, case management, and 
        transportation are necessary strategies to reach and engage 
        women and girls in medical care.
            (9) From 2015 through 2019 in the United States and 6 
        dependent areas, the number of diagnoses of HIV infection for 
        transgender adults and adolescents increased. In 2019, among 
        transgender adults and adolescents, the largest percentage (93 
        percent) of diagnoses of HIV infections was for transgender 
        male-to-female (MTF) people. By age, in 2019, the largest 
        percentage (24 percent) of diagnoses of HIV infection among 
        transgender persons was for transgender MTF adults and 
        adolescents aged 20 to 24 years, followed by transgender MTF 
        adults and adolescents aged 25 to 29 years (23 percent).
            (10) Stigma and discrimination contribute to such 
        disparities.
            (11) The Centers for Disease Control and Prevention has 
        determined that increasing the proportion of people who know 
        their HIV status is an essential component of comprehensive HIV 
        treatment and prevention efforts and that early diagnosis is 
        critical in order for people with HIV to receive life-extending 
        therapy. Additionally, the Centers for Disease Control and 
        Prevention recommend routine HIV screening in health care 
        settings for all patients aged 13 to 64, regardless of risk.
            (12) In 1998, Congress created the National Minority AIDS 
        Initiative to provide technical assistance, build capacity, and 
        strengthen outreach efforts among local institutions and 
        community-based organizations that serve racial and ethnic 
        minorities living with or vulnerable to HIV.
            (13) To combat the HIV epidemic in the United States, the 
        National HIV/AIDS Strategy (referred to in this section as 
        ``NHAS'') provides a framework of increasing access to care, 
        reducing new infections, and eliminating HIV-related health 
        disparities. The vision of NHAS is ``The United States will be 
        a place where new HIV infections are prevented, every person 
        knows their status, and every person with HIV has high-quality 
        care and treatment, lives free from stigma and discrimination, 
        and can achieve their full potential for health and well-being 
        across the lifespan. This vision includes all people, 
        regardless of age, sex, gender identity, sexual orientation, 
        race, ethnicity, religion, disability, geographic location, or 
        socioeconomic circumstance.''.
            (14) In January 2019, the Department of Health and Human 
        Services began implementing the initiative ``Ending the HIV 
        Epidemic: A Plan for America''. The initiative seeks to reduce 
        the number of new HIV infections in the United States by 75 
        percent by 2025, and then by at least 90 percent by 2030, for 
        an estimated 250,000 total HIV infection averted.
            (15) At present, many States and United States territories 
        have criminal statutes based on ``exposure'' to HIV. Most of 
        these laws were adopted before the availability of effective 
        antiretroviral treatment for HIV/AIDS.
            (16) Research shows that stable housing leads to better 
        health outcomes for those living with HIV. Inadequate or 
        unstable housing is not only a barrier to effective treatment, 
        but also increases the likelihood of engaging in risky 
        behaviors leading to HIV infection. Insecure housing puts 
        people with HIV/AIDS at risk of premature death from exposure 
        to other diseases, poor nutrition, and lack of medical care.
            (17) Due to advances in treatment, many people living with 
        HIV today are living healthy lives and have the ability and 
        desire to fully participate in all aspects of community life, 
        including employment. Research associates being employed with 
        tremendous economic, social, and health benefits for many 
        people living with HIV.
            (18) Despite the tremendous progress made in the treatment 
        and prevention of HIV/AIDS, discriminatory policies stemming 
        from continued stigmatization of HIV/AIDS and the LGBTQ+ 
        community continue to plague the scientific community. This 
        includes blood donation guidance updated by Food and Drug 
        Administration in 2020 that recommends a 3-month deferral 
        policy for gay and bisexual men before they are eligible to 
        donate blood. Health agencies in the United States must 
        implement blood donation policies that are grounded in science 
        and that do not unfairly single out any group of individuals.
            (19) The common benefits associated with employment include 
        income, autonomy, productivity, and status within society, 
        daily structure, making a contribution to one's community, and 
        increased skills and self-esteem. Research also indicates that 
        many people with disabilities, including people living with 
        HIV, report perceiving themselves as being less disabled or not 
        disabled at all, when working. Furthermore, some studies link 
        working with better physical and mental health outcomes for 
        people living with HIV when compared to those who are not 
        working. Preliminary data also suggest that transitioning to 
        employment is associated with reduced HIV-related health risk 
        behavior for many people.
            (20) In July 2012, the Food and Drug Administration 
        approved the first drug to be used as pre-exposure prophylaxis 
        (PrEP). PrEP reduces the risk of HIV infection in HIV-negative 
        individuals. Studies have shown that PrEP reduces HIV 
        transmission from sex by about 99 percent when taken 
        consistently. Despite increases in PrEP uptake, PrEP use 
        remains low among gay and bisexual men of color. The Centers 
        for Disease Control and Prevention found that uptake was lower 
        among African-American (26 percent) and Latino (30 percent) men 
        compared with White men (42 percent). Similarly, PrEP awareness 
        was lower among African-American (86 percent) and Latino (87 
        percent) men compared with White men (95 percent). While 
        clinical research on transgender populations and PrEP is 
        currently limited, the Centers for Disease Control and 
        Prevention recommends PrEP use in transgender populations. In 
        September 2019, the Food and Drug Administration approved the 
        second drug to be used as PrEP.
            (21) Syringe service programs have been associated with 
        lowered HIV infections, lower hepatitis C infections, and 
        increased linkage to substance use treatment.
            (22) There is now conclusive scientific evidence that a 
        person living with HIV who is on antiretroviral therapy and is 
        durably virally suppressed (defined as having a consistent 
        viral load of less than 200 copies/ml) does not sexually 
        transmit HIV. The conclusive evidence about the highly 
        effective preventative benefits of antiretroviral therapy 
        provides an unprecedented opportunity to improve the lives of 
        people living with HIV, improve treatment uptake and adherence, 
        and advocate for expanded access to treatment and care.

SEC. 7203. ADDITIONAL FUNDING FOR AIDS DRUG ASSISTANCE PROGRAM 
              TREATMENTS.

    Section 2623 of the Public Health Service Act (42 U.S.C. 300ff-31b) 
is amended by adding at the end the following:
    ``(c) Additional Funding for AIDS Drug Assistance Program 
Treatments.--In addition to amounts otherwise authorized to be 
appropriated for carrying out this subpart, there are authorized to be 
appropriated such sums as may be necessary to carry out sections 
2612(b)(3)(B) and 2616 for each of fiscal years 2023 through 2026.''.

SEC. 7204. ENHANCING THE NATIONAL HIV SURVEILLANCE SYSTEM.

    (a) Grants.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall make grants to States to support integration of public health 
surveillance systems into all electronic health records in order to 
allow rapid communications between the clinical setting and health 
departments, by means that include--
            (1) providing technical assistance and policy guidance to 
        State and local health departments, clinical providers, and 
        other agencies serving individuals with HIV to improve the 
        interoperability of data systems relevant to monitoring HIV 
        care and supportive services;
            (2) capturing longitudinal data pertaining to the 
        initiation and ongoing prescription or dispensing of 
        antiretroviral therapy for individuals diagnosed with HIV (such 
        as through pharmacy-based reporting);
            (3) obtaining information--
                    (A) on a voluntary basis, on sexual orientation and 
                gender identity; and
                    (B) on sources of coverage (or the lack of 
                coverage) for medical treatment (including coverage 
                through the Medicaid program under title XIX of the 
                Social Security Act (42 U.S.C. 1396 et seq.), the 
                Medicare program under title XVIII of such Act (42 
                U.S.C. 1395 et seq.), the program under title XXVI of 
                the Public Health Service Act (42 U.S.C. 300ff-11 et 
                seq.); commonly referred to as the ``Ryan White HIV/
                AIDS Program''), other public funding, private 
                insurance, and health maintenance organizations); and
            (4) obtaining and using current geographic markers of 
        residence (such as current address, zip code, partial zip code, 
        and census block).
    (b) Privacy and Security Safeguards.--In carrying out this section, 
the Secretary of Health and Human Services shall ensure that 
appropriate privacy and security safeguards are met to prevent 
unauthorized disclosure of protected health information and compliance 
with the HIPAA privacy and security law (as defined in section 3009 of 
the Public Health Service Act (42 U.S.C. 300jj-19)) and other relevant 
laws and regulations.
    (c) Prohibition Against Improper Use of Data.--No grant under this 
section may be used to allow or facilitate the collection or use of 
surveillance or clinical data or records--
            (1) for punitive measures of any kind, civil or criminal, 
        against the subject of such data or records; or
            (2) for imposing any requirement or restriction with 
        respect to an individual without the individual's written 
        consent.
    (d) 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 2023 through 2026.

SEC. 7205. EVIDENCE-BASED STRATEGIES FOR IMPROVING LINKAGE TO, AND 
              RETENTION IN, APPROPRIATE CARE.

    (a) Strategies.--The Secretary of Health and Human Services, in 
collaboration with the Director of the Centers for Disease Control and 
Prevention, the Assistant Secretary for Mental Health and Substance 
Use, the Director of the Office of AIDS Research, the Administrator of 
the Health Resources and Services Administration, and the Administrator 
of the Centers for Medicare & Medicaid Services, shall--
            (1) identify evidence-based strategies most effective at 
        addressing the multifaceted issues that impede disease status 
        awareness with respect to HIV/AIDS and linkage to, and 
        retention in, appropriate care, taking into consideration 
        health care systems issues, clinic and provider issues, and 
        individual psychosocial, environmental, and other contextual 
        factors;
            (2) support the wide-scale implementation of the evidence-
        based strategies identified pursuant to paragraph (1), 
        including through incorporating such strategies into health 
        care coverage supported by the Medicaid program under title XIX 
        of the Social Security Act (42 U.S.C. 1396 et seq.), the 
        program under title XXVI of the Public Health Service Act (42 
        U.S.C. 300ff-11 et seq.; commonly referred to as the ``Ryan 
        White HIV/AIDS Program''), and health plans purchased through 
        an Exchange established under title I of the Patient Protection 
        and Affordable Care Act (Public Law 111-148); and
            (3) not later than 1 year after the date of the enactment 
        of this Act, submit a report to the Congress on the status of 
        activities under paragraphs (1) and (2).
    (b) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2026.

SEC. 7206. IMPROVING ENTRY INTO, AND RETENTION IN, CARE AND 
              ANTIRETROVIRAL ADHERENCE FOR PERSONS WITH HIV.

    (a) Sense of Congress.--It is the sense of Congress that AIDS 
research has led to scientific advancements that have--
            (1) saved the lives of millions of people living with HIV;
            (2) prevented millions of individuals from receiving new 
        diagnoses of HIV; and
            (3) had broad benefits that extend far beyond helping 
        people at risk for, or living with, HIV.
    (b) In General.--The Secretary of Health and Human Services, acting 
through the Director of the National Institutes of Health, shall 
expand, intensify, and coordinate operational and translational 
research and other activities of the National Institutes of Health 
regarding methods--
            (1) to increase adoption of evidence-based adherence 
        strategies within HIV care and treatment programs;
            (2) to increase HIV testing and case detection rates;
            (3) to reduce HIV-related health disparities;
            (4) to ensure that research to improve adherence to HIV 
        care and treatment programs address the unique concerns of 
        women;
            (5) to integrate HIV prevention and care services with 
        mental health and substance use prevention and treatment 
        delivery systems;
            (6) to increase knowledge on the implementation of 
        preexposure prophylaxis (referred to in this section as 
        ``PrEP''), including with respect to--
                    (A) who can benefit most from PrEP;
                    (B) how to provide PrEP safely and efficiently;
                    (C) how to integrate PrEP with other essential 
                prevention methods such as condoms; and
                    (D) how to ensure high levels of adherence; and
            (7) to increase knowledge of ``undetectable and 
        untransmittable'', when a person living with HIV who is on 
        antiretroviral therapy and is durably virally suppressed 
        (defined as having a consistent viral load of less than 200 
        copies/ml) cannot sexually transmit HIV.
    (c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2026.

SEC. 7207. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND ETHNIC MINORITY 
              COMMUNITIES.

    (a) In General.--For the purpose of reducing new HIV diagnoses in 
racial and ethnic minority communities, the Secretary of Health and 
Human Services, acting through the Deputy Assistant Secretary for 
Minority Health, may make grants to public health agencies and faith-
based organizations to conduct--
            (1) outreach activities related to HIV prevention and 
        testing activities;
            (2) HIV prevention activities;
            (3) HIV testing activities; and
            (4) public health education campaigns on accessing HIV 
        prevention medication.
    (b) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2026.

SEC. 7208. MINORITY AIDS INITIATIVE.

    (a) Expanded Funding.--The Secretary of Health and Human Services, 
in collaboration with the Deputy Assistant Secretary for Minority 
Health, the Director of the Centers for Disease Control and Prevention, 
the Administrator of the Health Resources and Services Administration, 
and the Assistant Secretary for Mental Health and Substance Use, shall 
provide funds and carry out activities to expand the Minority AIDS 
Initiative.
    (b) Use of Funds.--The additional funds made available under this 
section may be used, through the Minority AIDS Initiative, to support 
the following activities:
            (1) Providing technical assistance and infrastructure 
        support to reduce HIV/AIDS in minority populations.
            (2) Increasing minority populations' access to HIV 
        prevention and care services.
            (3) Building strong community programs and partnerships to 
        address HIV prevention and the health care needs of specific 
        racial and ethnic minority populations.
    (c) Priority Interventions.--Within the racial and ethnic minority 
populations referred to in subsection (b), priority in conducting 
intervention services shall be given to--
            (1) men who have sex with men;
            (2) youth;
            (3) persons who engage in intravenous drug abuse;
            (4) women;
            (5) homeless individuals;
            (6) individuals incarcerated or in the penal system;
            (7) transgender individuals; and
            (8) nonbinary individuals.
    (d) Authorization of Appropriations.--For carrying out this 
section, there are authorized to be appropriated $610,000,000 for 
fiscal year 2023 and such sums as may be necessary for each of fiscal 
years 2024 through 2027.

SEC. 7209. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV.

    (a) In General.--The Secretary of Health and Human Services, acting 
through the Administrator of the Health Resources and Services 
Administration, shall expand, intensify, and coordinate workforce 
initiatives of the Health Resources and Services Administration to 
increase the capacity of the health workforce focusing primarily on HIV 
to meet the demand for culturally competent care, and may award grants 
for any of the following:
            (1) Development of curricula for training primary care 
        providers in HIV/AIDS prevention and care, including routine 
        HIV testing.
            (2) Support to expand access to culturally and 
        linguistically accessible benefits counselors, trained peer 
        navigators, and mental and behavioral health professionals with 
        expertise in HIV.
            (3) Training health care professionals to provide care to 
        individuals living with HIV.
            (4) Development by grant recipients under title XXVI of the 
        Public Health Service Act (42 U.S.C. 300ff-11 et seq.; commonly 
        referred to as the ``Ryan White HIV/AIDS Program'') and other 
        persons, of policies for providing culturally relevant and 
        sensitive treatment to individuals living with HIV, with 
        particular emphasis on treatment to racial and ethnic 
        minorities, men who have sex with men, and women, young people, 
        and children living with HIV.
            (5) Development and implementation of programs to increase 
        the use of telehealth to respond to HIV-specific health care 
        needs in rural and minority communities, with particular 
        emphasis given to medically underserved communities and insular 
        areas.
            (6) Evaluating interdisciplinary medical provider care team 
        models that promote high-quality care, with particular emphasis 
        on care to racial and ethnic minorities.
            (7) Training health care professionals to make them aware 
        of the high rates of chronic hepatitis B and chronic hepatitis 
        C in adult racial and ethnic minority populations, and the 
        importance of prevention, detection, and medical management of 
        hepatitis B and hepatitis C and of liver cancer screening.
            (8) Development of curricula for training primary care 
        providers that HIV and tuberculosis are significant mutual 
        comorbidities, and that a patient who tests positive for one 
        disease should be offered and encouraged to receive testing for 
        the other.
    (b) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2026.

SEC. 7210. HIV/AIDS PROVIDER LOAN REPAYMENT PROGRAM.

    (a) In General.--The Secretary may enter into an agreement with any 
physician, nurse practitioner, or physician assistant under which--
            (1) the physician, nurse practitioner, or physician 
        assistant agrees to serve as a medical provider for a period of 
        not less than 2 years--
                    (A) at a Ryan White-funded or title X-funded 
                facility with a critical shortage of doctors (as 
                determined by the Secretary); or
                    (B) in an area with a high incidence of HIV/AIDS; 
                and
            (2) the Secretary agrees to make payments in accordance 
        with subsection (b) on the professional education loans of the 
        physician, nurse practitioner, or physician assistant.
    (b) Manner of Payments.--The payments described in subsection (a) 
shall be made by the Secretary as follows:
            (1) Upon completion by the physician, nurse practitioner, 
        or physician assistant for whom the payments are to be made of 
        the first year of the service specified in the agreement 
        entered into with the Secretary under subsection (a), the 
        Secretary shall pay 30 percent of the principal of and the 
        interest on the individual's professional education loans.
            (2) Upon completion by the physician, nurse practitioner, 
        or physician assistant of the second year of such service, the 
        Secretary shall pay another 30 percent of the principal of and 
        the interest on such loans.
            (3) Upon completion by that individual of a third year of 
        such service, the Secretary shall pay another 25 percent of the 
        principal of and the interest on such loans.
    (c) Applicability of Certain Provisions.--Subpart III of part D of 
title III of the Public Health Service Act (42 U.S.C. 254l et seq.) 
shall, except as inconsistent with this section, apply to the program 
carried out under this section in the same manner and to the same 
extent as such provisions apply to the National Health Service Corps 
loan repayment program.
    (d) Reports.--Not later than 18 months after the date of the 
enactment of this Act, and annually thereafter, the Secretary shall 
prepare and submit to Congress a report describing the program carried 
out under this section, including statements regarding the following:
            (1) The number of physicians, nurse practitioners, and 
        physician assistants enrolled in the program.
            (2) The number and amount of loan repayments provided 
        through the program.
            (3) The placement location of loan repayment recipients at 
        facilities described in subsection (a)(1).
            (4) The default rate on such loans and actions required.
            (5) The amount of outstanding default funds with respect to 
        such loans.
            (6) To the extent that it can be determined, the reason for 
        the default on such a loan.
            (7) The demographics of individuals participating in the 
        program.
            (8) An evaluation of the overall costs and benefits of the 
        program.
    (e) Definitions.--In this section:
            (1) HIV/AIDS.--The term ``HIV/AIDS'' means human 
        immunodeficiency virus and acquired immune deficiency syndrome.
            (2) Nurse practitioner.--The term ``nurse practitioner'' 
        means a registered nurse who has completed an accredited 
        graduate degree program in advanced nurse practice and has 
        successfully passed a national certification exam.
            (3) Physician.--The term ``physician'' means a graduate of 
        a school of medicine who has completed postgraduate training in 
        general or pediatric medicine.
            (4) Physician assistant.--The term ``physician assistant'' 
        means a medical provider who completed an accredited physician 
        assistant training program and successfully passed the 
        Physician Assistant National Certifying Examination.
            (5) Professional education loan.--The term ``professional 
        education loan''--
                    (A) means a loan that is incurred for the cost of 
                attendance (including tuition, other reasonable 
                educational expenses, and reasonable living costs) at a 
                school of medicine, nursing, or physician assistant 
                training program; and
                    (B) includes only the portion of the loan that is 
                outstanding on the date the physician, nurse 
                practitioner, or physician assistant involved begins 
                the service specified in the agreement under subsection 
                (a).
            (6) Ryan white-funded.--The term ``Ryan White-funded'' 
        means, with respect to a facility, receiving funds under title 
        XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et 
        seq.).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) School of medicine.--The term ``school of medicine'' 
        has the meaning given to that term in section 799B of the 
        Public Health Service Act (42 U.S.C. 295p).
            (9) Title x-funded.--The term ``title X-funded'' means, 
        with respect to a facility, receiving funds under title X of 
        the Public Health Service Act (42 U.S.C. 300 et seq.).
    (f) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2026.

SEC. 7211. DENTAL EDUCATION LOAN REPAYMENT PROGRAM.

    (a) In General.--The Secretary may enter into an agreement with any 
dentist under which--
            (1) the dentist agrees to serve as a dentist for a period 
        of not less than 2 years at a facility with a critical shortage 
        of dentists (as determined by the Secretary) in an area with a 
        high incidence of HIV/AIDS; and
            (2) the Secretary agrees to make payments in accordance 
        with subsection (b) on the dental education loans of the 
        dentist.
    (b) Manner of Payments.--The payments described in subsection (a) 
shall be made by the Secretary as follows:
            (1) Upon completion by the dentist for whom the payments 
        are to be made of the first year of the service specified in 
        the agreement entered into with the Secretary under subsection 
        (a), the Secretary shall pay 30 percent of the principal of and 
        the interest on the dental education loans of the dentist.
            (2) Upon completion by the dentist of the second year of 
        such service, the Secretary shall pay another 30 percent of the 
        principal of and the interest on such loans.
            (3) Upon completion by that individual of a third year of 
        such service, the Secretary shall pay another 25 percent of the 
        principal of and the interest on such loans.
    (c) Applicability of Certain Provisions.--Subpart III of part D of 
title III of the Public Health Service Act (42 U.S.C. 254l et seq.) 
shall, except as inconsistent with this section, apply to the program 
carried out under this section in the same manner and to the same 
extent as such provisions apply to the National Health Service Corps 
Loan Repayment Program.
    (d) Reports.--Not later than 18 months after the date of the 
enactment of this Act, and annually thereafter, the Secretary shall 
prepare and submit to the Congress a report describing the program 
carried out under this section, including statements regarding the 
following:
            (1) The number of dentists enrolled in the program.
            (2) The number and amount of loan repayments provided 
        through the program.
            (3) The placement location of loan repayment recipients at 
        facilities described in subsection (a)(1).
            (4) The default rate on such loans and actions required.
            (5) The amount of outstanding default funds with respect to 
        such loans.
            (6) To the extent that it can be determined, the reason for 
        the default on such a loan.
            (7) The demographics of individuals participating in the 
        program.
            (8) An evaluation of the overall costs and benefits of the 
        program.
    (e) Definitions.--In this section:
            (1) Dental education loan.--The term ``dental education 
        loan''--
                    (A) means a loan that is incurred for the cost of 
                attendance (including tuition, other reasonable 
                educational expenses, and reasonable living costs) at a 
                school of dentistry; and
                    (B) includes only the portion of the loan that is 
                outstanding on the date the dentist involved begins the 
                service specified in the agreement under subsection 
                (a).
            (2) Dentist.--The term ``dentist'' means a graduate of a 
        school of dentistry who has completed postgraduate training in 
        general or pediatric dentistry.
            (3) HIV/AIDS.--The term ``HIV/AIDS'' means human 
        immunodeficiency virus and acquired immune deficiency syndrome.
            (4) School of dentistry.--The term ``school of dentistry'' 
        has the meaning given to that term in section 799B of the 
        Public Health Service Act (42 U.S.C. 295p).
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (f) 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 2023 through 2026.

SEC. 7212. REDUCING NEW HIV INFECTIONS AMONG INJECTING DRUG USERS.

    (a) Sense of Congress.--It is the sense of Congress that providing 
sterile syringes and sterilized equipment to injecting drug users 
substantially reduces risk of HIV infection, increases the probability 
that they will initiate drug treatment, and does not increase drug use.
    (b) In General.--The Secretary of Health and Human Services may 
provide grants and technical assistance for the purpose of reducing the 
rate of HIV infections among injecting drug users through a 
comprehensive package of services for such users, including the 
provision of sterile syringes, education and outreach, access to 
infectious disease testing, overdose prevention, and treatment for drug 
dependence.
    (c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal years 2023 through 2026.

SEC. 7213. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE POPULATIONS.

    (a) In General.--The Secretary shall submit to Congress and the 
President an annual report on the impact of HIV/AIDS for racial and 
ethnic minority communities, women, and youth aged 24 and younger.
    (b) Contents.--The report under subsection (a) shall include 
information on the--
            (1) progress that has been made in reducing the impact of 
        HIV/AIDS in such communities;
            (2) opportunities that exist to make additional progress in 
        reducing the impact of HIV/AIDS in such communities;
            (3) challenges that may impede such additional progress; 
        and
            (4) Federal funding necessary to achieve substantial 
        reductions in HIV/AIDS in racial and ethnic minority 
        communities.

SEC. 7214. NATIONAL HIV/AIDS OBSERVANCE DAYS.

    (a) National Observance Days.--It is the sense of Congress that 
national observance days highlighting the impact of HIV on communities 
of color include the following:
            (1) National Black HIV/AIDS Awareness Day.
            (2) National Latino AIDS Awareness Day.
            (3) National Asian and Pacific Islander HIV/AIDS Awareness 
        Day.
            (4) National Native American HIV/AIDS Awareness Day.
            (5) National Youth HIV/AIDS Awareness Day.
    (b) Call to Action.--It is the sense of Congress that the President 
should call on members of communities of color--
            (1) to become involved at the local community level in HIV 
        testing, policy, and advocacy;
            (2) to become aware, engaged, and empowered on the HIV 
        epidemic within their communities; and
            (3) to urge members of their communities to reduce risk 
        factors, practice safe sex and other preventive measures, be 
        tested for HIV, and seek care when appropriate.

SEC. 7215. REVIEW OF ALL FEDERAL AND STATE LAWS, POLICIES, AND 
              REGULATIONS REGARDING THE CRIMINAL PROSECUTION OF 
              INDIVIDUALS FOR HIV-RELATED OFFENSES.

    (a) Findings.--Congress makes the following findings:
            (1) At present, 32 States and 2 United States territories 
        have criminal statutes based on perceived exposure to HIV, 
        rather than behaviors motivated by an intent to harm, 
        presenting a significant risk of transmission and resulting in 
        actual transmission of HIV to another. 11 States have HIV-
        specific laws that make spitting or biting a felony, even 
        though it is not possible to transmit HIV via saliva. 24 States 
        require persons who are aware that they have HIV to disclose 
        their status to sexual partners, regardless of whether they are 
        noninfectious. 14 of these 24 States also require disclosure to 
        needle-sharing partners. 25 States criminalize 1 or more 
        behaviors that pose a low or negligible risk for HIV 
        transmission.
            (2) HIV-specific criminal laws are classified as felonies 
        in 28 States. In 3 States, a person's exposure to another to 
        HIV does not subject the person to criminal prosecution for 
        that act alone but may result in a sentence enhancement. 18 
        States impose sentences of up to 10 years per violation, 7 
        States impose sentences between 11 and 20 years, and 5 States 
        impose sentences of greater than 20 years.
            (3) When members of the Armed Forces acquire HIV, they are 
        issued orders that require them to disclose and use a condom 
        under all circumstances including when the known risk of 
        transmission is 0. Failure to disclose can result in 
        prosecution under the Uniform Code of Military Justice (UCMJ).
            (4) The number of prosecutions, arrests, and instances 
        where HIV-based charges are used to induce plea agreements is 
        unknown. Because State-level prosecution and arrest data are 
        not readily available in any national legal database, the 
        societal impact of these laws may be underestimated and most 
        cases that go to trial are not reduced to written, published 
        opinions.
            (5) State and Federal criminal law does not currently 
        reflect the 4 decades of medical advances and discoveries made 
        with regard to transmission and treatment of HIV/AIDS.
            (6) According to the CDC, correct and consistent male or 
        female condom use, or adherence to a preexposure prophylaxis 
        (PrEP) regimen that results in viral suppression, are very 
        effective in preventing HIV transmission. However, most State 
        HIV-specific laws and prosecutions do not treat the use of a 
        condom during sexual intercourse or adherence to PrEP as a 
        mitigating factor or evidence that the defendant did not intend 
        to transmit HIV.
            (7) Criminal laws and prosecutions do not take into account 
        the benefits of effective antiretroviral medications, which 
        suppress the virus to extremely low levels and further reduce 
        the already low risk of transmitting HIV to near 0.
            (8) In addition to HIV-specific criminal laws, general 
        criminal laws are often misused to prosecute people based on 
        their HIV status. Although HIV, and even AIDS, currently is 
        viewed as a treatable, chronic, medical condition, people 
        living with HIV have been charged under aggravated assault, 
        attempted murder, and even bioterrorism statutes because 
        prosecutors, courts, and legislators continue to view and 
        characterize the blood, semen, and saliva of people living with 
        HIV as a ``deadly weapon''.
            (9) Multiple peer-reviewed studies demonstrate that HIV-
        specific laws do not reduce risk-taking behavior or increase 
        disclosure by people living with or at risk of HIV, and there 
        is increasing evidence that these laws reduce the willingness 
        to get tested. Furthermore, placing legal responsibility for 
        preventing the transmission of HIV and other pathogens that can 
        be sexually transmitted exclusively on people diagnosed with a 
        sexually transmitted infection undermines the public health 
        message that all people are responsible for practicing 
        behaviors that protect themselves from HIV and other sexually 
        transmitted infections. Unfortunately, some State laws create 
        an expectation of disclosure work against public health 
        communication and discourage risk-reduction measures that could 
        prevent transmission as a result of those who are acutely 
        infected and unaware of their status.
            (10) The identity of an individual subject to an HIV-based 
        prosecution is broadcast through media reports, potentially 
        destroying employment opportunities and relationships and 
        violating the person's right to privacy.
            (11) Individuals who are convicted after an HIV-based 
        prosecution often must register as sex offenders even in cases 
        involving consensual sexual activity. Their employability is 
        destroyed, and their family relationships are fractured.
            (12) The United Nations, including the Joint United Nations 
        Programme on HIV/AIDS (UNAIDS), urges governments to ``limit 
        criminalization to cases of intentional transmission''. This 
        requirement would limit prosecutions to situations ``where a 
        person knows his or her HIV-positive status, acts with the 
        intention to transmit HIV, and does in fact transmit it''. 
        UNAIDS also recommends that criminal law should not be applied 
        to cases where there is no significant risk of transmission.
            (13) In 2010, the Federal Government released the first 
        ever National HIV/AIDS Strategy (NHAS), which addressed HIV-
        specific criminal laws, stating: ``While we understand the 
        intent behind these laws, they may not have the desired effect 
        and they may make people less willing to disclose their status 
        by making people feel at even greater risk of discrimination. 
        In some cases, it may be appropriate for legislators to 
        reconsider whether existing laws continue to further the public 
        interest and public health. In many instances, the continued 
        existence and enforcement of these types of laws run counter to 
        scientific evidence about routes of HIV transmission and may 
        undermine the public health goals of promoting HIV screening 
        and treatment.''. The NHAS also states that State legislatures 
        should consider reviewing HIV-specific criminal statutes to 
        ensure that they are consistent with current knowledge of HIV 
        transmission and support public health approaches to preventing 
        and treating HIV.
            (14) The Global Commission on HIV and the Law was launched 
        in June 2010 to examine laws and practices that criminalize 
        people living with and vulnerable to HIV and to develop 
        evidence-based recommendations for effective HIV responses. The 
        Commission calls for ``governments, civil society and 
        international bodies to repeal punitive laws and enact laws 
        that facilitate and enable effective responses to HIV 
        prevention, care and treatment services for all who need 
        them''. The Commission recommends against the enactment of 
        ``laws that explicitly criminalize HIV transmission, exposure 
        or non-disclosure of HIV status, which are counterproductive''.
            (15) In February 2019, the Department of Health and Human 
        Services (HHS) launched ``Ending the HIV Epidemic: A Plan for 
        America'', a new initiative with an ambitious goal to end the 
        domestic HIV epidemic in 10 years by reducing new cases of HIV 
        by 75 percent by 2025 and by 90 percent by 2030. In this plan, 
        HHS notes that stigma ``can be a debilitating barrier 
        preventing people living with, or at risk for, HIV from 
        receiving the health care, services, and respect they need and 
        deserve''. Many of the States and jurisdictions identified as a 
        priority for the first 5 years of the plan have stigma-based 
        criminal statutes for perceived exposure to HIV. These statutes 
        run counter to the goals of this new initiative and stand in 
        the way of ending the domestic HIV epidemic.
    (b) Sense of Congress Regarding Laws or Regulations Directed at 
People Living With HIV.--It is the sense of Congress that Federal and 
State laws, policies, and regulations regarding people living with 
HIV--
            (1) should not place unique or additional burdens on such 
        individuals solely as a result of their HIV status; and
            (2) should instead demonstrate a public health-oriented, 
        evidence-based, medically accurate, and contemporary 
        understanding of--
                    (A) the multiple factors that lead to HIV 
                transmission;
                    (B) the relative risk of demonstrated HIV 
                transmission routes;
                    (C) the current health implications of living with 
                HIV;
                    (D) the associated benefits of treatment and 
                support services for people living with HIV; and
                    (E) the impact of punitive HIV-specific laws, 
                policies, regulations, and judicial precedents and 
                decisions on public health, on people living with or 
                affected by HIV, and on their families and communities.
    (c) Review of Federal and State Laws.--
            (1) Review of federal and state laws.--
                    (A) In general.--Not later than 90 days after the 
                date of the enactment of this Act, the Attorney 
                General, the Secretary of Health and Human Services, 
                and the Secretary of Defense acting jointly (in this 
                section referred to as the ``designated officials'') 
                shall initiate a national review of Federal and State 
                laws, policies, regulations, and judicial precedents 
                and decisions regarding criminal and related civil 
                commitment cases involving people living with HIV/AIDS, 
                including the Uniform Code of Military Justice.
                    (B) Consultation.--In carrying out the review under 
                subparagraph (A), the designated officials shall seek 
                to include diverse participation from, and consultation 
                with, each of the following:
                            (i) Each State.
                            (ii) State attorneys general (or their 
                        representatives).
                            (iii) State public health officials (or 
                        their representatives).
                            (iv) State judicial and court system 
                        officers, including judges, district attorneys, 
                        prosecutors, defense attorneys, law 
                        enforcement, and correctional officers.
                            (v) Members of the United States Armed 
                        Forces, including members of other Federal 
                        services subject to the UCMJ.
                            (vi) People living with HIV/AIDS, 
                        particularly those who have been subject to 
                        HIV-related prosecution or who are from 
                        minority communities whose members have been 
                        disproportionately subject to HIV-specific 
                        arrests and prosecution.
                            (vii) Legal advocacy and HIV/AIDS service 
                        organizations that work with people living with 
                        HIV/AIDS.
                            (viii) Nongovernmental health organizations 
                        that work on behalf of people living with HIV/
                        AIDS, including syringe services programs, 
                        LGBTQ-focused health organizations, and 
                        organizations who serve people who engage in 
                        sex work.
                            (ix) Trade organizations or associations 
                        representing persons or entities described in 
                        clause (i) through (vii).
                    (C) Relation to other reviews.--In carrying out the 
                review under subparagraph (A), the designated officials 
                may utilize other existing reviews of criminal and 
                related civil commitment cases involving people living 
                with HIV, including any such review conducted by any 
                Federal or State agency or any public health, legal 
                advocacy, or trade organization or association if the 
                designated officials determines that such reviews were 
                conducted in accordance with the principles set forth 
                in subsection (b).
            (2) Report.--Not later than 180 days after initiating the 
        review required by paragraph (1), the Attorney General shall 
        transmit to the Congress and make publicly available a report 
        containing the results of the review, which includes the 
        following:
                    (A) For each State and for the UCMJ, a summary of 
                the relevant laws, policies, regulations, and judicial 
                precedents and decisions regarding criminal cases 
                involving people living with HIV, including the 
                following:
                            (i) A determination of whether such laws, 
                        policies, regulations, and judicial precedents 
                        and decisions place any unique or additional 
                        burdens upon people living with HIV.
                            (ii) A determination of whether such laws, 
                        policies, regulations, and judicial precedents 
                        and decisions demonstrate a public health-
                        oriented, evidence-based, medically accurate, 
                        and contemporary understanding of--
                                    (I) the multiple factors that lead 
                                to HIV transmission;
                                    (II) the relative risk of HIV 
                                transmission routes, including that a 
                                person that has an undetectable viral 
                                load cannot transmit the disease;
                                    (III) the current health 
                                implications of living with HIV, 
                                including data disaggregated by race 
                                and ethnicity;
                                    (IV) the current status of 
                                providing protection to people who 
                                engage in survival sex work against 
                                whom condom possession has been used as 
                                evidence to intent to commit a crime;
                                    (V) States that have the 
                                classification of mandatory sex 
                                offenders;
                                    (VI) the associated benefits of 
                                treatment and support services for 
                                people living with HIV; and
                                    (VII) the impact of punitive HIV-
                                specific laws and policies on public 
                                health, on people living with or 
                                affected by HIV, and on their families 
                                and communities, including people who 
                                are in abusive, dependent, violent, and 
                                nonconsensual relationships and are 
                                unable to both negotiate the use of 
                                condoms and status disclosure.
                            (iii) An analysis of the public health and 
                        legal implications of such laws, policies, 
                        regulations, and judicial precedents and 
                        decisions, including an analysis of the 
                        consequences of having a similar penal scheme 
                        applied to comparable situations involving 
                        other communicable diseases.
                            (iv) An analysis of the proportionality of 
                        punishments imposed under HIV-specific laws, 
                        policies, regulations, and judicial precedents, 
                        taking into consideration penalties attached to 
                        violation of State laws against similar degrees 
                        of endangerment or harm, such as driving while 
                        intoxicated or transmission of other 
                        communicable diseases, or more serious harms, 
                        such as vehicular manslaughter offenses.
                    (B) An analysis of common elements shared between 
                State laws, policies, regulations, and judicial 
                precedents.
                    (C) A set of best practice recommendations directed 
                to State governments, including State attorneys 
                general, public health officials, and judicial 
                officers, in order to ensure that laws, policies, 
                regulations, and judicial precedents regarding people 
                living with HIV are in accordance with the principles 
                set forth in subsection (b).
                    (D) Recommendations for adjustments to the UCMJ, 
                including discontinuing the use of a service member's 
                HIV diagnosis as the basis for prosecution, enhanced 
                penalties, or discharge from military service, in order 
                to ensure that laws, policies, regulations, and 
                judicial precedents regarding people living with HIV 
                are in accordance with the principles set forth in 
                subsection (b). Such recommendations should include any 
                necessary and appropriate changes to ``Orders to Follow 
                Preventative Medicine Requirements''.
            (3) Guidance.--Within 90 days of the release of the report 
        required by paragraph (2), the Attorney General and the 
        Secretary of Health and Human Services, acting jointly, shall 
        develop and publicly release updated guidance for States based 
        on the set of best practice recommendations required by 
        paragraph (2)(C) in order to assist States dealing with 
        criminal and related civil commitment cases regarding people 
        living with HIV.
            (4) Monitoring and evaluation system.--Within 60 days of 
        the release of the guidance required by paragraph (3), the 
        Attorney General and the Secretary of Health and Human 
        Services, acting jointly, shall establish an integrated 
        monitoring and evaluation system which includes, where 
        appropriate, objective and quantifiable performance goals and 
        indicators to measure progress toward statewide implementation 
        in each State of the best practice recommendations required in 
        paragraph (2)(C).
            (5) Modernization of federal laws, policies, and 
        regulations.--Within 90 days of the release of the report 
        required by paragraph (2), the designated officials shall 
        develop and transmit to the President and the Congress, and 
        make publicly available, such proposals as may be necessary to 
        implement adjustments to Federal laws, policies, or 
        regulations, including to the UCMJ, based on the 
        recommendations required by paragraph (2)(D), either through 
        Executive order or through changes to statutory law.
    (d) Rule of Construction.--Nothing in this section shall be 
construed to discourage the prosecution of individuals who 
intentionally transmit or attempt to transmit HIV to another 
individual.
    (e) No Additional Appropriations Authorized.--This section shall 
not be construed to increase the amount of appropriations that are 
authorized to be appropriated for any fiscal year.

SEC. 7216. EXPANDING SUPPORT FOR CONDOMS IN PRISONS.

    (a) Sense of Congress Regarding Distribution of Sexual Barrier 
Protection Devices in State Prison Systems.--It is the sense of the 
Congress that States shall allow for the legal distribution of sexual 
barrier protection devices in State correctional facilities to reduce 
the prevalence and spread of STIs in those facilities.
    (b) Authority To Allow Community Organizations To Provide STI 
Counseling, STI Prevention Education, and Sexual Barrier Protection 
Devices in Federal Correctional Facilities.--
            (1) Directive to attorney general.--Not later than 30 days 
        after the date of enactment of this Act, the Attorney General 
        shall direct the Director of the Bureau of Prisons to allow 
        community organizations to, in accordance with all relevant 
        Federal laws and regulations that govern visitation in Federal 
        correctional facilities--
                    (A) distribute sexual barrier protection devices in 
                Federal correctional facilities; and
                    (B) engage in STI counseling and STI prevention 
                education in Federal correctional facilities.
            (2) Information requirement.--Any community organization 
        permitted to distribute sexual barrier protection devices under 
        paragraph (1) shall ensure that the individuals to whom the 
        devices are distributed are informed about the proper use and 
        disposal of sexual barrier protection devices in accordance 
        with established public health practices. Any community 
        organization conducting STI counseling or STI prevention 
        education under paragraph (1) shall offer comprehensive 
        sexuality education.
            (3) Possession of device protected.--A Federal correctional 
        facility may not, because of the possession or use of a sexual 
        barrier protection device--
                    (A) take adverse action against an incarcerated 
                individual; or
                    (B) consider possession or use as evidence of 
                prohibited activity for the purpose of any Federal 
                correctional facility administrative proceeding.
            (4) Implementation.--The Attorney General and the Director 
        of the Bureau of Prisons shall implement this section according 
        to established public health practices in a manner that 
        protects the health, safety, and privacy of incarcerated 
        individuals and of correctional facility staff.
    (c) Survey of and Report on Correctional Facility Programs Aimed at 
Reducing the Spread of STIs.--
            (1) Survey.--Not later than 180 days after the date of 
        enactment of this Act, and annually thereafter for 5 years, the 
        Attorney General, after consulting with the Secretary of Health 
        and Human Services, State officials, and community 
        organizations, shall, to the maximum extent practicable, 
        conduct a survey of all Federal and State correctional 
        facilities, to determine the following:
                    (A) Counseling, treatment, and supportive 
                services.--Whether the correctional facility--
                            (i) requires incarcerated individuals to 
                        participate in counseling, treatment, and 
                        supportive services related to STIs; or
                            (ii) offers such programs to incarcerated 
                        individuals.
                    (B) Access to sexual barrier protection devices.--
                Whether incarcerated individuals can--
                            (i) possess sexual barrier protection 
                        devices;
                            (ii) purchase sexual barrier protection 
                        devices;
                            (iii) purchase sexual barrier protection 
                        devices at a reduced cost; or
                            (iv) obtain sexual barrier protection 
                        devices without cost.
                    (C) Incidence of sexual violence.--The incidence of 
                sexual violence and assault committed by incarcerated 
                individuals and by correctional facility staff.
                    (D) Prevention education offered.--The type of 
                prevention education, information, or training offered 
                to incarcerated individuals and correctional facility 
                staff regarding sexual violence and the spread of STIs, 
                including whether such education, information, or 
                training--
                            (i) constitutes comprehensive sexuality 
                        education;
                            (ii) is compulsory for new incarcerated 
                        individuals and for new correctional facility 
                        staff; and
                            (iii) is offered on an ongoing basis.
                    (E) STI testing.--Whether the correctional facility 
                tests incarcerated individuals for STIs or gives them 
                the option to undergo such testing--
                            (i) at intake;
                            (ii) on a regular basis; and
                            (iii) prior to release.
                    (F) STI test results.--The number of incarcerated 
                individuals who are tested for STIs and the outcome of 
                such tests at each correctional facility, disaggregated 
                to include results for--
                            (i) the type of STI tested for;
                            (ii) the race and ethnicity of an 
                        individual tested;
                            (iii) the age of an individual tested; and
                            (iv) the gender of the individual tested.
                    (G) Prerelease referral policy.--Whether 
                incarcerated individuals are informed prior to release 
                about STI-related services or other health services in 
                their communities, including free and low-cost 
                counseling and treatment options.
                    (H) Prerelease referrals made.--The number of 
                referrals to community-based organizations or public 
                health facilities offering STI-related or other health 
                services provided to incarcerated individuals prior to 
                release, and the type of counseling or treatment for 
                which the referral was made.
                    (I) Reinstatement of medicaid benefits.--Whether 
                the correctional facility assists incarcerated 
                individuals that were enrolled in the State Medicaid 
                program prior to their incarceration, in reinstating 
                their enrollment upon release and whether such 
                individuals receive referrals as provided by 
                subparagraph (G) to entities that accept the State 
                Medicaid program, including if applicable--
                            (i) the number of such individuals, 
                        including those diagnosed with HIV, that have 
                        been reinstated;
                            (ii) a list of obstacles to reinstating 
                        enrollment or to making determinations of 
                        eligibility for reinstatement, if any; and
                            (iii) the number of individuals denied 
                        enrollment.
                    (J) Other actions taken.--Whether the correctional 
                facility has taken any other action, in conjunction 
                with community organizations or otherwise, to reduce 
                the prevalence and spread of STIs in that facility.
            (2) Privacy.--In conducting the survey under paragraph (1), 
        the Attorney General shall not request or retain the identity 
        of any individual who has sought or been offered counseling, 
        treatment, testing, or prevention education information 
        regarding an STI (including information about sexual barrier 
        protection devices), or who has tested positive for an STI.
            (3) Report.--
                    (A) In general.--The Attorney General shall 
                transmit to Congress and make publicly available the 
                results of the survey required under paragraph (1), 
                both for the United States as a whole and disaggregated 
                as to each State and each correctional facility.
                    (B) Deadlines.--To the maximum extent possible, the 
                Attorney General shall--
                            (i) issue the first report under 
                        subparagraph (A) not later than 1 year after 
                        the date of enactment of this Act; and
                            (ii) issue reports under subparagraph (A) 
                        annually thereafter for 5 years.
    (d) Strategy.--
            (1) Directive to attorney general.--The Attorney General, 
        in consultation with the Secretary of Health and Human 
        Services, State officials, and community organizations, shall 
        develop and implement a 5-year strategy to reduce the 
        prevalence and spread of STIs in Federal and State correctional 
        facilities. To the maximum extent possible, the strategy shall 
        be developed, transmitted to Congress, and made publicly 
        available no later than 180 days after the transmission of the 
        first report required under subsection (d)(3).
            (2) Contents of strategy.--The strategy developed under 
        paragraph (1) shall include the following:
                    (A) Prevention education.--A plan for improving 
                prevention education, information, and training offered 
                to incarcerated individuals and correctional facility 
                staff, including information and training on sexual 
                violence and the spread of STIs, and comprehensive 
                sexuality education.
                    (B) Sexual barrier protection device access.--A 
                plan for expanding access to sexual barrier protection 
                devices in correctional facilities.
                    (C) Sexual violence reduction.--A plan for reducing 
                the incidence of sexual violence among incarcerated 
                individuals and correctional facility staff, developed 
                in consultation with the National Prison Rape 
                Elimination Commission.
                    (D) Counseling and supportive services.--A plan for 
                expanding access to counseling and supportive services 
                related to STIs in correctional facilities.
                    (E) Testing.--A plan for testing incarcerated 
                individuals for STIs during intake, during regular 
                health exams, and prior to release, and that--
                            (i) is conducted in accordance with 
                        guidelines established by the Centers for 
                        Disease Control and Prevention;
                            (ii) includes pretest counseling;
                            (iii) requires that incarcerated 
                        individuals are notified of their option to 
                        decline testing at any time;
                            (iv) requires that incarcerated individuals 
                        are confidentially notified of their test 
                        results in a timely manner; and
                            (v) ensures that incarcerated individuals 
                        testing positive for STIs receive post-test 
                        counseling, care, treatment, and supportive 
                        services.
                    (F) Treatment.--A plan for ensuring that 
                correctional facilities have the necessary medicine and 
                equipment to treat and monitor STIs and for ensuring 
                that incarcerated individuals living with or testing 
                positive for STIs receive and have access to care and 
                treatment services.
                    (G) Strategies for demographic groups.--A plan for 
                developing and implementing culturally appropriate, 
                sensitive, and specific strategies to reduce the spread 
                of STIs among demographic groups heavily impacted by 
                STIs.
                    (H) Linkages with communities and facilities.--A 
                plan for establishing and strengthening linkages to 
                local community and health facilities that--
                            (i) provide counseling, testing, care, and 
                        treatment services;
                            (ii) may receive individuals recently 
                        released from incarceration who are living with 
                        STIs; and
                            (iii) accept payment through the State 
                        Medicaid program.
                    (I) Enrollment in state medicaid programs.--Plans 
                to ensure that--
                            (i) incarcerated individuals who were 
                        enrolled in their State Medicaid program prior 
                        to incarceration in a correctional facility are 
                        automatically reenrolled in such program upon 
                        their release; and
                            (ii) incarcerated individuals who were not 
                        enrolled in their State Medicaid program prior 
                        to incarceration, and who are diagnosed with 
                        HIV while incarcerated in a correctional 
                        facility, are automatically enrolled in such 
                        program upon their release.
                    (J) Other plans.--Any other plans developed by the 
                Attorney General for reducing the spread of STIs or 
                improving the quality of health care in correctional 
                facilities.
                    (K) Monitoring system.--A monitoring system that 
                establishes performance goals related to reducing the 
                prevalence and spread of STIs in correctional 
                facilities and which, where feasible, express such 
                goals in quantifiable form.
                    (L) Monitoring system performance indicators.--
                Performance indicators that measure or assess the 
                achievement of the performance goals described in 
                subparagraph (K).
                    (M) Cost estimate.--A detailed estimate of the 
                funding necessary to implement the strategy at the 
                Federal and State levels for all 5 years, including the 
                amount of funds required by community organizations to 
                implement the parts of the strategy in which they take 
                part.
            (3) Report.--Not later than 1 year after the date of the 
        enactment of this Act, and annually thereafter, the Attorney 
        General shall transmit to Congress and make publicly available 
        an annual progress report regarding the implementation and 
        effectiveness of the strategy described in paragraph (1). The 
        progress report shall include an evaluation of the 
        implementation of the strategy using the monitoring system and 
        performance indicators provided for in subparagraphs (K) and 
        (L) of paragraph (2).
    (e) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this section for 
        each of fiscal years 2023 through 2027.
            (2) Availability of funds.--Amounts made available under 
        paragraph (1) are authorized to remain available until 
        expended.
    (f) Definitions.--In this section:
            (1) Community organization.--The term ``community 
        organization'' means a public health care facility or a 
        nonprofit organization that provides health- or STI-related 
        services according to established public health standards.
            (2) Comprehensive sexuality education.--The term 
        ``comprehensive sexuality education'' means sexuality 
        education--
                    (A) that includes information about abstinence and 
                about the proper use and disposal of sexual barrier 
                protection devices; and
                    (B) that is--
                            (i) evidence-based;
                            (ii) medically accurate;
                            (iii) age and developmentally appropriate;
                            (iv) gender and identity sensitive;
                            (v) culturally and linguistically 
                        appropriate; and
                            (vi) structured to promote critical 
                        thinking, self-esteem, respect for others, and 
                        the development of healthy attitudes and 
                        relationships.
            (3) Correctional facility.--The term ``correctional 
        facility'' means any prison, penitentiary, adult detention 
        facility, juvenile detention facility, jail, or other facility 
        to which individuals may be sent after conviction of a crime or 
        act of juvenile delinquency within the United States.
            (4) Incarcerated individual.--The term ``incarcerated 
        individual'' means any individual who is serving a sentence in 
        a correctional facility after conviction of a crime.
            (5) Sexual barrier protection device.--The term ``sexual 
        barrier protection device'' means any physical device approved, 
        cleared, or otherwise authorized by the Food and Drug 
        Administration that has not been tampered with and which 
        reduces the probability of STI transmission or infection 
        between sexual partners, including female condoms, male 
        condoms, and dental dams.
            (6) Sexually transmitted infection.--The term ``sexually 
        transmitted infection'' or ``STI'' means any disease or 
        infection that is commonly transmitted through sexual activity, 
        including HIV, gonorrhea, chlamydia, syphilis, genital herpes, 
        viral hepatitis, and human papillomavirus.
            (7) State.--The term ``State'' includes the District of 
        Columbia, American Samoa, the Commonwealth of the Northern 
        Mariana Islands, Guam, Puerto Rico, and the United States 
        Virgin Islands.
            (8) State medicaid program.--The term ``State Medicaid 
        program'' means the State plan (or a waiver of such plan) under 
        title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

SEC. 7217. AUTOMATIC REINSTATEMENT OR ENROLLMENT IN MEDICAID FOR PEOPLE 
              WHO TEST POSITIVE FOR HIV BEFORE REENTERING COMMUNITIES.

    (a) In General.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following:
            ``(17) Enrollment of ex-offenders.--
                    ``(A) Automatic enrollment or reinstatement.--
                            ``(i) In general.--The State plan shall 
                        provide for the automatic enrollment or 
                        reinstatement of enrollment of an eligible 
                        individual--
                                    ``(I) if such individual is 
                                scheduled to be released from a public 
                                institution due to the completion of 
                                sentence, not less than 30 days prior 
                                to the scheduled date of the release; 
                                and
                                    ``(II) if such individual is to be 
                                released from a public institution on 
                                parole or on probation, as soon as 
                                possible after the date on which the 
                                determination to release such 
                                individual was made, and before the 
                                date such individual is released.
                            ``(ii) Exception.--If a State makes a 
                        determination that an individual is not 
                        eligible to be enrolled under the State plan--
                                    ``(I) on or before the date by 
                                which the individual would be enrolled 
                                under clause (i), such clause shall not 
                                apply to such individual; or
                                    ``(II) after such date, the State 
                                may terminate the enrollment of such 
                                individual.
                    ``(B) Relationship of enrollment to payment for 
                services.--
                            ``(i) In general.--Subject to subparagraph 
                        (A)(ii), an eligible individual who is 
                        enrolled, or whose enrollment is reinstated, 
                        under subparagraph (A) shall be eligible for 
                        all services for which medical assistance is 
                        provided under the State plan after the date 
                        that the eligible individual is released from 
                        the public institution.
                            ``(ii) Relationship to payment prohibition 
                        for inmates.--No provision of this paragraph 
                        may be construed to permit payment for care or 
                        services for which payment is excluded under 
                        subdivision (A) following paragraph (31) of 
                        section 1905(a).
                    ``(C) Treatment of continuous eligibility.--
                            ``(i) Suspension for inmates.--Any period 
                        of continuous eligibility under this title 
                        shall be suspended on the date an individual 
                        enrolled under this title becomes an inmate of 
                        a public institution (except as a patient of a 
                        medical institution).
                            ``(ii) Determination of remaining period.--
                        Notwithstanding any changes to State law 
                        related to continuous eligibility during the 
                        time that an individual is an inmate of a 
                        public institution (except as a patient of a 
                        medical institution), subject to clause (iii), 
                        with respect to an eligible individual who was 
                        subject to a suspension under clause (i), on 
                        the date that such individual is released from 
                        a public institution the suspension of 
                        continuous eligibility under such clause shall 
                        be lifted for a period that is equal to the 
                        time remaining in the period of continuous 
                        eligibility for such individual on the date 
                        that such period was suspended under such 
                        clause.
                            ``(iii) Exception.--If a State makes a 
                        determination that an individual is not 
                        eligible to be enrolled under the State plan--
                                    ``(I) on or before the date that 
                                the suspension of continuous 
                                eligibility is lifted under clause 
                                (ii), such clause shall not apply to 
                                such individual; or
                                    ``(II) after such date, the State 
                                may terminate the enrollment of such 
                                individual.
                    ``(D) Automatic enrollment or reinstatement of 
                enrollment defined.--For purposes of this paragraph, 
                the term `automatic enrollment or reinstatement of 
                enrollment' means that the State determines eligibility 
                for medical assistance under the State plan without a 
                program application from, or on behalf of, the eligible 
                individual, but an individual can only be automatically 
                enrolled in the State Medicaid plan if the individual 
                affirmatively consents to being enrolled through 
                affirmation in writing, by telephone, orally, through 
                electronic signature, or through any other means 
                specified by the Secretary.
                    ``(E) Eligible individual defined.--For purposes of 
                this paragraph, the term `eligible individual' means an 
                individual who is an inmate of a public institution 
                (except as a patient in a medical institution)--
                            ``(i) who was enrolled under the State plan 
                        for medical assistance immediately before 
                        becoming an inmate of such an institution; or
                            ``(ii) who is diagnosed with human 
                        immunodeficiency virus.''.
    (b) Supplemental Funding for State Implementation of Automatic 
Reinstatement of Medicaid Benefits.--
            (1) In general.--Subject to paragraph (3), with respect to 
        a State, for each of the first 4 calendar quarters in which the 
        State plan meets the requirements of paragraph (17) of section 
        1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as 
        added by subsection (a)), the Federal matching payments 
        (including payments based on the Federal medical assistance 
        percentage) made to such State under section 1903 of the Social 
        Security Act (42 U.S.C. 1396b) for the State expenditures 
        described in paragraph (2) shall be increased by 5 percentage 
        points.
            (2) Expenditures.--The expenditures described in this 
        paragraph are the following:
                    (A) Expenditures for which payment is available 
                under section 1903 of the Social Security Act (42 
                U.S.C. 1396b) and which are attributable to 
                strengthening the State's enrollment and administrative 
                resources for the purpose of improving processes for 
                enrolling (or reinstating the enrollment of) eligible 
                individuals (as such term is defined in subparagraph 
                (E) of paragraph (16) of section 1902(e) of the Social 
                Security Act (42 U.S.C. 1396a(e)) (as amended by 
                subsection (a))).
                    (B) Expenditures for medical assistance (as such 
                term is defined in section 1905(a) of the Social 
                Security Act (42 U.S.C. 1396d(a))) provided to such 
                eligible individuals.
            (3) Requirements; limitation.--
                    (A) Report.--A State is not eligible for an 
                increase in its Federal matching payments under 
                paragraph (1) unless the State agrees to submit to the 
                Secretary of Health and Human Services, and make 
                publicly available, a report that contains the 
                information required under paragraph (4) by the end of 
                the 1-year period during which the State receives 
                increased Federal matching payments in accordance with 
                that paragraph.
                    (B) Maintenance of eligibility.--
                            (i) In general.--Subject to clause (ii), a 
                        State is not eligible for an increase in its 
                        Federal matching payments under paragraph (1) 
                        if eligibility standards, methodologies, or 
                        procedures under its State plan under title XIX 
                        of the Social Security Act (42 U.S.C. 1396 et 
                        seq.), or waiver of such a plan, are more 
                        restrictive than the eligibility standards, 
                        methodologies, or procedures, respectively, 
                        under such plan or waiver as in effect on the 
                        date of enactment of this Act.
                            (ii) State reinstatement of eligibility 
                        permitted.--A State that has restricted 
                        eligibility standards, methodologies, or 
                        procedures under its State plan under title XIX 
                        of the Social Security Act (42 U.S.C. 1396 et 
                        seq.), or a waiver of such plan, after the date 
                        of enactment of this Act, is no longer 
                        ineligible under clause (i) beginning with the 
                        first calendar quarter in which the State has 
                        reinstated eligibility standards, 
                        methodologies, or procedures that are no more 
                        restrictive than the eligibility standards, 
                        methodologies, or procedures, respectively, 
                        under such plan (or waiver) as in effect on 
                        such date.
                    (C) Limitation of matching payments to 100 
                percent.--In no case shall an increase in Federal 
                matching payments under paragraph (1) result in Federal 
                matching payments that exceed 100 percent of State 
                expenditures.
            (4) Required report information.--The information that is 
        required in the report under paragraph (3)(A) shall include--
                    (A) the results of an evaluation of the impact of 
                the implementation of the requirements of paragraph 
                (17) of section 1902(e) of the Social Security Act (42 
                U.S.C. 1396a(e)) on improving the State's processes for 
                enrolling individuals who are released from public 
                institutions under the State Medicaid plan;
                    (B) the number of individuals who were 
                automatically enrolled (or whose enrollment was 
                reinstated) under such paragraph during the 1-year 
                period during which the State received increased 
                payments under this subsection; and
                    (C) any other information that is required by the 
                Secretary of Health and Human Services.
    (c) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by subsection (a) shall take effect 180 days 
        after the date of the enactment of this Act.
            (2) Rule for changes requiring state legislation.--In the 
        case of a State plan for medical assistance under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.) which the 
        Secretary of Health and Human Services determines requires 
        State legislation (other than legislation appropriating funds) 
        in order for the plan to meet the additional requirement 
        imposed by the amendments made by subsection (a), the State 
        plan shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet this additional requirement before the first day of the 
        first calendar quarter beginning after the close of the first 
        regular session of the State legislature that begins after the 
        date of the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of such session shall be deemed to be a 
        separate regular session of the State legislature.

SEC. 7218. STOP HIV IN PRISON.

    (a) Short Title.--This section may be cited as the ``Stop HIV in 
Prison Act''.
    (b) In General.--The Director of the Bureau of Prisons (referred to 
in this section as the ``Director'') shall develop a comprehensive 
policy to provide HIV testing, treatment, and prevention for inmates 
within the correctional setting and upon reentry.
    (c) Purpose.--The purposes of the policy required to be developed 
under subsection (b) shall be as follows:
            (1) To stop the spread of HIV among inmates.
            (2) To protect prison guards and other personnel from HIV 
        infection.
            (3) To provide comprehensive medical treatment to inmates 
        who are living with HIV.
            (4) To promote HIV awareness and prevention among inmates.
            (5) To encourage inmates to take personal responsibility 
        for their health.
            (6) To reduce the risk that inmates will transmit HIV to 
        other persons in the community following their release from 
        prison.
    (d) Consultation.--The Director shall consult with appropriate 
officials of the Department of Health and Human Services, the Office of 
National Drug Control Policy, and the Centers for Disease Control and 
Prevention regarding the development of the policy required under 
subsection (b).
    (e) Time Limit.--Not later than 1 year after the date of enactment 
of this Act, the Director shall draft appropriate regulations to 
implement the policy required to be developed under subsection (b).
    (f) Requirements for Policy.--The policy required to be developed 
under subsection (b) shall provide for the following:
            (1) Testing and counseling upon intake.--
                    (A) Health care personnel shall provide routine HIV 
                testing to all inmates as a part of a comprehensive 
                medical examination immediately following admission to 
                a facility. Health care personnel need not provide 
                routine HIV testing to an inmate who is transferred to 
                a facility from another facility if the inmate's 
                medical records are transferred with the inmate and 
                indicate that the inmate has been tested previously.
                    (B) To all inmates admitted to a facility prior to 
                the effective date of this policy, health care 
                personnel shall provide routine HIV testing within no 
                more than 6 months. HIV testing for these inmates may 
                be performed in conjunction with other health services 
                provided to these inmates by health care personnel.
                    (C) All HIV tests under this paragraph shall comply 
                with the opt-out provision.
            (2) Pre-test and post-test counseling.--Health care 
        personnel shall provide confidential pre-test and post-test 
        counseling to all inmates who are tested for HIV. Counseling 
        may be included with other general health counseling provided 
        to inmates by health care personnel.
            (3) HIV prevention education.--
                    (A) Health care personnel shall improve HIV 
                awareness through frequent educational programs for all 
                inmates. HIV educational programs may be provided by 
                community-based organizations, local health 
                departments, and inmate peer educators.
                    (B) HIV educational materials shall be made 
                available to all inmates at orientation, at health care 
                clinics, at regular educational programs, and prior to 
                release. Both written and audiovisual materials shall 
                be made available to all inmates.
                    (C)(i) The HIV educational programs and materials 
                under this paragraph shall include information on--
                            (I) modes of transmission, including 
                        transmission through tattooing, sexual contact, 
                        and intravenous drug use;
                            (II) prevention methods;
                            (III) treatment; and
                            (IV) disease progression.
                    (ii) The programs and materials shall be culturally 
                sensitive, written or designed for low-literacy levels, 
                available in a variety of languages, and present 
                scientifically accurate information in a clear and 
                understandable manner.
            (4) HIV testing upon request.--
                    (A) Health care personnel shall allow inmates to 
                obtain HIV tests upon request once per year or whenever 
                an inmate has a reason to believe the inmate may have 
                been exposed to HIV. Health care personnel shall, both 
                orally and in writing, inform inmates, during 
                orientation and periodically throughout incarceration, 
                of their right to obtain HIV tests.
                    (B) Health care personnel shall encourage inmates 
                to request HIV tests if the inmate is sexually active, 
                has been raped, uses intravenous drugs, receives a 
                tattoo, or if the inmate is concerned that the inmate 
                may have been exposed to HIV.
                    (C) An inmate's request for an HIV test shall not 
                be considered an indication that the inmate has put 
                themselves at risk of infection or committed a 
                violation of prison rules.
            (5) HIV testing of pregnant woman.--
                    (A) Health care personnel shall provide routine HIV 
                testing to all inmates who become pregnant.
                    (B) All HIV tests under this paragraph shall comply 
                with the opt-out provision under paragraph (9).
            (6) Comprehensive treatment.--
                    (A) Health care personnel shall provide all inmates 
                who test positive for HIV--
                            (i) timely, comprehensive medical 
                        treatment;
                            (ii) confidential counseling on managing 
                        their medical condition and preventing its 
                        transmission to other persons; and
                            (iii) voluntary partner notification 
                        services.
                    (B) Health care provided under this paragraph shall 
                be consistent with Department of Health and Human 
                Services guidelines and standard medical practice. 
                Health care personnel shall discuss treatment options, 
                the importance of adherence to antiretroviral therapy, 
                and the side effects of medications with inmates 
                receiving treatment.
                    (C) Health care personnel and pharmacy personnel 
                shall ensure that the facility formulary contains all 
                Food and Drug Administration-approved medications 
                necessary to provide comprehensive treatment for 
                inmates living with HIV, and that the facility 
                maintains adequate supplies of such medications to meet 
                inmates' medical needs. Health care personnel and 
                pharmacy personnel shall also develop and implement 
                automatic renewal systems for these medications to 
                prevent interruptions in care.
                    (D) Correctional staff, health care personnel, and 
                pharmacy personnel shall develop and implement 
                distribution procedures to ensure timely and 
                confidential access to medications.
            (7) Protection of confidentiality.--
                    (A) Health care personnel shall develop and 
                implement procedures to ensure the confidentiality of 
                inmate tests, diagnoses, and treatment. Health care 
                personnel and correctional staff shall receive regular 
                training on the implementation of these procedures. 
                Penalties for violations of inmate confidentiality by 
                health care personnel or correctional staff shall be 
                specified and strictly enforced.
                    (B) HIV testing, counseling, and treatment shall be 
                provided in a confidential setting where other routine 
                health services are provided and in a manner that 
                allows the inmate to request and obtain these services 
                as routine medical services.
            (8) Testing, counseling, and referral prior to reentry.--
                    (A) Health care personnel shall provide routine HIV 
                testing to all inmates not earlier than 3 months prior 
                to their release and reentry into the community. 
                Inmates who are already known to be infected need not 
                be tested again. This requirement may be waived if an 
                inmate's release occurs without sufficient notice to 
                the Director to allow health care personnel to perform 
                a routine HIV test and notify the inmate of the 
                results.
                    (B) All HIV tests under this paragraph shall comply 
                with the opt-out provision.
                    (C) To all inmates who test positive for HIV and 
                all inmates who already are known to have HIV, health 
                care personnel shall provide--
                            (i) confidential prerelease counseling on 
                        managing their medical condition in the 
                        community, accessing appropriate treatment and 
                        services in the community, and preventing the 
                        transmission of their condition to family 
                        members and other persons in the community;
                            (ii) referrals to appropriate health care 
                        providers and social service agencies in the 
                        community that meet the inmate's individual 
                        needs, including voluntary partner notification 
                        services and prevention counseling services for 
                        people living with HIV; and
                            (iii) a 30-day supply of any medically 
                        necessary medications the inmate is currently 
                        receiving.
            (9) Opt-out provision.--Inmates shall have the right to 
        refuse routine HIV testing. Inmates shall be informed both 
        orally and in writing of this right. Oral and written 
        disclosure of this right may be included with other general 
        health information and counseling provided to inmates by health 
        care personnel. If an inmate refuses a routine test for HIV, 
        health care personnel shall make a note of the inmate's refusal 
        in the inmate's confidential medical records. However, the 
        inmate's refusal shall not be considered a violation of prison 
        rules or result in disciplinary action. Any reference in this 
        section to the ``opt-out provision'' shall be deemed a 
        reference to the requirement of this paragraph.
            (10) Exclusion of tests performed under section 4014(b) 
        from the definition of routine hiv testing.--HIV testing of an 
        inmate under section 4014(b) of title 18, United States Code, 
        is not routine HIV testing for the purposes of the opt-out 
        provision. Health care personnel shall document the reason for 
        testing under section 4014(b) of title 18, United States Code, 
        in the inmate's confidential medical records.
            (11) Timely notification of test results.--Health care 
        personnel shall provide timely notification to inmates of the 
        results of HIV tests.
    (g) Changes in Existing Law.--
            (1) Screening in general.--Section 4014(a) of title 18, 
        United States Code, is amended--
                    (A) by striking ``for a period of 6 months or 
                more'';
                    (B) by striking ``, as appropriate,''; and
                    (C) by striking ``if such individual is determined 
                to be at risk for infection with such virus in 
                accordance with the guidelines issued by the Bureau of 
                Prisons relating to infectious disease management'' and 
                inserting ``unless the individual declines. The 
                Attorney General shall also cause such individual to be 
                so tested before release unless the individual 
                declines.''.
            (2) Inadmissibility of hiv test results in civil and 
        criminal proceedings.--Section 4014(d) of title 18, United 
        States Code, is amended by inserting ``or under the Stop HIV in 
        Prison Act'' after ``under this section''.
            (3) Screening as part of routine screening.--Section 
        4014(e) of title 18, United States Code, is amended by adding 
        at the end the following: ``Such rules shall also provide that 
        the initial test under this section be performed as part of the 
        routine health screening conducted at intake.''.
    (h) Reporting Requirements.--
            (1) Report on hepatitis, liver, and other diseases.--Not 
        later than 1 year after the date of enactment of this Act, the 
        Director shall provide a report to the Congress on the policies 
        and procedures of the Bureau of Prisons to provide testing, 
        treatment, and prevention education programs for hepatitis, 
        liver failure, and other liver-related diseases transmitted 
        through sexual activity, intravenous drug use, or other means. 
        The Director shall consult with appropriate officials of the 
        Department of Health and Human Services, the Office of National 
        Drug Control Policy, the Office of National AIDS Policy, and 
        the Centers for Disease Control and Prevention regarding the 
        development of this report.
            (2) Annual reports.--
                    (A) Generally.--Not later than 2 years after the 
                date of enactment of this Act, and then annually 
                thereafter, the Director shall report to Congress on 
                the incidence among inmates of diseases transmitted 
                through sexual activity and intravenous drug use.
                    (B) Matters pertaining to various diseases.--Each 
                report under subparagraph (A) shall discuss--
                            (i) the incidence among inmates of HIV, 
                        hepatitis, and other diseases transmitted 
                        through sexual activity and intravenous drug 
                        use; and
                            (ii) updates on the testing, treatment, and 
                        prevention education programs for these 
                        diseases conducted by the Bureau of Prisons.
                    (C) Matters pertaining to hiv only.--Each report 
                under subparagraph (A) shall also include--
                            (i) the number of inmates who tested 
                        positive for HIV upon intake;
                            (ii) the number of inmates who tested 
                        positive prior to reentry;
                            (iii) the number of inmates who were not 
                        tested prior to reentry because they were 
                        released without sufficient notice;
                            (iv) the number of inmates who opted out of 
                        taking the test;
                            (v) the number of inmates who were tested 
                        under section 4014(b) of title 18, United 
                        States Code; and
                            (vi) the number of inmates under treatment 
                        for HIV.
                    (D) Consultation.--The Director shall consult with 
                appropriate officials of the Department of Health and 
                Human Services, the Office of National Drug Control 
                Policy, and the Centers for Disease Control and 
                Prevention regarding the development of each report 
                under subparagraph (A).

SEC. 7219. TRANSFER OF FUNDS FOR IMPLEMENTATION OF ENDING THE HIV 
              EPIDEMIC: A PLAN FOR AMERICA.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by inserting after section 241 (42 U.S.C. 238j) the 
following:

``SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS 
              STRATEGY.

    ``(a) Transfer Authorization.--Of the discretionary appropriations 
made available to the Department of Health and Human Services for any 
fiscal year for programs and activities that, as determined by the 
Secretary, pertain to HIV, the Secretary may transfer up to 1 percent 
of such appropriations to the Office of the Assistant Secretary for 
Health for implementation of the Ending the HIV Epidemic: A Plan for 
America.
    ``(b) Congressional Notification.--Not less than 30 days before 
making any transfer under this section, the Secretary shall give notice 
of the transfer to the Congress.
    ``(c) Definitions.--In this section, the term `Ending the HIV 
Epidemic: A Plan for America' means the initiative of the Department of 
Health and Human Services that seeks to reduce the number of new HIV 
infections in the United States by 75 percent by 2025, and then by at 
least 90 percent by 2030, for an estimated 250,000 total HIV infections 
averted.''.

SEC. 7220. PREP ACCESS AND COVERAGE.

    (a) Coverage of HIV Testing and Prevention Services.--
            (1) Private insurance.--
                    (A) In general.--Section 2713(a) of the Public 
                Health Service Act (42 U.S.C. 300gg-13(a)) is amended--
                            (i) in paragraph (2), by striking ``; and'' 
                        and inserting a semicolon;
                            (ii) in paragraph (3), by striking the 
                        period and inserting a semicolon;
                            (iii) in paragraph (4), by striking the 
                        period and inserting a semicolon;
                            (iv) in paragraph (5), by striking the 
                        period and inserting ``; and''; and
                            (v) by adding at the end the following:
            ``(6) any prescription drug approved by the Food and Drug 
        Administration for the prevention of HIV (other than a drug 
        subject to preauthorization requirements consistent with 
        section 2729A), administrative fees for such drugs, laboratory 
        and other diagnostic procedures associated with the use of such 
        drugs, and clinical follow up and monitoring, including any 
        related services recommended in current United States Public 
        Health Service clinical practice guidelines, without 
        limitation.''.
                    (B) Prohibition on preauthorization requirements.--
                Subpart II of part A of title XXVII of the Public 
                Health Service Act (42 U.S.C. 300gg-11 et seq.) is 
                amended by adding at the end the following:

``SEC. 2729A. PROHIBITION ON PREAUTHORIZATION REQUIREMENTS WITH RESPECT 
              TO CERTAIN SERVICES.

    ``A group health plan or a health insurance issuer offering group 
or individual health insurance coverage shall not impose any 
preauthorization requirements with respect to coverage of the services 
described in section 2713(a)(6), except that a plan or issuer may 
impose preauthorization requirements with respect to coverage of a 
particular drug approved under section 505(c) of the Federal Food, 
Drug, and Cosmetic Act or section 351(a) of this Act if such plan or 
issuer provides coverage without any preauthorization requirements for 
a drug that is therapeutically equivalent.''.
            (2) Coverage under federal employees health benefits 
        program.--Section 8904 of title 5, United States Code, is 
        amended by adding at the end the following:
    ``(c) Any health benefits plan offered under this chapter shall 
include benefits for, and may not impose any cost sharing requirements 
for, any prescription drug approved by the Food and Drug Administration 
for the prevention of HIV, administrative fees for such drugs, 
laboratory and other diagnostic procedures associated with the use of 
such drugs, and clinical follow up and monitoring, including any 
related services recommended in current United States Public Health 
Service clinical practice guidelines, without limitation.''.
            (3) Medicaid.--
                    (A) In general.--Section 1905 of the Social 
                Security Act (42 U.S.C. 1396d) is amended--
                            (i) in subsection (a)(4)--
                                    (I) by striking ``; and (D)'' and 
                                inserting ``; (D)'';
                                    (II) by striking ``; and (E)'' and 
                                inserting ``; (E)'';
                                    (III) by striking ``; and (F)'' and 
                                inserting ``; (F)''; and
                                    (IV) by striking the semicolon at 
                                the end and inserting ``; and (G) HIV 
                                prevention services;''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(jj) HIV Prevention Services.--For purposes of subsection 
(a)(4)(G), the term `HIV prevention services' means prescription drugs 
for the prevention of HIV acquisition, administrative fees for such 
drugs, laboratory and other diagnostic procedures associated with the 
use of such drugs, and clinical follow up and monitoring, including any 
related services recommended in current United States Public Health 
Service clinical practice guidelines, without limitation.''.
                    (B) No cost-sharing.--Title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.) is amended--
                            (i) in section 1916, by inserting ``HIV 
                        prevention services described in section 
                        1905(a)(4)(G),'' after ``section 
                        1905(a)(4)(C),'' each place it appears; and
                            (ii) in section 1916A(b)(3)(B), by adding 
                        at the end the following new clause:
                            ``(xii) HIV prevention services described 
                        in section 1905(a)(4)(G).''.
                    (C) Inclusion in benchmark coverage.--Section 
                1937(b)(7) of the Social Security Act (42 U.S.C. 1396u-
                7(b)(7)) is amended--
                            (i) in the paragraph header, by inserting 
                        ``and hiv prevention services'' after 
                        ``supplies''; and
                            (ii) by striking ``includes for any 
                        individual described in section 1905(a)(4)(C), 
                        medical assistance for family planning services 
                        and supplies in accordance with such section'' 
                        and inserting ``includes medical assistance for 
                        HIV prevention services described in section 
                        1905(a)(4)(G), and includes, for any individual 
                        described in section 1905(a)(4)(C), medical 
                        assistance for family planning services and 
                        supplies in accordance with such section''.
            (4) CHIP.--
                    (A) In general.--Section 2103 of the Social 
                Security Act (42 U.S.C. 1397cc) is amended--
                            (i) in subsection (a), by striking ``and 
                        (8)'' and inserting ``(8), (10), (11), and 
                        (12)''; and
                            (ii) in subsection (c), by adding at the 
                        end the following new paragraph:
            ``(12) HIV prevention services.--Regardless of the type of 
        coverage elected by a State under subsection (a), the child 
        health assistance provided for a targeted low-income child, 
        and, in the case of a State that elects to provide pregnancy-
        related assistance pursuant to section 2112, the pregnancy-
        related assistance provided for a targeted low-income pregnant 
        woman (as such terms are defined for purposes of such section), 
        shall include coverage of HIV prevention services (as defined 
        in section 1905(jj)).''.
                    (B) No cost-sharing.--Section 2103(e)(2) of the 
                Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended 
                by inserting ``HIV prevention services described in 
                subsection (c)(12),'' before ``or for pregnancy-related 
                assistance''.
                    (C) Effective date.--
                            (i) In general.--Subject to clause (ii), 
                        the amendments made by paragraph (3) and this 
                        paragraph shall take effect on January 1, 2023.
                            (ii) Delay permitted if state legislation 
                        required.--In the case of a State plan approved 
                        under title XIX of the Social Security Act 
                        which the Secretary of Health and Human 
                        Services determines requires State legislation 
                        (other than legislation appropriating funds) in 
                        order for the plan to meet the additional 
                        requirements imposed by this subsection, the 
                        State plan shall not be regarded as failing to 
                        comply with the requirements of such title 
                        solely on the basis of the failure of the plan 
                        to meet such additional requirements before the 
                        1st day of the 1st calendar quarter beginning 
                        after the close of the 1st regular session of 
                        the State legislature that ends after the 1-
                        year period beginning with the date of the 
                        enactment of this Act. For purposes of the 
                        preceding sentence, in the case of a State that 
                        has a 2-year legislative session, each year of 
                        the session is deemed to be a separate regular 
                        session of the State legislature.
            (5) Coverage and elimination of cost-sharing under 
        medicare.--
                    (A) Coverage of hiv prevention services under part 
                b.--
                            (i) Coverage.--
                                    (I) In general.--Section 1861(s)(2) 
                                of the Social Security Act (42 U.S.C. 
                                1395x(s)(2)) is amended--
                                            (aa) in subparagraph (GG), 
                                        by striking ``and'' at the end;
                                            (bb) in subparagraph (HH), 
                                        by striking the period at the 
                                        end and inserting ``; and''; 
                                        and
                                            (cc) by adding at the end 
                                        the following new subparagraph:
                    ``(II) HIV prevention services (as defined in 
                subsection (lll));''.
                                    (II) Definition.--Section 1861 of 
                                the Social Security Act (42 U.S.C. 
                                1395x) is amended by adding at the end 
                                the following new subsection:
    ``(LLL) HIV Prevention Services.--The term `HIV prevention 
services' means--
            ``(1) drugs or biologicals approved by the Food and Drug 
        Administration for the prevention of HIV;
            ``(2) administrative fees for such drugs;
            ``(3) laboratory and other diagnostic procedures associated 
        with the use of such drugs; and
            ``(4) clinical follow up and monitoring, including any 
        related services recommended in current United States Public 
        Health Service clinical practice guidelines, without 
        limitation.''.
                            (ii) Elimination of coinsurance.--Section 
                        1833(a)(1) of the Social Security Act (42 
                        U.S.C. 1395l(a)(1)) is amended--
                                    (I) by striking ``and (DD)'' and 
                                inserting ``(DD)''; and
                                    (II) by inserting before the 
                                semicolon at the end the following: 
                                ``and (EE) with respect to HIV 
                                prevention services (as defined in 
                                section 1861(lll)), the amount paid 
                                shall be 100 percent of (i) except as 
                                provided in clause (ii), the lesser of 
                                the actual charge for the service or 
                                the amount determined under the fee 
                                schedule that applies to such services 
                                under this part, and (ii) in the case 
                                of such services that are covered OPD 
                                services (as defined in subsection 
                                (t)(1)(B)), the amount determined under 
                                subsection (t)''.
                            (iii) Exemption from part b deductible.--
                        Section 1833(b) of the Social Security Act (42 
                        U.S.C. 1395l(b)) is amended--
                                    (I) in paragraph (11), by striking 
                                ``and'' at the end; and
                                    (II) in paragraph (12), by striking 
                                the period at the end and inserting ``, 
                                and (13) such deductible shall not 
                                apply with respect to HIV prevention 
                                services (as defined in section 
                                1861(lll).''.
                            (iv) Effective date.--The amendments made 
                        by this subparagraph shall apply to items and 
                        services furnished on or after January 1, 2023.
                    (B) Elimination of cost-sharing for drugs for the 
                prevention of hiv under part d.--
                            (i) In general.--Section 1860D-2(b) of the 
                        Social Security Act (42 U.S.C. 1395w-102(b)) is 
                        amended--
                                    (I) in paragraph (1)(A), by 
                                striking ``The coverage'' and inserting 
                                ``Subject to paragraph (8), the 
                                coverage'';
                                    (II) in paragraph (2)(A), by 
                                striking ``and (D)'' and inserting 
                                ``and (D) and paragraph (8)'';
                                    (III) in paragraph (3)(A), by 
                                striking ``and (4)'' and inserting 
                                ``(4), and (8)'';
                                    (IV) in paragraph (4)(A)(i), by 
                                striking ``The coverage'' and inserting 
                                ``Subject to paragraph (8), the 
                                coverage''; and
                                    (V) by adding at the end the 
                                following new paragraph:
            ``(8) Elimination of cost-sharing for drugs for the 
        prevention of hiv.--
                    ``(A) In general.--For plan year 2023 and each 
                subsequent plan year, there shall be no cost-sharing 
                under this part (including under section 1814D-14) for 
                covered part D drugs that are for the prevention of 
                HIV.
                    ``(B) Cost-sharing.--For purposes of subparagraph 
                (A), the elimination of cost-sharing shall include the 
                following:
                            ``(i) No application of deductible.--The 
                        waiver of the deductible under paragraph (1).
                            ``(ii) No application of coinsurance.--The 
                        waiver of coinsurance under paragraph (2).
                            ``(iii) No application of initial coverage 
                        limit.--The initial coverage limit under 
                        paragraph (3) shall not apply.
                            ``(iv) No cost-sharing above annual out-of-
                        pocket threshold.--The waiver of cost-sharing 
                        under paragraph (4).''.
                            (ii) Conforming amendments to cost-sharing 
                        for low-income individuals.--Section 1860D-
                        14(a) of the Social Security Act (42 U.S.C. 
                        1395w-114(a)) is amended--
                                    (I) in paragraph (1), in the matter 
                                preceding subparagraph (A), by striking 
                                ``In the case'' and inserting ``Subject 
                                to section 1860D-2(b)(8), in the 
                                case''; and
                                    (II) in paragraph (2), in the 
                                matter preceding subparagraph (A), by 
                                striking ``In the case'' and inserting 
                                ``Subject to section 1860D-2(b)(8), in 
                                the case''.
            (6) Coverage of hiv prevention treatment by department of 
        veterans affairs.--
                    (A) Elimination of medication copayments.--Section 
                1722A(a) of title 38, United States Code, is amended by 
                adding at the end the following new paragraph:
            ``(5) Paragraph (1) does not apply to a medication for the 
        prevention of HIV.''.
                    (B) Elimination of hospital care and medical 
                services copayments.--Section 1710 of such title is 
                amended--
                            (i) in subsection (f)--
                                    (I) by redesignating paragraph (5) 
                                as paragraph (6); and
                                    (II) by inserting after paragraph 
                                (4) the following new paragraph (5):
            ``(5) A veteran shall not be liable to the United States 
        under this subsection for any amounts for laboratory and other 
        diagnostic procedures associated with the use of any 
        prescription drug approved by the Food and Drug Administration 
        for the prevention of HIV, administrative fees for such drugs, 
        or for laboratory or other diagnostic procedures associated 
        with the use of such drugs, or clinical follow up and 
        monitoring, including any related services recommended in 
        current United States Public Health Service clinical practice 
        guidelines, without limitation.''; and
                            (ii) in subsection (g)(3), by adding at the 
                        end the following new subparagraph:
                    ``(C) Any prescription drug approved by the Food 
                and Drug Administration for the prevention of HIV, 
                administrative fees for such drugs, laboratory and 
                other diagnostic procedures associated with the use of 
                such drugs, and clinical follow up and monitoring, 
                including any related services recommended in current 
                United States Public Health Service clinical practice 
                guidelines, without limitation.''.
                    (C) Inclusion as preventive health service.--
                Section 1701(9) of such title is amended--
                            (i) in subparagraph (K), by striking ``; 
                        and'' and inserting a semicolon;
                            (ii) by redesignating subparagraph (L) as 
                        subparagraph (M); and
                            (iii) by inserting after subparagraph (K) 
                        the following new subparagraph (L):
                    ``(L) any prescription drug approved by the Food 
                and Drug Administration for the prevention of HIV, 
                administrative fees for such drugs, laboratory and 
                other diagnostic procedures associated with the use of 
                such drugs, and clinical follow up and monitoring, 
                including any related services recommended in current 
                United States Public Health Service clinical practice 
                guidelines, without limitation; and''.
            (7) Coverage of hiv prevention treatment by department of 
        defense.--
                    (A) In general.--Chapter 55 of title 10, United 
                States Code, is amended by inserting after section 
                1079c the following new section:
``Sec. 1079d. Coverage of HIV prevention treatment
    ``(a) In General.--The Secretary of Defense shall ensure coverage 
under the TRICARE program of HIV prevention treatment described in 
subsection (b) for any beneficiary under section 1074(a) of this title.
    ``(b) HIV Prevention Treatment Described.--HIV prevention treatment 
described in this subsection includes any prescription drug approved by 
the Food and Drug Administration for the prevention of HIV, 
administrative fees for such drugs, laboratory and other diagnostic 
procedures associated with the use of such drugs, and clinical follow 
up and monitoring, including any related services recommended in 
current United States Public Health Service clinical practice 
guidelines, without limitation.
    ``(c) No Cost-Sharing.--Notwithstanding section 1075, 1075a, or 
1074g(a)(6) of this title or any other provision of law, there is no 
cost-sharing requirement for HIV prevention treatment covered under 
this section.''.
                    (B) Clerical amendment.--The table of sections at 
                the beginning of such chapter is amended by inserting 
                after the item relating to section 1079c the following 
                new item:

``1079d. Coverage of HIV prevention treatment.''.
            (8) Indian health service testing, monitoring, and 
        prescription drugs for the prevention of hiv.--The Indian 
        Health Care Improvement Act is amended by inserting after 
        section 223 (25 U.S.C. 1621v) the following:

``SEC. 224. TESTING, MONITORING, AND PRESCRIPTION DRUGS FOR THE 
              PREVENTION OF HIV.

    ``(a) In General.--The Secretary, acting through the Service, 
Indian tribes, and Tribal organizations, shall provide funding for any 
prescription drug approved by the Food and Drug Administration for the 
prevention of human immunodeficiency virus (commonly known as `HIV'), 
administrative fees for such a drug, laboratory and other diagnostic 
procedures associated with the use of such a drug, and clinical follow 
up and monitoring, including any related services recommended in 
current United States Public Health Service clinical practice 
guidelines, without limitation.
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.
            (9) Effective date.--The amendments made by paragraphs (1), 
        (2), (5), (6), (7), and (8) shall take effect with respect to 
        plan years beginning on or after January 1, 2023.
    (b) Prohibition on Denial of Coverage or Increase in Premiums of 
Life, Disability, or Long-Term Care Insurance for Individuals Taking 
Medication for the Prevention of HIV Acquisition.--
            (1) Prohibition.--Notwithstanding any other provision of 
        law, it shall be unlawful to--
                    (A) decline or limit coverage of a person under any 
                life insurance policy, disability insurance policy, or 
                long-term care insurance policy, on account of the 
                individual taking medication for the purpose of 
                preventing the acquisition of HIV;
                    (B) preclude an individual from taking medication 
                for the purpose of preventing the acquisition of HIV as 
                a condition of receiving a life insurance policy, 
                disability insurance policy, or long-term care 
                insurance policy;
                    (C) consider whether an individual is taking 
                medication for the purpose of preventing the 
                acquisition of HIV in determining the premium rate for 
                coverage of such individual under a life insurance 
                policy, disability insurance policy, or long-term care 
                insurance policy; or
                    (D) otherwise discriminate in the offering, 
                issuance, cancellation, amount of such coverage, price, 
                or any other condition of a life insurance policy, 
                disability insurance policy, or long-term care 
                insurance policy for an individual, based solely and 
                without any additional actuarial risks upon whether the 
                individual is taking medication for the purpose of 
                preventing the acquisition of HIV.
            (2) Enforcement.--A State insurance regulator may take such 
        actions to enforce paragraph (1) as are specifically authorized 
        under the laws of such State.
            (3) Definitions.--In this subsection:
                    (A) Disability insurance policy.--The term 
                ``disability insurance policy'' means a contract under 
                which an entity promises to pay a person a sum of money 
                in the event that an illness or injury resulting in a 
                disability prevents such person from working.
                    (B) Life insurance policy.--The term ``life 
                insurance policy'' means a contract under which an 
                entity promises to pay a designated beneficiary a sum 
                of money upon the death of the insured.
                    (C) Long-term care insurance policy.--The term 
                ``long-term care insurance policy'' means a contract 
                for which the only insurance protection provided under 
                the contract is coverage of qualified long-term care 
                services (as defined in section 7702B(c) of the 
                Internal Revenue Code of 1986).
    (c) Patient Confidentiality.--The Secretary of Health and Human 
Services shall amend the regulations promulgated under section 264(c) 
of the Health Insurance Portability and Accountability Act of 1996 (42 
U.S.C. 1320d-2 note), as necessary, to ensure that individuals are able 
to access the benefits described in section 2713(a)(6) under a family 
plan without any other individual enrolled in such family plan, 
including a primary subscriber of or policyholder, being informed of 
such use of such benefits.
    (d) Pre-Exposure Prophylaxis and Post-Exposure Prophylaxis 
Funding.--Part P of title III of the Public Health Service Act (42 
U.S.C. 280g et seq.), as amended by section 7153, is further amended by 
adding at the end the following:

``SEC. 399V-8. PRE-EXPOSURE PROPHYLAXIS AND POST-EXPOSURE PROPHYLAXIS 
              FUNDING.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this Act, the Secretary shall establish a program that 
awards grants to States, territories, Indian Tribes, and directly 
eligible entities for the establishment and support of pre-exposure 
prophylaxis (referred to in this section as `PrEP') and post-exposure 
prophylaxis (referred to in this section as `PEP') programs.
    ``(b) Applications.--To be eligible to receive a grant under 
subsection (a), a State, territory, Indian Tribe, or directly eligible 
entity shall--
            ``(1) submit an application to the Secretary at such time, 
        in such manner, and containing such information as the 
        Secretary may require, including a plan describing how any 
        funds awarded will be used to increase access to PrEP for 
        uninsured and underinsured individuals and reduce disparities 
        in access to PrEP and PEP for uninsured and underinsured 
        individuals and reduce disparities in access to PrEP and PEP; 
        and
            ``(2) appoint a PrEP and PEP grant administrator to manage 
        the program.
    ``(c) Directly Eligible Entity.--For purposes of this section, the 
term `directly eligible entity'--
            ``(1) means a Federally qualified health center or other 
        nonprofit entity engaged in providing PrEP and PEP information 
        and services; and
            ``(2) may include--
                    ``(A) a Federally qualified health center (as 
                defined in section 1861(aa)(4) of the Social Security 
                Act (42 U.S.C. 1395x(aa)(4)));
                    ``(B) a family planning grantee (other than States) 
                funded under section 1001 of the Public Health Service 
                Act (42 U.S.C. 300);
                    ``(C) a rural health clinic (as defined in section 
                1861(aa)(2) of the Social Security Act (42 U.S.C. 
                1395x(aa)(2));
                    ``(D) a health facility operated by or pursuant to 
                a contract with the Indian Health Service;
                    ``(E) a community-based organization, clinic, 
                hospital, or other health facility that provides 
                services to individuals at risk for or living with HIV; 
                and
                    ``(F) a nonprofit private entity providing 
                comprehensive primary care to populations at risk of 
                HIV, including faith-based and community-based 
                organizations.
    ``(d) Awards.--In determining whether to award a grant, and the 
grant amount for each grant awarded, the Secretary shall consider the 
grant application and the need for PrEP and PEP services in the area, 
the number of uninsured and underinsured individuals in the area, and 
how the State, territory, or Indian Tribe coordinates PrEP and PEP 
activities with the directly funded entity, if the State, territory, or 
Indian Tribe applies for the funds.
    ``(e) Use of Funds.--
            ``(1) In general.--Any State, territory, Indian Tribe, or 
        directly eligible entity that is awarded funds under subsection 
        (a) shall use such funds for eligible PrEP and PEP expenses.
            ``(2) Eligible prep expenses.--The Secretary shall publish 
        a list of expenses that qualify as eligible PrEP and PEP 
        expenses for purposes of this section, which shall include--
                    ``(A) any prescription drug approved by the Food 
                and Drug Administration for the prevention of HIV, 
                administrative fees for such drugs, laboratory and 
                other diagnostic procedures associated with the use of 
                such drugs, and clinical follow up and monitoring, 
                including any related services recommended in current 
                United States Public Health Service clinical practice 
                guidelines, without limitation;
                    ``(B) outreach and public education activities 
                directed toward populations overrepresented in the 
                domestic HIV epidemic that increase awareness about the 
                existence of PrEP and PEP, provide education about 
                access to and health care coverage of PrEP and PEP, 
                PrEP and PEP adherence programs, and counter stigma 
                associated with the use of PrEP and PEP; and
                    ``(C) outreach activities directed toward 
                physicians and other providers that provide education 
                about PrEP and PEP.
    ``(f) Report to Congress.--The Secretary shall, in each of the 
first 5 years beginning one year after the date of the enactment of 
this section, submit to Congress, and make public on the internet 
website of Department of Health and Human Services, a report on the 
impact of any grants provided to States, territories, and Indian Tribes 
and directly eligible entities for the establishment and support of 
pre-exposure prophylaxis programs under this section.
    ``(g) 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 2023 through 2028.''.
    (e) Clarification.--This section, including the amendments made by 
this section, shall apply notwithstanding any other provision of law, 
including Public Law 103-141.
    (f) Private Right of Action.--Any person aggrieved by a violation 
of this section, including the amendments made by this section, may 
commence a civil action in an appropriate United States District Court 
or other court of competent jurisdiction to obtain relief as allowed by 
law as either an individual or member of a class. If the plaintiff is 
the prevailing party in such an action, the court shall order the 
defendant to pay the costs and reasonable attorney fees of the 
plaintiff.

                          Subtitle F--Diabetes

SEC. 7251. RESEARCH, TREATMENT, AND EDUCATION.

    Subpart 3 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285c et seq.) is amended by adding at the end the following 
new section:

``SEC. 434B. DIABETES IN MINORITY POPULATIONS.

    ``(a) In General.--The Director of NIH shall expand, intensify, and 
support ongoing research and other activities with respect to 
prediabetes and diabetes, particularly type 2, in minority populations.
    ``(b) Research.--
            ``(1) Description.--Research under subsection (a) shall 
        include investigation into--
                    ``(A) the causes of diabetes, including 
                socioeconomic, geographic, clinical, environmental, 
                genetic, and other factors that may contribute to 
                increased rates of diabetes in minority populations; 
                and
                    ``(B) the causes of increased incidence of diabetes 
                complications in minority populations, and possible 
                interventions to decrease such incidence.
            ``(2) Inclusion of minority participants.--In conducting 
        and supporting research described in subsection (a), the 
        Director of NIH shall seek to include minority participants as 
        study subjects in clinical trials.
    ``(c) Report; Comprehensive Plan.--
            ``(1) In general.--The Diabetes Mellitus Interagency 
        Coordinating Committee shall--
                    ``(A) prepare and submit to the Congress, not later 
                than 6 months after the date of enactment of this 
                section, a report on Federal research and public health 
                activities with respect to prediabetes and diabetes in 
                minority populations; and
                    ``(B) develop and submit to Congress, not later 
                than 1 year after the date of enactment of this 
                section, an effective and comprehensive Federal plan 
                (including all appropriate Federal health programs) to 
                address prediabetes and diabetes in minority 
                populations.
            ``(2) Contents.--The report under paragraph (1)(A) shall at 
        minimum address each of the following:
                    ``(A) Research on diabetes and prediabetes in 
                minority populations, including such research on--
                            ``(i) genetic, behavioral, socioeconomic, 
                        and environmental factors;
                            ``(ii) prevention of diabetes within these 
                        populations and who have individuals at 
                        increased risk of developing diabetes;
                            ``(iii) prevention of complications among 
                        individuals in these populations who have 
                        already developed diabetes; and
                            ``(iv) barriers to health care access and 
                        diabetes treatment within populations at 
                        increased risk of developing diabetes.
                    ``(B) Surveillance and data collection on diabetes 
                and prediabetes in minority populations, including with 
                respect to--
                            ``(i) efforts to better determine the 
                        prevalence of diabetes among Asian-American and 
                        Pacific Islander subgroups; and
                            ``(ii) efforts to coordinate data 
                        collection on the American Indian population.
                    ``(C) Community-based interventions to address 
                diabetes and prediabetes targeting minority 
                populations, including--
                            ``(i) the evidence base for such 
                        interventions;
                            ``(ii) the cultural appropriateness of such 
                        interventions; and
                            ``(iii) efforts to educate the public on 
                        the causes and consequences of diabetes.
                    ``(D) Education and training programs for health 
                professionals (including community health workers) on 
                the prevention and management of diabetes and its 
                related complications that is supported by the Health 
                Resources and Services Administration, including such 
                programs supported by--
                            ``(i) the National Health Service Corps; or
                            ``(ii) the community health centers program 
                        under section 330.
    ``(d) Education.--The Director of NIH shall--
            ``(1) through the National Institute on Minority Health and 
        Health Disparities and the National Diabetes Education 
        Program--
                    ``(A) make grants to programs funded under section 
                464z-4 for the purpose of establishing a medical 
                education program for health care professionals to be 
                more involved in weight counseling, obesity research, 
                nutrition, and shared decision-making; and
                    ``(B) provide for the participation of minority 
                health professionals in diabetes-focused research 
                programs; and
            ``(2) make grants to programs that establish a professional 
        pipeline that will increase the participation of minority 
        individuals in diabetes-focused health fields by expanding 
        Minority Access to Research Careers program internships and 
        mentoring opportunities for the purposes of recruitment.
    ``(e) Definitions.--For purposes of this section:
            ``(1) Diabetes mellitus interagency coordinating 
        committee.--The `Diabetes Mellitus Interagency Coordinating 
        Committee' means the Diabetes Mellitus Interagency Coordinating 
        Committee established under section 429.
            ``(2) Minority population.--The term `minority population' 
        means a racial and ethnic minority group, as defined in section 
        1707.''.

SEC. 7252. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.), as amended by section 7101, is further amended by inserting 
after section 317V the following section:

``SEC. 317W. DIABETES IN MINORITY POPULATIONS.

    ``(a) Research and Other Activities.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall conduct and support research and public health activities 
        with respect to diabetes in minority populations.
            ``(2) Certain activities.--Activities under paragraph (1) 
        regarding diabetes in minority populations shall include the 
        following:
                    ``(A) Further enhancing the National Health and 
                Nutrition Examination Survey by oversampling Asian 
                Americans, Native Hawaiians, and Pacific Islanders in 
                appropriate geographic areas to better determine the 
                prevalence of diabetes in such populations as well as 
                to improve the data collection of diabetes penetration 
                disaggregated into major ethnic groups within such 
                populations. The Secretary shall ensure that any such 
                oversampling does not reduce the oversampling of other 
                minority populations including African-American and 
                Latino populations.
                    ``(B) Through the Division of Diabetes 
                Translation--
                            ``(i) providing for prevention research to 
                        better understand how to influence health care 
                        systems changes to improve quality of care 
                        being delivered to such populations;
                            ``(ii) carrying out model demonstration 
                        projects to design, implement, and evaluate 
                        effective diabetes prevention and control 
                        interventions for minority populations, 
                        including culturally appropriate community-
                        based interventions;
                            ``(iii) developing and implementing a 
                        strategic plan to reduce diabetes in minority 
                        populations through applied research to reduce 
                        disparities and culturally and linguistically 
                        appropriate community-based interventions;
                            ``(iv) supporting, through the national 
                        diabetes prevention program under section 399V-
                        3, diabetes prevention program sites in 
                        underserved regions highly impacted by 
                        diabetes; and
                            ``(v) implementing, through the national 
                        diabetes prevention program under section 399V-
                        3, a demonstration program developing new 
                        metrics measuring health outcomes related to 
                        diabetes that can be stratified by specific 
                        minority populations.
    ``(b) Education.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall direct the Division 
of Diabetes Translation to conduct and support both programs to educate 
the public on diabetes in minority populations and programs to educate 
minority populations about the causes and effects of diabetes.
    ``(c) Diabetes; Health Promotion, Prevention Initiatives, and 
Access.--The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention and the National Diabetes Education 
Program, shall conduct and support programs to educate specific 
minority populations through culturally appropriate and linguistically 
appropriate information campaigns and initiatives about prevention of, 
and managing, diabetes.
    ``(d) Definition.--For purposes of this section, the term `minority 
population' means a racial and ethnic minority group, as defined in 
section 1707.''.

SEC. 7253. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND 
              EFFECTS OF DIABETES IN MINORITY POPULATIONS.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 7220, is further amended by adding 
at the end the following new section:

``SEC. 399V-9. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND 
              EFFECTS OF DIABETES IN MINORITY POPULATIONS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Health Resources and Services Administration, shall conduct and 
support programs described in subsection (b) to educate health 
professionals on the causes and effects of diabetes in minority 
populations.
    ``(b) Programs.--Programs described in this subsection, with 
respect to education on diabetes in minority populations, shall include 
the following:
            ``(1) Giving priority, under the primary care training and 
        enhancement program under section 747--
                    ``(A) to awarding grants to focus on or address 
                diabetes; and
                    ``(B) to adding minority populations to the list of 
                vulnerable populations that should be served by such 
                grants.
            ``(2) Providing additional funds for the Health Careers 
        Opportunity Program, the Centers for Excellence, and the 
        Minority Faculty Fellowship Program to partner with the Office 
        of Minority Health under section 1707 and the National 
        Institutes of Health to strengthen programs for career 
        opportunities focused on diabetes treatment and care within 
        underserved regions highly impacted by diabetes.
            ``(3) Developing a diabetes focus within, and providing 
        additional funds for, the National Health Service Corps 
        scholarship program--
                    ``(A) to place individuals in areas that are 
                disproportionately affected by diabetes and to provide 
                diabetes treatment and care in such areas; and
                    ``(B) to provide such individuals continuing 
                medical education specific to diabetes care.''.

SEC. 7254. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING DIABETES 
              IN AMERICAN INDIAN POPULATIONS.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 7253, is further amended by adding 
at the end the following section:

``SEC. 399V-10. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING 
              DIABETES IN AMERICAN INDIAN POPULATIONS.

    ``In addition to activities under sections 317W, 399V-9, and 434B, 
the Secretary, acting through the Indian Health Service and in 
collaboration with other appropriate Federal agencies, shall--
            ``(1) conduct and support research and other activities 
        with respect to diabetes; and
            ``(2) coordinate the collection of data on clinically and 
        culturally appropriate diabetes treatment, care, prevention, 
        and services by health care professionals to the American 
        Indian population.''.

SEC. 7255. UPDATED REPORT ON HEALTH DISPARITIES.

    The Secretary of Health and Human Services shall seek to enter into 
an arrangement with the National Academy of Medicine under which the 
National Academy will--
            (1) not later than 1 year after the date of enactment of 
        this Act, submit to Congress an updated version of the 2003 
        report entitled ``Unequal Treatment: Confronting Racial and 
        Ethnic Disparities in Health Care''; and
            (2) in such updated version, address how racial and ethnic 
        health disparities have changed since the publication of the 
        original report.

                        Subtitle G--Lung Disease

SEC. 7301. NATIONAL ASTHMA BURDEN.

    Congress finds as follows:
            (1) The prevalence of asthma has increased since 1980 and 
        affects more than 26,000,000 people in the United States.
            (2) Significant disparities in asthma morbidity and 
        mortality exist for both adults and children particularly for 
        low-income and minority populations, particularly African 
        Americans and Puerto Ricans.
            (3) African-American children are twice as likely to have 
        asthma as White children.
            (4) In 2016, almost 4,500,000 non-Hispanic African 
        Americans reported having asthma. African Americans with asthma 
        are 3 times as likely to visit the emergency department and 
        twice as likely to get hospitalized as White patients with 
        asthma.
            (5) Puerto Ricans are 3.4 times as likely to die from 
        asthma compared with all other Hispanic or Latino groups. 
        Overall Hispanic Americans are 30 percent more likely to be 
        hospitalized for asthma than non-Hispanic Whites.
            (6) The majority of adults with asthma are women.

SEC. 7302. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL 
              AND PREVENTION.

    Section 317I of the Public Health Service Act (42 U.S.C. 247b-10) 
is amended to read as follows:

``SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE 
              CONTROL AND PREVENTION.

    ``(a) Program for Providing Information and Education to the 
Public.--The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, shall collaborate with State and local 
health departments to conduct activities, including the provision of 
information and education to the public regarding asthma including--
            ``(1) deterring the harmful consequences of uncontrolled 
        asthma; and
            ``(2) disseminating health education and information 
        regarding prevention of asthma episodes and strategies for 
        managing asthma.
    ``(b) Development of State Asthma Plans.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention, 
shall collaborate with State and local health departments to develop 
State plans incorporating public health responses to reduce the burden 
of asthma, particularly regarding disproportionately affected 
populations.
    ``(c) Compilation of Data.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall, in 
cooperation with State and local public health officials--
            ``(1) conduct asthma surveillance activities to collect 
        data on the prevalence and severity of asthma, the 
        effectiveness of public health asthma interventions, and the 
        quality of asthma management, including--
                    ``(A) collection of data among people with asthma 
                to monitor the impact on health and quality of life;
                    ``(B) surveillance of health care facilities; and
                    ``(C) collection of data not containing 
                individually identifiable information from electronic 
                health records or other electronic communications;
            ``(2) compile and annually publish data regarding the 
        prevalence and incidence of childhood asthma, the child 
        mortality rate, and the number of hospital admissions and 
        emergency department visits by children associated with asthma 
        nationally and in each State and at the county level by age, 
        sex, race, and ethnicity, as well as lifetime and current 
        prevalence; and
            ``(3) compile and annually publish data regarding the 
        prevalence and incidence of adult asthma, the adult mortality 
        rate, and the number of hospital admissions and emergency 
        department visits by adults associated with asthma nationally 
        and in each State and at the county level by age, sex, race, 
        ethnicity, industry, and occupation, as well as lifetime and 
        current prevalence.
    ``(d) Coordination of Data Collection.--The Director of the Centers 
for Disease Control and Prevention, in conjunction with State and local 
health departments, shall coordinate data collection activities under 
paragraphs (2) and (3) of subsection (c) so as to maximize 
comparability of results.
    ``(e) Collaboration.--
            ``(1) In general.--The Centers for Disease Control and 
        Prevention may collaborate with national, State, and local 
        nonprofit organizations to provide information and education 
        about asthma, and to strengthen such collaborations when 
        possible.
            ``(2) Specific activities.--The Director of the Centers for 
        Disease Control and Prevention, acting through the Division of 
        Population Health of the Centers, may expand activities 
        relating to asthma with non-Federal partners, especially State-
        level entities.
    ``(f) Reports to Congress.--
            ``(1) In general.--Not later than 3 years after the date of 
        the enactment of the Health Equity and Accountability Act of 
        2022, and once 2 years thereafter, the Secretary shall, in 
        consultation with patient groups, nonprofit organizations, 
        medical societies, and other relevant governmental and 
        nongovernmental entities, submit to Congress a report that--
                    ``(A) catalogs, with respect to asthma prevention, 
                management, and surveillance--
                            ``(i) the activities of the Federal 
                        Government, including an assessment of the 
                        progress of the Federal Government and States, 
                        with respect to achieving the goals of the 
                        Healthy People 2030 initiative; and
                            ``(ii) the activities of other entities 
                        that participate in the program under this 
                        section, including nonprofit organizations, 
                        patient advocacy groups, and medical societies; 
                        and
                    ``(B) makes recommendations for the future 
                direction of asthma activities, in consultation with 
                researchers from the National Institutes of Health and 
                other member bodies of the Asthma Disparities 
                Subcommittee, including--
                            ``(i) a description of how the Federal 
                        Government may improve its response to asthma, 
                        including identifying any barriers that may 
                        exist;
                            ``(ii) a description of how the Federal 
                        Government may continue, expand, and improve 
                        its private-public partnerships with respect to 
                        asthma including identifying any barriers that 
                        may exist;
                            ``(iii) identification of steps that may be 
                        taken to reduce the--
                                    ``(I) morbidity, mortality, and 
                                overall prevalence of asthma;
                                    ``(II) financial burden of asthma 
                                on society;
                                    ``(III) burden of asthma on 
                                disproportionately affected areas, 
                                particularly those in medically 
                                underserved populations (as defined in 
                                section 330(b)(3)); and
                                    ``(IV) burden of asthma as a 
                                chronic disease that can be worsened by 
                                environmental exposures;
                            ``(iv) the identification of programs and 
                        policies that have achieved the steps described 
                        under clause (iii), and steps that may be taken 
                        to expand such programs and policies to benefit 
                        larger populations; and
                            ``(v) recommendations for future research 
                        and interventions.
            ``(2) Subsequent reports.--
                    ``(A) Congressional request.--During the 5-year 
                period following the submission of the second report 
                under paragraph (1), the Secretary shall submit updates 
                and revisions of the report upon the request of the 
                Congress.
                    ``(B) Five-year reevaluation.--At the end of the 5-
                year period referred to in subparagraph (A), the 
                Secretary shall--
                            ``(i) evaluate the analyses and 
                        recommendations made in previous reports; and
                            ``(ii) determine whether an additional 
                        report is needed and if so submit such an 
                        updated report to the Congress, including 
                        appropriate recommendations.
    ``(g) Authorization of Appropriations Funding.--In addition to any 
other authorization of appropriations that is available to the Centers 
for Disease Control and Prevention for the purpose of carrying out this 
section, there is authorized to be appropriated to such Centers 
$65,000,000 for the period of fiscal years 2023 through 2027 for the 
purpose of carrying out this section.''.

SEC. 7303. INFLUENZA AND PNEUMONIA VACCINATION CAMPAIGN.

    (a) In General.--The Secretary of Health and Human Services shall--
            (1) enhance the annual campaign by the Department of Health 
        and Human Services to increase the number of people vaccinated 
        each year for influenza and pneumonia; and
            (2) include in such campaign the use of written educational 
        materials, public service announcements, physician education, 
        and any other means which the Secretary deems effective.
    (b) Materials and Announcements.--In carrying out the annual 
campaign described in subsection (a), the Secretary of Health and Human 
Services shall ensure that--
            (1) educational materials and public service announcements 
        are readily and widely available in communities experiencing 
        disparities in the incidence and mortality rates of influenza 
        and pneumonia; and
            (2) the campaign uses targeted, culturally appropriate 
        messages and messengers to reach underserved communities.
    (c) 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 2023 through 2027.

SEC. 7304. CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

    (a) Findings.--Congress finds as follows:
            (1) Chronic obstructive pulmonary disease (referred to in 
        this subsection as ``COPD'') refers to chronic bronchitis and 
        emphysema, incurable diseases that make it difficult to exhale 
        all the air from one's lungs, and that can cause persistent 
        coughing, shortness of breath, and sputum.
            (2) COPD exacerbations--episodes of acute difficulty 
        breathing and moderate to severe fatigue--are dangerous, and 
        their treatment often requires hospitalization.
            (3) While smoking is the primary risk factor for COPD, 
        other risk factors include air pollution, occupational 
        exposures, heredity, a history of childhood respiratory 
        infections, and socioeconomic status.
            (4) It is estimated that over 16,000,000 adults in the 
        United States have COPD.
            (5) COPD is a leading cause of death in the United States, 
        claiming over 156,000 lives in 2019.
            (6) Since 2000, deaths for women with COPD have exceeded 
        deaths in men.
            (7) Although African Americans have a lower prevalence of 
        COPD in the United States, researchers have shown that African 
        Americans may be underdiagnosed. Furthermore, research has 
        shown that African Americans develop COPD with less cumulative 
        smoke exposure and at a younger age.
    (b) In General.--The Director of the Centers for Disease Control 
and Prevention shall conduct, support, and expand public health 
strategies, prevention, diagnosis, surveillance, and public and 
professional awareness activities regarding chronic obstructive 
pulmonary disease.
    (c) Chronic Disease Prevention Programs.--The Director of the 
National Heart, Lung, and Blood Institute shall carry out the 
following:
            (1) Conduct public education and awareness activities with 
        patient and professional organizations to stimulate earlier 
        diagnosis and improve patient outcomes from treatment of 
        chronic obstructive pulmonary disease. To the extent known and 
        relevant, such public education and awareness activities shall 
        reflect differences in chronic obstructive pulmonary disease by 
        cause (tobacco, environmental, occupational, biological, and 
        genetic) and include a focus on outreach to undiagnosed and, as 
        appropriate, minority populations.
            (2) Supplement and expand upon the activities of the 
        National Heart, Lung, and Blood Institute by making grants to 
        nonprofit organizations, State and local jurisdictions, and 
        Indian Tribes for the purpose of reducing the burden of chronic 
        obstructive pulmonary disease, especially in disproportionately 
        impacted communities, through public health interventions and 
        related activities.
            (3) Coordinate with the Centers for Disease Control and 
        Prevention, the Indian Health Service, the Health Resources and 
        Services Administration, and the Department of Veterans Affairs 
        to develop pilot programs to demonstrate best practices for the 
        diagnosis and management of chronic obstructive pulmonary 
        disease.
            (4) Develop improved techniques and identify best 
        practices, in coordination with the Secretary of Veterans 
        Affairs, for assisting chronic obstructive pulmonary disease 
        patients to successfully stop smoking, including identification 
        of subpopulations with different needs. Initiatives under this 
        paragraph may include research to determine whether successful 
        smoking cessation strategies are different for chronic 
        obstructive pulmonary disease patients compared to such 
        strategies for patients with other chronic diseases.
    (d) Environmental and Occupational Health Programs.--The Director 
of the Centers for Disease Control and Prevention shall--
            (1) support research into the environmental and 
        occupational causes and biological mechanisms that contribute 
        to chronic obstructive pulmonary disease; and
            (2) develop and disseminate public health interventions 
        that will lessen the impact of environmental and occupational 
        causes of chronic obstructive pulmonary disease.
    (e) Data Collection.--Not later than 180 days after the enactment 
of this Act, the Director of the National Heart, Lung, and Blood 
Institute and the Director of the Centers for Disease Control and 
Prevention, acting jointly, shall assess the depth and quality of 
information on chronic obstructive pulmonary disease that is collected 
in surveys and population studies conducted by the Centers for Disease 
Control and Prevention, including whether there are additional 
opportunities for information to be collected in the National Health 
and Nutrition Examination Survey, the National Health Interview Survey, 
and the Behavioral Risk Factors Surveillance System surveys.
    (f) 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 2023 through 2027.

                        Subtitle H--Tuberculosis

SEC. 7351. ELIMINATION OF ALL FORMS OF TUBERCULOSIS.

    (a) Short Title.--This subtitle may be cited as the ``End 
Tuberculosis Act''.
    (b) Findings.--Congress makes the following findings:
            (1) In the United States, 7,174 people were diagnosed with 
        tuberculosis (referred to in this section as ``TB'') in 2020.
            (2) Disparities in TB exist and significantly impact 
        minority communities in the United States. The Centers for 
        Disease Control and Prevention (referred to in this section as 
        ``CDC'') finds that 89 percent of people diagnosed with TB 
        disease in 2020 self-identified as racial and ethnic 
        minorities.
            (3) African Americans comprised 19.6 percent of people 
        diagnosed with TB disease during 2020. The population-adjusted 
        rate of TB among African Americans is 1.5 times higher than the 
        national total, and 8.0 times higher than among Whites.
            (4) Asian Americans, Native Hawaiians, and other Pacific 
        Islanders comprised 37.4 percent of people diagnosed with TB 
        disease during 2020. The population-adjusted rate of TB among 
        Asian Americans is 6 times higher than the national total, and 
        33.25 times higher than among Whites. The population-adjusted 
        rate of TB among Native Hawaiians and other Pacific Islanders 
        is 8.5 times higher than the national total, and 46.75 times 
        higher than among Whites.
            (5) Hispanics and Latinos comprised 29.7 percent of people 
        diagnosed with TB disease during 2020. The population-adjusted 
        rate of TB among Hispanics and Latinos is 1.6 times higher than 
        the national total, and 8.75 times higher than among Whites.
            (6) TB is both preventable and curable, but the current 
        rate of decline of TB in the United States remains too slow to 
        achieve TB elimination in this century.
            (7) TB is transmitted through the air when a person who has 
        TB disease in their lungs coughs or sneezes. People who are in 
        close proximity to the person with TB can breathe in the TB 
        bacteria, and the bacteria will initially settle in their 
        lungs. Living conditions related to poverty, such as crowded 
        housing and poor ventilation, can greatly increase the risk of 
        transmission. Without proper and timely diagnosis and access to 
        treatment, the TB bacteria may grow and spread to other parts 
        of their body.
            (8) As many as 13,000,000 people in the United States may 
        have latent TB infection (referred to in this section as 
        ``LTBI''). People with LTBI have TB bacteria in their bodies, 
        but their immune system is containing the bacteria, and they 
        are not sick, nor do they have any current risk of spreading TB 
        to others. LTBI can activate into infectious, life-threatening 
        TB if not treated. Modeling has shown that eliminating TB is 
        not possible without addressing LTBI.
            (9) Comorbidities associated with TB include cancer, 
        diabetes mellitus, and HIV. People with these medical 
        conditions and compromised immune systems are more likely to 
        develop active TB disease and to have worse outcomes from TB. 
        Many of the communities placed at highest risk of other adverse 
        health outcomes and injustices are also disproportionately 
        impacted by TB, and these include people experiencing 
        homelessness and housing instability, people in congregate 
        living and carceral settings, and people born outside of the 
        United States.
            (10) Forms of active TB that do not show drug resistance 
        are classified as drug-susceptible TB (referred to in this 
        section as ``DS-TB''). Drug-resistant TB (referred to in this 
        section as ``DR-TB'') is a rising threat to the public health 
        of the United States. DR-TB that exhibits resistance to two or 
        more first-line drugs is referred to as multi-drug resistant TB 
        (referred to in this section as ``MDR-TB''). MDR-TB that also 
        is resistant to at least one fluoroquinolone, and at least one 
        additional group A second-line medicine is classified as 
        extensively drug-resistant TB (referred to in this section as 
        ``XDR-TB'').
            (11) Approximately 56 people in the United States were 
        diagnosed with MDR-TB in 2020. One person was diagnosed with 
        XDR-TB in the same year.
            (12) In the United States, $503,000,000 was spent in 2020 
        to treat TB; direct treatment costs average $20,211 to treat a 
        patient with DS-TB, $182,186 to treat a patient with MDR-TB, 
        and $567,708 to treat a patient with XDR-TB. When factoring in 
        productivity losses during treatment, DS-TB averages $24,661, 
        MDR-TB averages $347,324, and XDR-TB averages $729,039. 
        Treatment is often difficult, with daily complex multi-pill 
        regimens, with side-effects ranging from hearing and vision 
        loss to mental health issues.
            (13) Recognizing the public health, economic, and societal 
        costs to the threat of MDR-TB, the National Action Plan to 
        Combat MDR-TB was developed by the White House to provide the 
        United States with a comprehensive three-pronged strategy to 
        address MDR-TB by strengthening domestic capacity to combat 
        MDR-TB; improve international capacity and cooperation to 
        combat MDR-TB; and accelerate basic and applied research and 
        development for new therapies, diagnostics, and prevention 
        strategies to combat MDR-TB.
            (14) Additional Federal support is necessary to expand TB 
        control efforts in case finding and treatment to address LTBI 
        in a national prevention initiative. Key policy and research 
        breakthroughs increase the success of a TB prevention 
        initiative: the U.S. Preventative Services Task Force 
        recommendation's ``B'' rating, screening for LTBI among high-
        risk adults as a covered service increases the likelihood that 
        impacted racial and ethnic minority groups can get tested for 
        TB; a new, shorter course treatment regimen reduces the length 
        of treatment for LTBI from every day for 6 to 9 months to one 
        dose per week for 12 weeks, increasing the likelihood of 
        treatment completion; and the use of blood-based diagnostic 
        tests, Interferon-gamma release assays or IGRAs, increases the 
        ability to detect LTBI among patients in affected communities.
            (15) The right to health, and the right to science as a 
        necessary human right to help achieve the right to health, is 
        enshrined in Articles 25 and 27 of the Universal Declaration of 
        Human Rights. These fundamental human rights cannot be achieved 
        when anyone lacks access to TB prevention or treatment, and 
        when the benefits of scientific innovation are not extended to 
        people with all forms of TB.

SEC. 7352. ADDITIONAL FUNDING FOR STATES IN COMBATING AND ELIMINATING 
              TUBERCULOSIS.

    Section 317E(h) of the Public Health Act (42 U.S.C. 247b-6(h)) is 
amended by adding at the end the following:
            ``(3) Additional funding for states in combating and 
        eliminating tuberculosis.--In addition to amounts otherwise 
        authorized to be appropriated to carry out this section, there 
        are authorized to be appropriated such sums as may be necessary 
        to carry out this section for each of fiscal years 2023 through 
        2024.''.

SEC. 7353. STRENGTHENING CLINICAL RESEARCH FUNDING FOR TUBERCULOSIS.

    (a) In General.--The Secretary of Health and Human Services shall 
expand and intensify support for current and prospective research 
activities of the National Institutes of Health, the Biomedical 
Advanced Research and Development Authority, and the Centers for 
Disease Control and Prevention Division of Tuberculosis Elimination to 
develop new therapeutics, diagnostics, vaccines, and other prevention 
modalities in addressing all forms of tuberculosis (referred to in this 
section as ``TB'').
    (b) Included Research Activities.--Research activities under 
subsection (a) shall include--
            (1) research and development, and pathways to approval, for 
        novel, safe drugs and drug regimens for the treatment of TB, 
        including in adolescent and pediatric populations and in 
        pregnant and lactating people;
            (2) research to develop rapid diagnostic tests for all 
        forms of TB, including diagnostics that can be used for 
        pediatric populations and people living with HIV, diagnostics 
        that can detect extra pulmonary TB and drug resistance, and 
        diagnostics that can be used at the point of care;
            (3) research to advance basic knowledge of the pathogenesis 
        of TB and its major comorbidities, including HIV and diabetes 
        mellitus;
            (4) research to improve knowledge and understandings of the 
        role of latency in TB and the factors that increase the risk of 
        latent TB infection progressing to active, symptomatic TB 
        disease;
            (5) awarding grants and contracts to specifically develop 
        new and needed vaccines to address TB;
            (6) awarding grants and contracts to support the training 
        and development of clinical researchers whose research improves 
        the landscape of tools to combat TB; and
            (7) awarding grants and contracts to support capacity-
        building and develop clinical trial site infrastructure in the 
        United States and in TB endemic countries to support the 
        aforementioned research activities.

        Subtitle I--Osteoarthritis and Musculoskeletal Diseases

SEC. 7401. FINDINGS.

    Congress finds as follows:
            (1) Eighty percent of African-American women and nearly 74 
        percent of Hispanic men are either overweight or obese, 
        speeding the onset and progression of knee arthritis.
            (2) Arthritis affects 58,500,000 people in the United 
        States, and that number will rise to 78,000,000 by the year 
        2040.
            (3) 32,500,000 people in the United States suffer from 
        osteoarthritis, the most common form of arthritis, making it 
        the leading cause of disability in the United States. 
        Osteoarthritis is sometimes referred to as degenerative joint 
        disease.
            (4) Obesity accelerates the onset of arthritis: 70 percent 
        of obese adults with mild osteoarthritis of the knee at age 60 
        will develop advanced end-stage disease by age 80. In contrast, 
        just 43 percent of non-obese adults will have end-stage disease 
        over the same time period.
            (5) Arthritis affects 1 in 4 people in the United States 
        and is the single greatest cause of chronic pain and disability 
        in the United States.
            (6) Women, Black Americans, and Hispanics have more severe 
        arthritis and functional limitations. These same individuals 
        are more likely to be obese and diabetic, and have a higher 
        incidence of heart diseases.
            (7) Arthritis costs $304,000,000,000 a year, including 
        $140,000,000,000 in direct costs (medical) and $164,000,000,000 
        in indirect costs (lost earnings).
            (8) Obesity and other chronic health conditions exacerbate 
        the debilitating impact of arthritis, leading to inactivity, 
        loss of independence, and a perpetual cycle of comorbid chronic 
        conditions.
            (9) Sixty-one percent of arthritis sufferers are women, and 
        women represent 64 percent of an estimated 43,000,000 annual 
        visits to physicians' offices and outpatient clinics where 
        arthritis was the primary diagnosis. Women also represented 60 
        percent of approximately 1,000,000 hospitalizations that 
        occurred in 2003 for which arthritis was the primary diagnosis.
            (10) Women ages 65 and older have up to 2\1/2\ times more 
        disabilities than men of the same age. Higher rates of obesity 
        and arthritis among this group explained up to 48 percent of 
        the gender gap in disability, above all other common chronic 
        health conditions.
            (11) The primary indication for total knee arthroplasty 
        (referred to in this section as ``TKA''), also known as knee 
        replacement, is relief of significant, disabling pain caused by 
        severe arthritis.
            (12) Knee replacement is surgery for people with severe 
        knee damage. Knee replacement can relieve pain and allow an 
        individual to be more active. The process for a total knee 
        replacement involves the surgeon removing damaged cartilage and 
        bone from the surface of the knee joint and replacing the 
        cartilage and bone with a man-made surface of metal and 
        plastic. In a partial knee replacement, the surgeon only 
        replaces part of the knee joint.
            (13) Total hip replacement, also called total hip 
        arthroplasty (referred to in this section as ``THA''), is used 
        if hip pain interferes with daily activities and more 
        conservative treatments have not helped. Arthritis damage is 
        the most common reason to need hip replacement.
            (14) The odds of a family practice physician recommending 
        TKA to a male patient with moderate arthritis are twice that of 
        a female patient, while the odds of an orthopedic surgeon 
        recommending TKA to a male patient with moderate arthritis are 
        22 times that of a female patient.
            (15) Black Americans with doctor-diagnosed arthritis have a 
        higher prevalence of severe pain attributable to arthritis, 
        compared with White Americans (34.0 percent versus 22.6 
        percent). Black Americans, compared to White Americans, report 
        a higher proportion of work limitations (39.5 percent versus 
        28.0 percent) and a higher prevalence of arthritis-attributable 
        work limitation (6.6 percent versus 4.6 percent).
            (16) Hispanics are 50 percent more likely than non-Hispanic 
        Whites to report needing assistance with at least one 
        instrumental activity of daily living and to have difficulty 
        walking.
            (17) Black Americans and Hispanics were 1.3 times more 
        likely to have activity limitation, 1.6 times more likely to 
        have work limitations, and 1.9 times more likely to have severe 
        joint pain than Whites.
            (18) In 2003, the National Academy of Medicine reported 
        that the rates of TKA and THA among Black American and Hispanic 
        patients are significantly lower than for Whites--even for 
        those with equitable health care coverage such as through 
        Medicare or the Department of Veterans Affairs.
            (19) According to the Centers for Disease Control and 
        Prevention, in 2000, Black American Medicare enrollees were 37 
        percent less likely than White Medicare enrollees to undergo 
        total knee replacements. In 2006, the disparity increased to 39 
        percent.
            (20) Even after adjusting for insurance and health access, 
        Hispanics and Black Americans are almost 50 percent less likely 
        to undergo total knee replacement than Whites.

SEC. 7402. OSTEOARTHRITIS AND OTHER MUSCULOSKELETAL HEALTH-RELATED 
              ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    (a) Education and Awareness Activities.--The Secretary of Health 
and Human Services, acting through the Director of the Centers for 
Disease Control and Prevention, shall direct the National Center for 
Chronic Disease Prevention and Health Promotion to conduct and expand 
the Health Community Program and Arthritis Program to educate the 
public on--
            (1) the causes of, preventive health actions for, and 
        effects of arthritis, lupus, and other musculoskeletal 
        conditions in minority patient populations; and
            (2) the effects of such conditions on other comorbidities 
        including obesity, hypertension, and cardiovascular disease.
    (b) Programs on Arthritis and Musculoskeletal Conditions.--
Education and awareness programs of the Centers for Disease Control and 
Prevention on arthritis and other musculoskeletal conditions in 
minority communities shall--
            (1) be culturally and linguistically appropriate to 
        minority patients, targeting musculoskeletal health promotion 
        and prevention programs of each major ethnic group, including--
                    (A) Native Americans and Alaska Natives;
                    (B) Asian Americans;
                    (C) African Americans and Blacks;
                    (D) Hispanic and Latino Americans; and
                    (E) Native Hawaiians and Pacific Islanders; and
            (2) include public awareness campaigns directed toward 
        these patient populations that emphasize the importance of 
        musculoskeletal health, physical activity, diet and healthy 
        lifestyle, and weight reduction for overweight and obese 
        patients.
    (c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as are necessary for 
fiscal year 2023 and each subsequent fiscal year.

SEC. 7403. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS AND MUSCULOSKELETAL 
              DISEASE HEALTH EDUCATION WITHIN HEALTH PROFESSIONS 
              SCHOOLS.

    (a) Program Authorized.--The Secretary of Health and Human Services 
(in this section referred to as the ``Secretary''), in coordination 
with the Secretary of Education, shall award grants, on a competitive 
basis, to academic health science centers, health professions schools, 
and institutions of higher education to enable such centers, schools, 
and institutions to provide people with comprehensive education on 
arthritis and musculoskeletal health, particularly--
            (1) obesity-related musculoskeletal diseases;
            (2) arthritis and osteoarthritis;
            (3) arthritis and musculoskeletal health disparities; and
            (4) the relationship between arthritis and musculoskeletal 
        diseases and metabolic activity, psychological health, and 
        comorbidities such as diabetes, cardiovascular disease, lupus, 
        and hypertension.
    (b) Duration.--Grants awarded under this section shall be for a 
period of 5 years.
    (c) Applications.--An academic health science center, health 
professions school, or institution of higher education seeking a grant 
under this section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    (d) Priority.--In awarding grants under this section, the Secretary 
shall give priority to an institution of higher education that--
            (1) has an enrollment of needy students, as defined in 
        section 318(b) of the Higher Education Act of 1965 (20 U.S.C. 
        1059e(b));
            (2) is a Hispanic-serving institution, as defined in 
        section 502(a) of such Act (20 U.S.C. 1101a(a));
            (3) is a Tribal College or University, as defined in 
        section 316(b) of such Act (20 U.S.C. 1059c(b));
            (4) is an Alaska Native-serving institution, as defined in 
        section 317(b) of such Act (20 U.S.C. 1059d(b));
            (5) is a Native Hawaiian-serving institution, as defined in 
        section 317(b) of such Act (20 U.S.C. 1059d(b));
            (6) is a Predominately Black Institution, as defined in 
        section 318(b) of such Act (20 U.S.C. 1059e(b));
            (7) is a Native American-serving, non-Tribal institution, 
        as defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
            (8) is an Asian American and Native American Pacific 
        Islander-serving institution, as defined in section 320(b) of 
        such Act (20 U.S.C. 1059g(b)); or
            (9) is a minority institution, as defined in section 365 of 
        such Act (20 U.S.C. 1067k), with an enrollment of needy 
        students, as defined in section 312 of such Act (20 U.S.C. 
        1058).
    (e) Uses of Funds.--An academic health science center, health 
professions school, or institution of higher education receiving a 
grant under this section may use grant funds to integrate issues 
relating to comprehensive arthritis and musculoskeletal health into the 
academic or support sectors of the center, school, or institution in 
order to reach a large number of students, by carrying out 1 or more of 
the following activities:
            (1) Developing educational content for issues relating to 
        comprehensive arthritis and musculoskeletal health education 
        that will be incorporated into first-year orientation or core 
        courses.
            (2) Creating innovative technology-based approaches to 
        deliver arthritis and musculoskeletal health education to 
        students, faculty, and staff.
            (3) Developing and employing peer-outreach and education 
        programs to generate discussion, educate, and raise awareness 
        among students about issues relating to arthritis and 
        musculoskeletal health disorders, and their relationship to 
        diabetes, hypertension, cardiovascular disease, psychological 
        health, and other comorbid conditions.
    (f) Report to Congress.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, and annually thereafter for a period 
        of 5 years, the Secretary shall prepare and submit to the 
        appropriate committees of Congress a report on the activities 
        to provide health professions students with comprehensive 
        arthritis and musculoskeletal health education funded under 
        this section.
            (2) Report elements.--The report described in paragraph (1) 
        shall include information about--
                    (A) the number of entities that are receiving grant 
                funds;
                    (B) the specific activities supported by grant 
                funds;
                    (C) the number of students served by grant 
                programs; and
                    (D) the status of program evaluations.
    (g) Definition of Institution of Higher Education.--In this 
section, the term ``institution of higher education'' has the meaning 
given such term in section 101(b) of the Higher Education Act of 1965 
(20 U.S.C. 1001(b)).

            Subtitle J--Sleep and Circadian Rhythm Disorders

SEC. 7451. SHORT TITLE; FINDINGS.

    (a) Short Title.--This subtitle may be cited as the ``Sleep and 
Circadian Rhythm Disorders Health Disparities Act''.
    (b) Findings.--Congress finds the following:
            (1) Decrements in sleep health such as sleep apnea, 
        insufficient sleep time, and insomnia, affect 50,000,000 to 
        70,000,000 adults in the United States. An estimated 25,000,000 
        adults in the United States have sleep apnea, a chronic 
        disorder characterized by one or more pauses in breathing which 
        can last from a few seconds to minutes. They may occur 30 times 
        or more an hour, disrupting sleep and resulting in excessive 
        daytime sleepiness and loss in productivity.
            (2) Seventy percent of high school students are not getting 
        enough sleep on school nights, while 35 percent of people in 
        the United States get fewer than 7 hours of sleep per night, 
        and roughly 1,550 fatal motor vehicle crashes are caused by 
        drowsy drivers.
            (3) Insufficient sleep and insomnia are more prevalent in 
        women. Women who are pregnant and have sleep apnea are at an 
        increased risk of cardiovascular complications during 
        pregnancy. The impact of disparities in sleep health is 
        associated with a growing number of health problems, including 
        the following:
                    (A) Hypertension.
                    (B) Cancer.
                    (C) Stroke.
                    (D) Cardiac arrhythmia.
                    (E) Chronic heart failure and heart disease.
                    (F) Diabetes.
                    (G) Cognitive functioning and behavior.
                    (H) Depression and bipolar disorder.
                    (I) Substance abuse.
            (4) A sleep disparity exists in that poor sleep quality is 
        strongly associated with poverty, race, and social determinants 
        of health. Factors such as employment, education, and health 
        status, amongst others, significantly mediated this effect only 
        in poor subjects, suggesting a differential vulnerability to 
        these factors in poor relative to nonpoor individuals in the 
        context of sleep quality.
            (5) Black Americans sleep worse than White Americans. Black 
        Americans take longer to fall asleep, report poorer sleep 
        quality, have more light and less deep sleep, and nap more 
        often and longer.
            (6) Black Americans and individuals in lower socioeconomic 
        status groups may be at an increased risk for sleep 
        disturbances and associated health consequences.
            (7) Among young Black Americans, the likelihood of having 
        sleep disordered breathing and exhibiting risk factors for poor 
        sleep is twice that in young White Americans. Frequent snoring 
        is more common among Black American and Hispanic women and 
        Hispanic men compared to non-Hispanic White Americans, 
        independent of other factors including obesity.
            (8) Black Americans with sleep-disordered breathing develop 
        symptoms at a younger age than Caucasians but appear less 
        likely to be diagnosed and treated in a timely manner. This 
        delay may at least in part be due to reduced access to care.
            (9) Sleep loss contributes to increased risk for chronic 
        conditions such as obesity, diabetes, and hypertension, all of 
        which have increased prevalence in underserved, 
        underrepresented minorities. Racial and ethnic disparities 
        related to obesity may also contribute to disparities in health 
        outcomes related to sleep-disordered breathing.
            (10) Underrepresented minorities in the United States 
        report an insomnia rate of 12.9 percent compared to only 6.6 
        percent for White Americans.
            (11) Black women have a higher incidence of insomnia than 
        Black men, perhaps related in part to higher risk for chronic 
        persisting symptoms.

SEC. 7452. SLEEP AND CIRCADIAN RHYTHM DISORDERS RESEARCH ACTIVITIES OF 
              THE NATIONAL INSTITUTES OF HEALTH.

    (a) In General.--The Director of the National Institutes of Health, 
acting through the Director of the National Heart, Lung, and Blood 
Institute, shall--
            (1) continue to expand research activities addressing sleep 
        health disparities; and
            (2) continue implementation of the NIH Sleep Disorders 
        Research Plan across all institutes and centers of the National 
        Institutes of Health to improve treatment and prevention of 
        sleep health disparities.
    (b) Required Research Activities.--In conducting or supporting 
research relating to sleep and circadian rhythm, the Director of the 
National Heart, Lung, and Blood Institute shall--
            (1) advance epidemiology and clinical research to achieve a 
        more complete understanding of disparities in domains of sleep 
        health and across population subgroups for which cardiovascular 
        and metabolic health disparities exist, including--
                    (A) prevalence and severity of sleep apnea;
                    (B) habitual sleep duration;
                    (C) sleep timing and regularity; and
                    (D) insomnia;
            (2) develop study designs and analytical approaches to 
        explain and predict multilevel and life-course determinants of 
        sleep health and to elucidate the sleep-related causes of 
        cardiovascular and metabolic health disparities across the age 
        spectrum, including such determinants and causes that are--
                    (A) environmental;
                    (B) biological or genetic;
                    (C) psychosocial;
                    (D) societal;
                    (E) political; or
                    (F) economic;
            (3) determine the contribution of sleep impairments such as 
        sleep apnea, insufficient sleep duration, irregular sleep 
        schedules, and insomnia to unexplained disparities in 
        cardiovascular and metabolic risk and disease outcomes;
            (4) develop study designs, data sampling and collection 
        tools, and analytical approaches to optimize understanding of 
        mediating and moderating factors, and feedback mechanisms 
        coupling sleep to cardiovascular and metabolic health 
        disparities;
            (5) advance research to understand cultural and linguistic 
        barriers (on the person, provider, or system level) to access 
        to care, medical diagnosis, and treatment of sleep disorders in 
        diverse population groups;
            (6) develop and test multilevel interventions (including 
        sleep health education in diverse communities) to reduce 
        disparities in sleep health that will impact ability to improve 
        disparities in cardiovascular and metabolic risk or disease;
            (7) create opportunities to integrate sleep and health 
        disparity science by strategically utilizing resources 
        (existing or anticipated cohorts), exchanging scientific data 
        and ideas (cross-over into scientific meetings), and develop 
        multidisciplinary investigator-initiated grant applications; 
        and
            (8) enhance the diversity and foster career development of 
        young investigators involved in sleep and health disparities 
        science.
    (c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal year 2023 and each subsequent fiscal year.

SEC. 7453. SLEEP AND CIRCADIAN RHYTHM HEALTH DISPARITIES-RELATED 
              ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention shall conduct, support, and expand public health 
strategies and prevention, diagnosis, surveillance, and public and 
professional awareness activities regarding sleep and circadian rhythm 
disorders.
    (b) Findings.--Congress finds as follows:
            (1) Sleep disorders and sleep deficiency unrelated to a 
        primary sleep disorder are underdiagnosed and are increasingly 
        detrimental to health status.
            (2) The consequences to society include additional 
        diseases, motor vehicle accidents, decreased longevity, 
        elevated direct medical costs, and indirect costs related to 
        work absenteeism and property damage.
    (c) Required Surveillance and Education Awareness Activities.--In 
conducting or supporting research relating to sleep and circadian 
rhythm disorders surveillance and education awareness activities, the 
Director of the Centers for Disease Control and Prevention shall--
            (1) ensure that such activities are culturally and 
        linguistically appropriate to minority patients, targeting 
        sleep and circadian rhythm health promotion and prevention 
        programs of each major ethnic group, including--
                    (A) Native Americans and Alaska Natives;
                    (B) Asian Americans;
                    (C) African Americans and Blacks;
                    (D) Hispanic and Latino-Americans; and
                    (E) Native Hawaiians and Pacific Islanders;
            (2) collect and compile national and State surveillance 
        data on sleep disorders health disparities;
            (3) continue to develop and implement new sleep questions 
        in public health surveillance systems to increase public 
        awareness of sleep health and sleep disorders and their impact 
        on health;
            (4) publish monthly reports highlighting geographic, 
        racial, and ethnic disparities in sleep health, as well as 
        relationships between insufficient sleep and chronic disease, 
        health risk behaviors, and other outcomes as determined 
        necessary by the Director; and
            (5) include public awareness campaigns that inform patient 
        populations from major ethnic groups about the prevalence of 
        sleep and circadian rhythm disorders and emphasize the 
        importance of sleep health.
    (d) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated such sums as may be necessary 
for fiscal year 2023 and each subsequent fiscal year.

SEC. 7454. GRANTS FOR COMPREHENSIVE SLEEP AND CIRCADIAN HEALTH 
              EDUCATION WITHIN HEALTH PROFESSIONS SCHOOLS.

    (a) Program Authorized.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in coordination 
with the Secretary of Education, shall award grants, on a competitive 
basis, to academic health science centers, health professions schools, 
and institutions of higher education to enable such centers, schools, 
and institutions to provide people with comprehensive education on 
sleep and circadian health, particularly--
            (1) poor sleep health;
            (2) sleep disorders;
            (3) sleep health disparities; and
            (4) the relationship between sleep and circadian health on 
        metabolic activity, neurological activity, comorbidities, and 
        other diseases.
    (b) Duration.--Grants awarded under this section shall be for a 
period of 5 years.
    (c) Applications.--An academic health science center, health 
professions school, or institution of higher education seeking a grant 
under this section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    (d) Priority.--In awarding grants under this section, the Secretary 
shall give priority to an institution of higher education that--
            (1) has an enrollment of needy students, as defined in 
        section 318(b) of the Higher Education Act of 1965 (20 U.S.C. 
        1059e(b));
            (2) is a Hispanic-serving institution, as defined in 
        section 502(a) of such Act (20 U.S.C. 1101a(a));
            (3) is a Tribal College or University, as defined in 
        section 316(b) of such Act (20 U.S.C. 1059c(b));
            (4) is an Alaska Native-serving institution, as defined in 
        section 317(b) of such Act (20 U.S.C. 1059d(b));
            (5) is a Native Hawaiian-serving institution, as defined in 
        section 317(b) of such Act (20 U.S.C. 1059d(b));
            (6) is a Predominately Black Institution, as defined in 
        section 318(b) of such Act (20 U.S.C. 1059e(b));
            (7) is a Native American-serving, nontribal institution, as 
        defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
            (8) is an Asian American and Native American Pacific 
        Islander-serving institution, as defined in section 320(b) of 
        such Act (20 U.S.C. 1059g(b)); or
            (9) is a minority institution, as defined in section 365 of 
        such Act (20 U.S.C. 1067k), with an enrollment of needy 
        students, as defined in section 312 of such Act (20 U.S.C. 
        1058).
    (e) Uses of Funds.--An academic health science center, health 
professions school, or institution of higher education receiving a 
grant under this section may use the grant funds to integrate issues 
relating to comprehensive sleep and circadian health into the academic 
or support sectors of the center, school, or institution, in order to 
reach a large number of students, by carrying out 1 or more of the 
following activities:
            (1) Developing educational content for issues relating to 
        comprehensive sleep and circadian health education that will be 
        incorporated into first-year orientation or core courses.
            (2) Creating innovative technology-based approaches to 
        deliver sleep health education to students, faculty, and staff.
            (3) Developing and employing peer-outreach and education 
        programs to generate discussion, educate, and raise awareness 
        among students about issues relating to poor quality sleep, 
        sleep and circadian disorders, and the role sleep health plays 
        in other diseases and comorbidities.
    (f) Report to Congress.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, and annually thereafter for a period 
        of 5 years, the Secretary shall prepare and submit to the 
        appropriate committees of Congress a report on the activities 
        to provide health professions students with comprehensive sleep 
        and circadian health education funded under this section.
            (2) Report elements.--The report described in paragraph (1) 
        shall include information about--
                    (A) the number of entities that are receiving grant 
                funds;
                    (B) the specific activities supported by grant 
                funds;
                    (C) the number of students served by grant 
                programs; and
                    (D) the status of program evaluations.
    (g) Definition of Institution of Higher Education.--In this 
section, the term ``institution of higher education'' has the meaning 
given such term in section 101(b) of the Higher Education Act of 1965 
(20 U.S.C. 1001(b)).

SEC. 7455. REPORT ON IMPACT OF SLEEP AND CIRCADIAN HEALTH DISORDERS IN 
              VULNERABLE AND RACIAL/ETHNIC POPULATIONS.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
Congress and the President a report on the impact of sleep and 
circadian health disorders for racial and ethnic minority communities 
and other vulnerable populations.
    (b) Contents.--The report under subsection (a) shall include 
information on the--
            (1) progress that has been made in reducing the impact of 
        sleep and circadian health disorders in such communities and 
        populations;
            (2) opportunities that exist to make additional progress in 
        reducing the impact of sleep and circadian health disorders in 
        such communities and populations;
            (3) challenges that may impede such additional progress; 
        and
            (4) Federal funding necessary to achieve substantial 
        reductions in sleep and circadian health disorders in racial 
        and ethnic minority communities.

  Subtitle K--Kidney Disease Research, Surveillance, Prevention, and 
                               Treatment

SEC. 7501. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, PREVENTION, AND 
              TREATMENT.

    (a) Short Title.--This section may be cited as the ``Kidney Disease 
Research, Surveillance, Prevention and Treatment Improvement Act of 
2022''.
    (b) Findings.--Congress makes the following findings:
            (1) Kidney diseases impact 37,000,000 individuals in the 
        United States.
            (2) Black Americans comprise just 13 percent of the United 
        States population, but 33 percent of the United States dialysis 
        patient population. Compared to White Americans, kidney failure 
        prevalence is about 3.7 times greater in Black Americans, 1.4 
        times greater in Native Americans, and 1.5 times greater in 
        Asian Americans.
            (3) Peritoneal dialysis and home hemodialysis use is 40-50 
        percent lower among Black Americans and Hispanics.
            (4) Every racial and ethnic minority group in the United 
        States is significantly less likely to be treated with home 
        dialysis than Whites, and demographic and clinical 
        characteristics are insufficient to explain this differential 
        use.
            (5) Black Americans on dialysis, irrespective of dialysis 
        modality, and Hispanics undergoing PD or in-center HD, are 
        significantly less likely than their White counterparts to 
        receive a kidney transplant.
            (6) Black Americans, Hispanics, and Asian Americans are 
        less likely to receive living donor kidney transplants than 
        Whites. Efforts to reduce disparities in live donor kidney 
        transplantation for Black American, Hispanic, and Asian 
        patients with kidney failure have been largely unsuccessful.
            (7) Medicare and Medicaid patients are less likely to 
        receive a preemptive transplant from a deceased donor compared 
        to private insurance patients (5 percent and 11 percent versus 
        24 percent), and Black and Hispanic patients are less likely to 
        receive a preemptive transplant from a deceased donor compared 
        with White patients even after changes to the kidney allocation 
        system (5 percent of Black patients and 5 percent of Hispanic 
        patients compared with 18 percent of White patients).
            (8) Low-income populations are significantly more likely to 
        progress to kidney failure.
            (9) Low socioeconomic status is associated with increased 
        incidence of chronic kidney disease, progression to kidney 
        failure, inadequate dialysis treatment, and reduced access to 
        kidney transplantation.
            (10) The 3 goals of Executive Order 13879 of July 10, 2019 
        (84 Fed. Reg. 33817; relating to Advancing American Kidney 
        Health), recognize the need for more transplants, better 
        prevention and education, and improved access to treatment 
        modalities.

SEC. 7502. KIDNEY DISEASE RESEARCH IN MINORITY POPULATIONS.

    (a) In General.--
            (1) Research and training centers.--Section 431(c)(3) of 
        the Public Health Service Act (42 U.S.C. 285c-5(c)(3)) is 
        amended--
                    (A) in subparagraph (B), by striking ``and'' at the 
                end;
                    (B) in subparagraph (C), by striking ``and'' at the 
                end; and
                    (C) by adding at the end the following:
                    ``(D) improving data science through improvement in 
                bioinformatics, data integration, and data sharing;
                    ``(E) defining the chronic kidney disease mechanism 
                and identifying new therapeutic targets for chronic 
                kidney disease using specific tools, including mapping 
                the genetic architecture of kidney function and disease 
                and translating genetic maps to disease-causing genes 
                and mechanisms, especially among minority populations;
                    ``(F) improving models of human disease including 
                better humanized animal models, improved 
                reproducibility, and functional characterization of 
                kidney organoids, and accelerating the development of 
                in vivo imaging technologies; and
                    ``(G) developing cell-specific drug delivery 
                systems and gene editing, including targeted systems 
                for the delivery of therapeutic compounds to specific 
                kidney compartments or cell types and accelerating the 
                implementation of gene editing and gene therapy for the 
                treatment of kidney diseases in vivo; and''.
            (2) Inclusion of minority participants.--In conducting and 
        supporting research described in the amendment made by 
        subsection (a), the Director of the National Institutes of 
        Health shall work with the Director of the National Institute 
        on Minority Health and Health Disparities to improve the number 
        of minority participants as study subjects in clinical trials. 
        Such work may include--
                    (A) developing and sustaining clinical trial 
                consortia that can recruit patients with chronic kidney 
                disease to ensure adequate capacity for assessment of 
                kidney outcomes and increase the enrollment of 
                underrepresented populations;
                    (B) encouraging the use of novel designs in 
                clinical trials to enhance the recruitment and 
                retention of underrepresented populations which will 
                enhance the generalizability of study findings;
                    (C) supporting outreach initiatives that 
                incorporate acknowledgment of both historical and 
                current grounds for participation reluctance, and that 
                prioritize demonstrating trustworthiness, in order to 
                enhance the ability to promote and effectively convey 
                the benefits of clinical research participation;
                    (D) completing clinical trials that test 
                interventions to improve patient quality of life and 
                address patient-reported outcomes; and
                    (E) encouraging inclusion of persons with chronic 
                kidney disease in clinical trials of treatments for 
                nonkidney diseases.
    (b) Report; Comprehensive Plan.--Section 429 of the Public Health 
Services Act (42 U.S.C. 285c-3) is amended by adding at the end the 
following:
    ``(c) Report by Kidney, Urologic, and Hematologic Diseases 
Coordinating Committee.--
            ``(1) In general.--The Kidney, Urologic, and Hematologic 
        Diseases Coordinating Committee, in coordination with the 
        Chronic Kidney Disease Initiative at the Centers for Disease 
        Control and Prevention, shall--
                    ``(A) prepare and submit to the Congress, not later 
                than 6 months after the date of enactment of this 
                subsection, a report on Federal research and public 
                health activities with respect to kidney disease in 
                minority populations; and
                    ``(B) develop and submit to the Congress, the 
                Secretary, the Director of the National Institutes of 
                Health, and the Advisory Board established under 
                section 430 for the diseases for which the Committee 
                was established, not later than 1 year after the date 
                of enactment of this subsection, an effective and 
                comprehensive Federal plan (including all appropriate 
                Federal health programs) to address kidney disease in 
                minority populations.
            ``(2) Contents.--The report under paragraph (1)(A) shall at 
        minimum address each of the following:
                    ``(A) Research on kidney disease in minority 
                populations, including such research on--
                            ``(i) genetic, behavioral, and 
                        environmental factors;
                            ``(ii) prevention and complications among 
                        individuals within these populations who have 
                        already developed kidney disease;
                            ``(iii) the delivery of evidenced-based 
                        care for all chronic kidney disease stages, 
                        especially in underrepresented and underserved 
                        populations;
                            ``(iv) expanding support for a root-cause 
                        analysis approach to disparities, including 
                        causes, detection, and management of chronic 
                        kidney disease for underserved populations;
                            ``(v) developing research teams that engage 
                        with community organizations to develop and 
                        implement interventions which halt or delay 
                        development and progression of chronic kidney 
                        disease; and
                            ``(vi) continued support of observational 
                        studies of kidney disease measures and 
                        outcomes.
                    ``(B) Surveillance and data collection on kidney 
                disease in minority populations, including with respect 
                to--
                            ``(i) efforts to better determine the 
                        prevalence of kidney disease among Asian-
                        American and Pacific Islander subgroups; and
                            ``(ii) efforts to coordinate data 
                        collection on the American Indian population.
                    ``(C) Community-based interventions to address 
                kidney disease targeting minority populations, 
                including--
                            ``(i) the evidence bases for such 
                        interventions;
                            ``(ii) the cultural appropriateness of such 
                        interventions; and
                            ``(iii) efforts to educate the public on 
                        the causes and consequences of kidney disease.
                    ``(D) Education and training programs for health 
                professionals (including community health workers) on 
                the prevention and management of kidney disease and its 
                related complications that are supported by the Health 
                Resources and Services Administration, including such 
                programs supported by the Bureau of Health Workforce, 
                the Bureau of Primary Health Care, and the Healthcare 
                Systems Bureau. This should include--
                            ``(i) identification of effective 
                        strategies to increase implementation of proven 
                        therapies to slow chronic kidney disease 
                        incidence and progression, especially in high-
                        risk underrepresented populations; and
                            ``(ii) identification of effective practice 
                        improvement strategies in large and small 
                        health systems to reduce chronic kidney disease 
                        incidence and progression.''.

SEC. 7503. KIDNEY DISEASE ACTION PLAN.

    (a) In General.--The Director of the Centers for Disease Control 
and Prevention shall conduct, support, and expand public health 
strategies, prevention, diagnosis, surveillance, and public and 
professional awareness activities regarding kidney disease.
    (b) National Action Plan.--
            (1) Development.--Pursuant to section 464z-3 of the Public 
        Health Service Act (42 U.S.C. 285t), not later than 2 years 
        after the date of the enactment of this Act, the Director of 
        the National Institute of Diabetes and Digestive and Kidney 
        Diseases, in consultation with the Director of the National 
        Institute on Minority Health and Health Disparities and the 
        Director of the Centers for Disease Control and Prevention, 
        shall develop a national action plan to address kidney disease 
        in the United States with participation from patients, 
        caregivers, health professionals, patient advocacy 
        organizations, researchers, providers, public health 
        professionals, and other stakeholders.
            (2) Contents.--At a minimum, such plan shall include 
        recommendations for--
                    (A) public health interventions for the purpose of 
                implementation of the national plan;
                    (B) biomedical, health services, and public health 
                research on kidney disease; and
                    (C) inclusion of kidney disease in the health data 
                collections of all Federal agencies.
    (c) Kidney Disease Prevention Programs.--The Director of the 
Centers for Disease Control and Prevention, through the Chronic Kidney 
Disease Initiative, shall carry out the following:
            (1) Conduct public education and awareness activities with 
        patient and professional organizations to stimulate earlier 
        diagnosis and improve patient outcomes from treatment of kidney 
        disease. To the extent known and relevant, such public 
        education and awareness activities shall reflect differences in 
        kidney disease by cause (such as hypertension, diabetes, lupus 
        nephritis, COVID-19, and polycystic kidney disease) and include 
        a focus on outreach to undiagnosed and, as appropriate, 
        minority populations.
            (2) Supplement and expand upon the activities of the 
        Centers for Disease Control and Prevention by making grants to 
        nonprofit organizations, State and local jurisdictions, and 
        Indian Tribes for the purpose of reducing the burden of kidney 
        disease, especially in disproportionately impacted communities, 
        through public health interventions and related activities.
            (3) Coordinate with the National Institute of Diabetes and 
        Digestive and Kidney Diseases, the Indian Health Service, the 
        Health Resources and Services Administration, and the 
        Department of Veterans Affairs to develop pilot programs to 
        demonstrate best practices for the diagnosis and management of 
        kidney disease.
            (4) Develop improved techniques and identify best 
        practices, in coordination with the Secretary of Veterans 
        Affairs, for assisting kidney disease patients.
    (d) Data Collection.--Not later than 180 days after the date of 
enactment of this Act, the Director of the National Institute of 
Diabetes and Digestive and Kidney Diseases and the Director of the 
Centers for Disease Control and Prevention, acting jointly, shall 
assess the depth and quality of information on kidney disease that is 
collected in surveys and population studies conducted by the Centers 
for Disease Control and Prevention, including whether there are 
additional opportunities for information to be collected in the 
National Health and Nutrition Examination Survey, the National Health 
Interview Survey, and the Behavioral Risk Factor Surveillance System 
surveys. The Director of the National Institute of Diabetes and 
Digestive and Kidney Diseases shall include the results of such 
assessment in the national action plan under subsection (b).
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $1,000,000 for fiscal year 2023, 
$1,000,000 for fiscal year 2024, $1,000,000 for fiscal year 2025, 
$1,000,000 for fiscal year 2026, and $1,000,000 for fiscal year 2027.

SEC. 7504. HOME DIALYSIS AND INCREASING END-STAGE RENAL DISEASE 
              TREATMENT MODALITIES IN MINORITY COMMUNITIES ACTION PLAN.

    (a) In General.--Section 1881(b)(14) of the Social Security Act (42 
U.S.C. 1395rr(b)(14)) is amended by adding at the end the following new 
subparagraph:
            ``(J)(i) For services furnished on or after the date which 
        is 1 year after the date of the enactment of this subparagraph 
        which are staff-assisted home dialysis (as defined in clause 
        (iv)(III)), the Secretary shall increase the single payment 
        that would otherwise apply under this paragraph for renal 
        dialysis services furnished to new and respite individuals in 
        accordance with the payment system established under clause 
        (iii) by qualified providers.
            ``(ii)(I) Subject to subclause (II), staff-assisted home 
        dialysis may only be furnished during--
                    ``(aa) with respect to an individual described in 
                subclause (iv)(I)(aa), one 90-day period which may be 
                renewed up to two 30-day periods; and
                    ``(bb) with respect to an individual described in 
                subclause (iv)(I)(bb) and notwithstanding whether such 
                an individual receives any respite care under part A, 
                any 30-day period.
            ``(II) Notwithstanding the limits described in subclause 
        (I), staff-assisted home dialysis may be furnished for as long 
        as the Secretary determines appropriate to an individual who--
                    ``(aa) is blind;
                    ``(bb) has a cognitive or neurological impairment 
                (including a stroke, Alzheimer's, dementia, amyotrophic 
                lateral sclerosis, or any other impairment determined 
                by the Secretary); or
                    ``(cc) has any other illness or injury that reduces 
                mobility (including cerebral palsy, spinal cord 
                injuries, or any other illness or injury determined by 
                the Secretary).
            ``(iii) The Secretary shall establish an add-on to the 
        single payment under this paragraph through regulations to 
        determine the amounts payable to qualified providers for staff-
        assisted home dialysis. In establishing such system add-on 
        payment, the Secretary may consider--
                    ``(I) the costs of furnishing staff-assisted home 
                dialysis;
                    ``(II) consultations with dialysis providers, 
                dialysis patients, private payers, and Medicare 
                Advantage plans;
                    ``(III) payment amounts for similar items and 
                services under parts A and B; and
                    ``(IV) payment amounts established by Medicare 
                Advantage plans under part C, group health plans, and 
                health insurance coverage offered by health insurance 
                issuers.
            ``(iv) In this subparagraph:
                    ``(I) The term `new and respite individual' means 
                an individual described in subsection (a) who is--
                            ``(aa) initiating either peritoneal or home 
                        hemodialysis;
                            ``(bb) receiving home dialysis and is 
                        unable to self-dialyze due to illness, injury, 
                        caregiver issues, or other temporary 
                        circumstances; or
                            ``(cc) returning to home dialysis after a 
                        period of hospitalization.
                    ``(II) The term `qualified provider' means a 
                trained professional (as determined by the Secretary, 
                including nurses and certified patient technicians) who 
                furnishes renal dialysis services and--
                            ``(aa) meets requirements (as determined by 
                        the Secretary) that ensures competency in 
                        patient care and modality usage; and
                            ``(bb) provides in-person assistance to a 
                        patient for an appropriate number of dialysis 
                        sessions (as determined by the Secretary) at 
                        least 75 percent of staff-assisted home 
                        dialysis sessions during a period described in 
                        clause (ii)(I).
                    ``(III)(aa) The term `staff-assisted home dialysis' 
                means home dialysis using trained professionals to 
                assist individuals who have been determined to have end 
                stage renal disease, and the frequency of such home 
                dialysis is determined by such professionals in 
                coordination with the patient and his or her care 
                partner, and outlined in a patient plan of care.
                    ``(bb) The term `care partner' means anyone who is 
                designated by the patient who assists the individual 
                with the furnishing of home dialysis.
                    ``(cc) The term `patient plan of care' has the 
                meaning given such term in section 494.90 of title 42, 
                Code of Federal Regulations.''.
    (b) Patient Education and Training Relating to Staff-Assisted Home 
Dialysis.--Section 1881(b)(5) of the Social Security Act (42 U.S.C. 
1395rr(b)(5)) is amended--
            (1) in subparagraph (C), by striking at the end ``and'';
            (2) in subparagraph (D), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
                    ``(E) educate patients of the opportunity to 
                receive staff-assisted home dialysis (as defined in 
                paragraph (14)(J)(iv)(III)) during the period beginning 
                30 days after the first day such facility furnishes 
                renal dialysis services to an individual and ending 60 
                days after such day; and
                    ``(F) provide for nurses, certified patient 
                technicians, social workers and or other professionals 
                to train patients and their care partners in skills and 
                procedures needed to perform home dialysis (as defined 
                in paragraph (14)(J)(iv)(III)) treatment--
                            ``(i) regularly and independently;
                            ``(ii) through telehealth services or 
                        through group training (as described in the 
                        interpretive guidance relating to tag number 
                        V590 of `Advance Copy-End Stage Renal Disease 
                        (ESRD) Program Interpretive Guidance Version 
                        1.1' (published on October 3, 2008)) in 
                        accordance with the Federal regulations 
                        (concerning the privacy of individually 
                        identifiable health information) promulgated 
                        under section 264(c) of the Health Insurance 
                        Portability and Accountability Act of 1996; and
                            ``(iii) in the home or residence of a 
                        patient, in a dialysis facility, or in the 
                        place in which the patient intends to receive 
                        staff-assisted home dialysis.''.
    (c) National Action Plan.--
            (1) Development.--Not later than 2 years after the date of 
        the enactment of this Act, the Director of the National 
        Institute of Diabetes and Digestive and Kidney Diseases, in 
        consultation with the Director of the Centers for Disease 
        Control and Prevention, shall develop a national action plan to 
        increase the number of home dialyzers and choice in dialysis 
        treatment modality in the United States with participation from 
        patients, caregivers, health professionals, patient advocacy 
        organizations, researchers, providers, public health 
        professionals, and other stakeholders in minority communities.
            (2) Contents.--At a minimum, such plan shall include 
        recommendations for--
                    (A) public health officials for the purpose of 
                implementation of the national plan;
                    (B) biomedical, health services, and public health 
                research on home dialysis and modalities in minority 
                communities; and
                    (C) inclusion of dialysis location and modality in 
                the health data collections of all Federal agencies.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $1,000,000 for fiscal year 2023, 
$1,000,000 for fiscal year 2024, $1,000,000 for fiscal year 2025, 
$1,000,000 for fiscal year 2026, and $1,000,000 for fiscal year 2027.

SEC. 7505. INCREASING KIDNEY TRANSPLANTS IN MINORITY POPULATIONS.

    (a) In General.--The Director of the National Institutes of Health 
shall expand, intensify, and support ongoing research and other 
activities with respect to kidney transplants in minority populations.
    (b) CMS Data Collection and Reporting.--The Centers for Medicare & 
Medicaid Services shall collect and report annual data on dialysis 
facility and nephrologist performance on transplant referral, with an 
emphasis on data relating to patients of color.
    (c) OPTN Data Collection and Reporting.--The Organ Procurement and 
Transplantation Network shall collect and the Scientific Registry of 
Transplant Recipients report annual data, broken down by demographic 
and socioeconomic characteristics, on individual transplant center 
performance as it relates to patients referred, evaluated, waitlisted, 
and successfully transplanted.
    (d) Transplant Center Data.--Each organ transplant center shall 
report on the percent of appropriate waitlisted patients (including 
socioeconomic and demographic data) giving and receiving annual 
informed consent for offers for suboptimal kidneys (such as kidneys 
with a kidney donor profile index of greater than 85 percent or kidney 
age 50 with diabetes, or age greater than 60).
    (e) Organ Procurement Organization Data.--Each organ procurement 
organization shall report annual data on referrals, refusals (patient 
or doctor), and acceptance of organs by hospital, ZIP Code, race, 
ethnicity, and age strata except as prohibited by need for 
confidentiality.
    (f) Data Transparency for Patients.--Each organ transplant center 
shall provide to each patient of such center, on an annual basis--
            (1) the number of times an organ was offered to the 
        patient, declined, and transplanted into another patient from 
        organs within a 500-mile radius; and
            (2) the number of times an organ was offered to and 
        declined for the patient from a low risk donor which was 
        subsequently transplanted into another patient.
    (g) Improved Transplantation Education.--The Centers for Medicare & 
Medicaid Services shall certify a nonbiased, third-party organization 
to accredit organ transplant education.
    (h) Research.--Research under subsection (a) shall include 
investigation into--
            (1) the causes of lower rates of kidney transplants in 
        minority populations, including socioeconomic, geographic, 
        clinical, environmental, genetic, and other factors that may 
        contribute to lower rates of kidney transplants in minority 
        populations; and
            (2) possible interventions to increase kidney transplants.
    (i) Report; Comprehensive Plan.--
            (1) In general.--The Secretary of Health and Human Services 
        shall--
                    (A) prepare and submit to the Congress, not later 
                than 6 months after the date of enactment of this 
                section, a report on Federal research and public health 
                activities with respect to kidney transplants as a 
                treatment for end-stage renal disease in minority 
                populations; and
                    (B) develop and submit to the Congress, not later 
                than 1 year after the date of enactment of this 
                section, an effective and comprehensive Federal plan 
                (including all appropriate Federal health programs) to 
                increase the number of kidney transplants in minority 
                populations.
            (2) Contents.--The report under paragraph (1)(A) shall at a 
        minimum address each of the following:
                    (A) Research on kidney transplants in minority 
                populations, including such research on financial, 
                insurance coverage, genetic, behavioral, and 
                environmental factors.
                    (B) Surveillance and data collection on kidney 
                transplants in minority populations, including with 
                respect to--
                            (i) efforts to increase kidney transplants 
                        among Asian-American and Pacific Islander 
                        subgroups with end-stage renal disease; and
                            (ii) efforts to increase kidney transplants 
                        in the American Indian population.
                    (C) Community-based efforts to increase kidney 
                transplants targeting minority populations, including--
                            (i) the evidence base for such increases;
                            (ii) the cultural appropriateness of such 
                        increases; and
                            (iii) efforts to educate the public on 
                        kidney transplants.
                    (D) Education and training programs for health 
                professionals (including community health workers) on 
                the kidney transplants that are supported by the Health 
                Resources and Services Administration, including such 
                programs supported by the Bureau of Health Workforce, 
                the Bureau of Primary Health Care, and the Healthcare 
                Systems Bureau.

SEC. 7506. ENVIRONMENTAL AND OCCUPATIONAL HEALTH PROGRAMS.

    The Director of the Centers for Disease Control and Prevention 
shall--
            (1) support research into the environmental and 
        occupational causes and biological mechanisms that contribute 
        to kidney disease; and
            (2) develop and disseminate public health interventions 
        that will lessen the impact of environmental and occupational 
        causes of kidney disease.

SEC. 7507. UNDERSTANDING THE TREATMENT PATTERNS ASSOCIATED WITH 
              PROVIDING CARE AND TREATMENT OF KIDNEY FAILURE IN 
              MINORITY POPULATIONS.

    (a) Study.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct a study on 
treatment patterns associated with providing care, under the Medicare 
program under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 
et seq.), and through private health insurance, to minority populations 
that are disproportionately affected by kidney failure.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Secretary shall submit to Congress a report on the 
study conducted under subsection (a), together with such 
recommendations as the Secretary determines to be appropriate.

SEC. 7508. IMPROVING ACCESS IN UNDERSERVED AREAS.

    (a) Definition of Primary Care Services.--Section 331(a)(3)(D) of 
the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by 
inserting ``nephrology,'' after ``dentistry,''.
    (b) National Health Service Corps Scholarship Program.--Section 
338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is 
amended by inserting ``, which may include kidney health 
professionals'' before the period at the end.
    (c) National Health Service Corps Loan Repayment Program.--Section 
338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l-1(a)(2)) is 
amended by inserting ``, which may include kidney health 
professionals'' before the period at the end.

SEC. 7509. THE JACK REYNOLDS MEMORIAL MEDIGAP EXPANSION ACT; MEDIGAP 
              COVERAGE FOR BENEFICIARIES WITH END-STAGE RENAL DISEASE.

    (a) Guaranteed Availability of Medigap Policies to All ESRD 
Medicare Beneficiaries.--
            (1) In general.--Section 1882(s) of the Social Security Act 
        (42 U.S.C. 1395ss(s)) is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A), by striking ``is 
                        65'' and all that follows through the period at 
                        the end and inserting the following: ``is--
                    ``(i) 65 years of age or older and is enrolled for 
                benefits under part B; or
                    ``(ii) is entitled to benefits under 226A(b) and is 
                enrolled for benefits under part B.''; and
                            (ii) in subparagraph (D), in the matter 
                        preceding clause (i), by inserting ``(or is 
                        entitled to benefits under 226A(b))'' after 
                        ``is 65 years of age or older''; and
                    (B) in paragraph (3)(B)--
                            (i) in clause (ii), by inserting ``(or is 
                        entitled to benefits under 226A(b))'' after 
                        ``is 65 years of age or older''; and
                            (ii) in clause (vi), by inserting ``(or 
                        under 226A(b))'' after ``at age 65''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to Medicare supplemental policies effective on or 
        after January 1, 2023.
    (b) Additional Enrollment Period for Certain Individuals.--
            (1) One-time enrollment period.--
                    (A) In general.--In the case of an individual 
                described in paragraph (2), the Secretary of Health and 
                Human Services shall establish a one-time enrollment 
                period during which such an individual may enroll in 
                any Medicare supplemental policy under section 1882 of 
                the Social Security Act (42 U.S.C. 1395ss) of the 
                individual's choosing.
                    (B) Enrollment period.--The enrollment period 
                established under subparagraph (A) shall begin on 
                January 1, 2023, and shall end June 30, 2023.
            (2) Individual described.--An individual described in this 
        paragraph is an individual who--
                    (A) is entitled to hospital insurance benefits 
                under part A of title XVIII of the Social Security Act 
                under section 226A(b) of such Act (42 U.S.C. 426-1(b));
                    (B) is enrolled for benefits under part B of such 
                title XVIII; and
                    (C) would not, but for the provisions of, and 
                amendments made by, subsection (a) be eligible for the 
                guaranteed issue of a Medicare supplemental policy 
                under paragraph (2) or (3) of section 1882(s) of such 
                Act (42 U.S.C. 1395ss(s)).
    (c) Allowing Individuals With Kidney Failure To Retain Access to 
Private Insurance.--
            (1) In general.--Section 1862(b)(1)(C) of the Social 
        Security Act (42 U.S.C. 1395y(b)(1)(C)) is amended--
                    (A) in the last sentence, by inserting ``and before 
                January 1, 2023'' after ``prior to such date''; and
                    (B) by adding at the end the following new 
                sentence: ``Effective for items and services furnished 
                on or after January 1, 2023 (with respect to periods 
                beginning on or after the date that is 42 months prior 
                to such date), clauses (i) and (ii) shall be applied by 
                substituting `42-month' for `12-month' each place it 
                appears.''.
            (2) Effective date.--The amendments made by this subsection 
        shall take effect on the date of enactment of this Act. For 
        purposes of determining an individual's status under section 
        1862(b)(1)(C) of the Social Security Act (42 U.S.C. 
        1395y(b)(1)(C)), as amended by paragraph (1), an individual who 
        is within the coordinating period as of the date of enactment 
        of this Act shall have that period extended to the full 42 
        months described in the last sentence of such section, as added 
        by the amendment made by paragraph (1)(B).

                Subtitle L--Diversity in Clinical Trials

SEC. 7551. FDA REVIEW OF CLINICAL TRIAL BEST PRACTICES.

    The Commissioner of Food and Drugs shall--
            (1) aggregate information on the accumulated experience of 
        sponsors of drugs that develop and execute clinical trial 
        diversity plans during drug development;
            (2) include in such aggregated information an analysis from 
        the perspectives of the Food and Drug Administration and such 
        sponsors of which actions worked or which did not work to 
        enhance clinical trial diversity;
            (3) not later than September 30, 2024, convene a public 
        meeting, including representatives from the regulated industry 
        and patient organizations, to discuss findings and 
        recommendations for specific actions that have led to 
        measurable improvements in the representation of racial and 
        ethnic populations in clinical research; and
            (4) not later than September 30, 2025, update the guidance 
        of the Food and Drug Administration titled ``Enhancing the 
        Diversity of Clinical Trial Populations--Eligibility Criteria, 
        Enrollment Practices, and Trial Designs'' to align such 
        guidance with findings and recommendations that were discussed 
        at the meeting under paragraph (3).

SEC. 7552. DIVERSIFYING INVESTIGATIONS VIA EQUITABLE RESEARCH STUDIES 
              FOR EVERYONE TRIALS ACT.

    (a) Guidance on Decentralized Clinical Trials.--
            (1) Definition.--In this subsection, the term 
        ``decentralized clinical trials'' includes clinical trials that 
        are executed through a broad spectrum of options, such as 
        telemedicine or other mobile or digital technologies, to allow 
        for the remote collection and assessment of clinical trial data 
        from participants, including in the home or office setting.
            (2) Guidance.--Not later than 6 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary''), 
        acting through the Commissioner of Food and Drugs (referred to 
        in this section as the ``Commissioner''), shall issue a draft 
        guidance that addresses how to conduct decentralized clinical 
        trials with meaningful demographic diversity, including racial, 
        ethnic, age, gender, and geographic diversity in patient 
        engagement, enrollment, and participation, including how to 
        appropriately use digital health technologies or other remote 
        assessment options, such as telemedicine, to support such 
        trials. Not later than 6 months after the date the public 
        comment period for the draft guidance ends, the Secretary shall 
        issue a final guidance.
            (3) Content of guidance.--The guidance under paragraph (2) 
        shall address the following:
                    (A) Strategies to engage with prospective clinical 
                trial participants and community partners, such as 
                patient advocacy groups with diverse representation, to 
                incorporate input of such patients and partners into 
                the design of decentralized clinical trials.
                    (B) Recommendations for--
                            (i) protocol design approaches;
                            (ii) appropriate clinical endpoints;
                            (iii) institutional review board 
                        composition and ensuring that such boards 
                        include members with expertise in decentralized 
                        clinical trials;
                            (iv) delegation of clinical research 
                        organization responsibilities and suitable 
                        proxies for clinical research organizations; 
                        and
                            (v) simplifying informed consent.
                    (C) Recommendations for how digital health 
                technology or other remote assessment options, such as 
                telemedicine, could support decentralized clinical 
                trials, including guidance on appropriate technological 
                platforms and mediums, data collection and use, data 
                integrity, and communication to study participants 
                through digital technology.
                    (D) Recommendations for appropriate methods of 
                patient recruitment and retention, including 
                institutional review board oversight, patient 
                communication, and the role of study participants and 
                community partners as advocates to facilitate clinical 
                trial recruitment, particularly with respect to 
                underrepresented populations.
                    (E) Information regarding when and how a study 
                sponsor may solicit a meeting with the Secretary 
                regarding the issues described in subparagraphs (A) 
                through (D).
            (4) International harmonization.--After issuing the final 
        guidance under paragraph (2), the Secretary, acting through the 
        Commissioner, may work with foreign regulators pursuant to 
        existing memoranda of understanding governing exchange of 
        information to facilitate international harmonization of the 
        regulation of decentralized clinical trials and use of digital 
        health technology or other remote assessment options.
    (b) Encouragement of Clinical Trial Enrollment by Racially and 
Ethnically Diverse Populations.--
            (1) No cost provision of digital health technologies.--The 
        free provision of digital health technologies by drug or device 
        manufacturers to their clinical trial participants shall not be 
        considered a violation of section 1128A of the Social Security 
        Act (commonly known as the ``Civil Monetary Penalties Law'') 
        (42 U.S.C. 1320a-7a), section 1128B of the Social Security Act 
        (42 U.S.C. 1320a-7b), or sections 3729 through 3733 of title 
        31, United States Code (commonly known as the ``False Claims 
        Act''), provided that--
                    (A) the use of digital health technologies will 
                facilitate in any phase of clinical development the 
                inclusion of diversity of patient populations, such as 
                underrepresented racial and ethnic minorities, low-
                income populations, and the elderly;
                    (B) the digital health technologies will facilitate 
                individuals' participation, or are necessary to such 
                participation;
                    (C) all features of the digital health technologies 
                that are unrelated to use in the clinical trial are 
                disabled or only allowed to remain activated to model 
                real-world usage of the digital technology; and
                    (D) the clinical trial sponsor requires 
                participants to return, purchase, or disable the 
                digital health technologies by the conclusion of the 
                trial.
            (2) Grants and contracts.--
                    (A) In general.--The Secretary may issue grants to, 
                and enter into contracts with, entities to support 
                community education, outreach, and recruitment 
                activities for clinical trials with respect to drugs, 
                including vaccines for diseases or conditions which 
                have a disproportionate impact on underrepresented 
                populations (including on racial and ethnic minority 
                populations), including for the diagnosis, prevention, 
                or treatment of COVID-19. Such activities may include--
                            (i) working with community clinical trial 
                        sites, including community health centers, 
                        academic health centers, and other facilities;
                            (ii) training health care personnel 
                        including potential clinical trial 
                        investigators, with a focus on significantly 
                        increasing the number of underrepresented 
                        racial and ethnic minority health care 
                        personnel who are clinical trial investigators 
                        at the community sites for ongoing clinical 
                        trials;
                            (iii) engaging community stakeholders to 
                        encourage participation in clinical trials, 
                        especially in underrepresented racial and 
                        ethnic minority communities; and
                            (iv) fostering partnerships with community-
                        based organizations serving underrepresented 
                        racial and ethnical minority populations, 
                        including employee unions and frontline health 
                        care workers.
                    (B) Priority for grant and contract awards.--In 
                awarding grants and contracts under this paragraph, the 
                Secretary shall prioritize entities that--
                            (i) develop educational, recruitment, and 
                        training materials in multiple languages; or
                            (ii) undertake clinical trial outreach 
                        efforts in more diverse racial and ethnic 
                        communities that are traditionally 
                        underrepresented in clinical trials, such as 
                        Tribal areas.
                    (C) Authorization of appropriations.--There is 
                authorized to be appropriated for fiscal years 2023 and 
                2024 such sums as may be necessary to carry out this 
                paragraph.
    (c) Clarification That Certain Remuneration Related to 
Participation in Clinical Trials Does Not Constitute Remuneration Under 
the Federal Civil Money Penalties Law.--
            (1) In general.--Section 1128A(i)(6)(F) of the Social 
        Security Act (42 U.S.C. 1320a-7a(i)(6)(F)) is amended by 
        inserting ``(including remuneration offered or transferred to 
        an individual to promote the participation in an approved 
        clinical trial, as defined in subsection (d) of the first 
        section 2709 of the Public Health Service Act, that is 
        registered with the database of clinical trials maintained by 
        the National Library of Medicine (or any successor database), 
        so long as such remuneration facilitates equitable inclusion of 
        patients from all relevant demographic and socioeconomic 
        populations and is related to patient participation in the 
        approved clinical trial)'' after ``promotes access to care''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to remuneration provided on or after the date of 
        the enactment of this Act.
    (d) National Academy of Medicine Study.--
            (1) In general.--The Secretary shall enter into an 
        arrangement with the National Academy of Medicine under which 
        the National Academy agrees to study and propose a design for a 
        national interoperable data platform to improve access to 
        health data, and other relevant data needs, during public 
        health emergencies.
            (2) Report.--The arrangement under paragraph (1) shall 
        provide for submission by the National Academy of Medicine to 
        the Secretary and Congress, not later than 120 days after the 
        date of enactment of this Act, of a report on the results of 
        the study under paragraph (1) and the design proposed based on 
        such study.

SEC. 7553. CLINICAL TRIAL DIVERSITY.

    (a) Diversity Requirements for Applications for Federal Funding for 
Clinical Trials.--
            (1) Applications.--Beginning on the date of the enactment 
        of this Act, the Secretary of Health and Human Services, acting 
        through the Director of the National Institutes of Health (in 
        this subsection referred to as the ``Secretary'') shall require 
        that an entity seeking to conduct a clinical trial 
        investigating a drug or device (as those terms are defined in 
        section 201 of the Federal Food, Drug, and Cosmetic Act (21 
        U.S.C. 321 et seq.)) or biological product (as defined in 
        section 351(i) of the Public Health Service Act (42 U.S.C. 
        262(i))), and funded by the National Institutes of Health and 
        conducted at any national research institute or national 
        center, submit an application (or renewal thereof) for such 
        funding that includes--
                    (A) clear and measurable goals for the recruitment 
                and retention of participants that reflect--
                            (i) the race, ethnicity, age, and gender or 
                        sex of patients with the disease or condition 
                        being investigated; or
                            (ii) the race, ethnicity, age, and gender 
                        or sex of the general population of the United 
                        States if the prevalence of the disease or 
                        condition is not known;
                    (B) a rationale for the goals specified under 
                subparagraph (A) that specifies--
                            (i) how investigators will calculate the 
                        number of participants for each population 
                        category that reflect the population groups 
                        specified in subparagraph (A); and
                            (ii) strategies that will be used to enroll 
                        and retain participants across the different 
                        racial, ethnic, age, and gender or sex 
                        categories;
                    (C) a detailed plan for how the clinical trial will 
                achieve the goals specified under subparagraph (A) that 
                specifies--
                            (i) the requirements for researchers, in 
                        conducting the trial to analyze the population 
                        groups specified in subparagraph (A) 
                        separately;
                            (ii) the role of community partners or 
                        community institutional review boards in 
                        reviewing the plans; and
                            (iii) how the trial will recruit a study 
                        population that is--
                                    (I) in proportion to the prevalence 
                                of the disease or condition in such 
                                groups relative to the prevalence of 
                                the disease or condition in the overall 
                                population of the United States;
                                    (II) in sufficient numbers to 
                                obtain clinically and statistically 
                                meaningful determinations of the safety 
                                and effectiveness of the drug being 
                                studied in the respective race, 
                                ethnicity, age, and gender or sex 
                                groups; and
                                    (III) consistent with the guidance 
                                under section 505(b)(1) of the Federal 
                                Food, Drug, and Cosmetic Act (21 U.S.C. 
                                355(b)(1)) and guidance issued by the 
                                National Institutes of Health on the 
                                inclusion of women and minorities in 
                                clinical trials;
                    (D) the entity's plan for implementing, or an 
                explanation of why the entity cannot implement, 
                alternative clinical trial follow-up requirements that 
                are less burdensome for trial participants, such as--
                            (i) requiring fewer follow-up visits;
                            (ii) allowing phone follow-up or home 
                        visits by nurse trial coordinators (in lieu of 
                        in-person visits by patients);
                            (iii) allowing for online follow-up 
                        options;
                            (iv) permitting the patient's primary care 
                        provider to perform some of the follow-up visit 
                        requirements and to reimburse the patient for 
                        any out-of-pocket costs incurred by the patient 
                        for such follow-up visits;
                            (v) allowing for weekend hours for required 
                        follow-up visits;
                            (vi) allowing virtual or telemedicine 
                        visits;
                            (vii) use of wearable technology to record 
                        key health parameters; and
                            (viii) use of alternate labs or imaging 
                        centers, which may be closer to the residence 
                        of the patients participating in the trial; and
                    (E) the entity's education and training 
                requirements for researchers and other individuals 
                conducting or supporting the clinical trial with 
                respect to diversity and health inequities in 
                underrepresented populations, including a requirement 
                to consult with, and review materials made available 
                by, such committees, task forces, and working groups 
                other entities the Director determines are appropriate, 
                including the following:
                            (i) The Equity Committee of the National 
                        Institutes of Health.
                            (ii) The National Advisory Council on 
                        Minority Health and Health Disparities.
                            (iii) The Advisory Committee on Research on 
                        Women's Health.
                            (iv) The Sexual & Gender Minority Research 
                        Coordinating Committee of the National 
                        Institutes of Health.
                            (v) The Tribal Health Research Coordinating 
                        Committee of the National Institutes of Health.
            (2) Terms.--
                    (A) In general.--As a condition on the receipt of 
                funding through the National Institutes of Health, as 
                described in paragraph (1), with respect to a clinical 
                trial, the sponsor of the clinical trial shall agree to 
                terms requiring that--
                            (i) the aggregate demographic information 
                        of trial participants be shared on an annual 
                        basis with the Secretary while participant 
                        recruitment and data collection in such trial 
                        is ongoing, and that such information is 
                        provided with respect to--
                                    (I) underrepresented populations, 
                                including populations grouped by race, 
                                ethnicity, age, sex, gender identity 
                                and expression, geographic region, 
                                primary written and spoken language, 
                                disability status, sexual orientation, 
                                socioeconomic status, occupation, and 
                                other relevant factors; and
                                    (II) such populations that reflect 
                                the prevalence of the disease or 
                                condition that is the subject of the 
                                clinical trial involved (as available 
                                and as appropriate to the scientific 
                                objective for the study, as determined 
                                by the Director of the National 
                                Institutes of Health);
                            (ii) the sponsor submits to the program 
                        officer and grants management specialist of the 
                        specific National Institutes of Health national 
                        research institute or national center, as 
                        frequently as such officer or specialist 
                        determines necessary, the retention rate of 
                        participants in the clinical trial, 
                        disaggregated by race, ethnicity, gender or 
                        sex, and age;
                            (iii) both the clinical trial researchers 
                        and the applicant reviewers to complete 
                        education and training programs on diversity in 
                        clinical trials; and
                            (iv) at the conclusion of the trial, the 
                        sponsor submits to the Secretary the number of 
                        participants in the trial, disaggregated by 
                        race, ethnicity, age, and gender or sex.
                    (B) Privacy protections.--Any data shared under 
                subparagraph (A) may not include any individually 
                identifiable information or protected health 
                information with respect to clinical trial participants 
                and shall only be disclosed to the extent allowed under 
                Federal privacy laws.
            (3) Exception.--In lieu of submitting an application under 
        paragraph (1) and documentation of goals as required by 
        subparagraph (A) of such subsection, an applicant may provide 
        reasoning (other than cost) for why the recruitment of each of 
        the population groups specified in subparagraph (A) of 
        paragraph (1) is not necessary and why such recruitment is not 
        scientifically justified or possible.
            (4) Publication.--The Secretary shall--
                    (A) publish on a public website of the National 
                Institutes of Health, upon receipt of an application to 
                which paragraph (1) applies--
                            (i) a summary of the disease being targeted 
                        in the clinical trial that is the subject of 
                        the application and the prevalence of such 
                        disease across race, ethnicity, gender or sex, 
                        age, and clinical trial representation in each 
                        such category;
                            (ii) the goals specified in such 
                        application, as required by paragraph (1)(A); 
                        or
                            (iii) the reasoning described in paragraph 
                        (3); and
                    (B) ensure that, in publishing information relating 
                to an application under subparagraph (A), the design of 
                the study involved is not disclosed.
            (5) Remediation.--
                    (A) In general.--In the case of a clinical trial 
                subject to paragraph (1) that fails to meet the 
                condition specified pursuant to paragraph (1) by such 
                date as may be agreed upon by the sponsor of the trial 
                and the program officer and grants management 
                specialist of the specific National Institutes of 
                Health national research institute or national center, 
                the Secretary shall require the sponsor of that 
                clinical trial, not later than 60 days after such date 
                occurs--
                            (i) to develop, in consultation with the 
                        Secretary and advocacy and community-based 
                        organizations representing individuals who are 
                        members of relevant demographic groups 
                        specified in paragraph (1)(A), a strategic plan 
                        to increase participation in such clinical 
                        trial of such individuals; and
                            (ii) to submit to the Secretary, such 
                        strategic plan.
                    (B) Publication.--The Secretary shall make publicly 
                available on the website of the National Institutes of 
                Health, the strategic plan received under subparagraph 
                (A) as soon as possible after receipt. The Secretary 
                shall ensure that, in publishing such plan under the 
                preceding sentence, the design of the study involved is 
                not disclosed.
                    (C) Implementation.--The sponsor of the clinical 
                trial that is the subject of the strategic plan 
                published under subparagraph (B), shall, not later than 
                60 days after such date as may be agreed upon by the 
                sponsor of the trial and the appropriate program 
                officer and grants management specialist of the 
                National Institutes of Health implement the strategic 
                plan.
                    (D) Technical assistance.--The Secretary may 
                provide technical assistance to a sponsor of a clinical 
                trial, as necessary for the sponsor to meet the 
                requirements of subparagraph (C).
            (6) Penalties in case of failure of remediation.--
                    (A) In general.--In the case of a clinical trial 
                subject to paragraph (1) that, after the close of the 
                60-day period specified in paragraph (5)(C), continues 
                to fail to meet the condition specified pursuant to 
                paragraph (1)(A), the Secretary shall--
                            (i) hold the noncompeting continuation of 
                        funding received through the grant involved;
                            (ii) apply specific conditions on the award 
                        of funds to such sponsor to conduct such 
                        clinical trial; or
                            (iii) terminate such funding.
                    (B) Waiver.--
                            (i) In general.--In the case of a clinical 
                        trial subject to the penalty under subparagraph 
                        (A) that, after the close of the 60-day period 
                        referred to in subparagraph (A), continues to 
                        fail to meet the condition referred to in such 
                        subparagraph, the sponsor of such clinical 
                        trial may submit an application to the relevant 
                        program officer and grants specialist 
                        requesting a waiver of such condition. Such an 
                        application shall specify reasoning for why the 
                        recruitment of each of the population groups 
                        specified in subparagraph (A) of paragraph (1) 
                        is not necessary or why such recruitment is not 
                        scientifically justified or possible.
                            (ii) Review.--Not later than 30 days after 
                        a date agreed upon by the sponsor of the trial 
                        and the appropriate program officer and grants 
                        management specialist of the National 
                        Institutes of Health, the Secretary shall--
                                    (I) complete the review of such 
                                application; and
                                    (II) make a determination to 
                                approve or deny the application.
                            (iii) No additional penalties.--No 
                        additional penalties may be applied with 
                        respect to a sponsor of a clinical trial under 
                        subparagraph (A) during the 30-day period 
                        specified in clause (ii).
                    (C) Termination of funding.--In the case of a 
                clinical trial described in subparagraph (B)(i), the 
                Secretary may elect to terminate funding described in 
                paragraph (1) for the clinical trial if no request for 
                a waiver under subparagraph (B) is received after the 
                60-day period referred to in subparagraph (A).
            (7) Waiver for certain clinical trials.--
                    (A) In general.--In the case of a clinical trial 
                that received funding through the National Institutes 
                of Health and is ongoing as of the date of the 
                enactment of this Act, the sponsor of such clinical 
                trial is exempt from the requirements of (and 
                associated penalties imposed by) this section.
                    (B) Report.--The Secretary shall include in the 
                triennial report required to be submitted under section 
                403 of the Public Health Service Act (42 U.S.C. 283), a 
                list of all clinical trials receiving funding through 
                the National Institutes of Health--
                            (i) that requested and received waivers 
                        under this subsection; or
                            (ii) with respect to which funding has been 
                        terminated pursuant to this subsection.
            (8) Study.--
                    (A) In general.--The Comptroller General of the 
                United States shall conduct a study that--
                            (i) examines which actions Federal agencies 
                        have taken to address barriers to participation 
                        in federally funded clinical trials by the 
                        demographic groups specified in paragraph 
                        (1)(A); and
                            (ii) identifies challenges, if any, in 
                        implementing such actions.
                    (B) Report.--Not later than 1 year after the date 
                of the enactment of this Act, the Comptroller General 
                of the United States shall submit to Congress a report 
                on the findings of the study conducted under 
                subparagraph (A).
            (9) Nondiscrimination.--Section 1557 of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18116) shall 
        apply with respect to a clinical trial subject to paragraph 
        (1).
    (b) Eliminating Cost Barriers.--
            (1) Study on modernization of human subject regulations.--
        Not later than 2 years after the date of the enactment of this 
        Act, the Secretary of Health and Human Services, acting through 
        the Director of the National Institutes of Health (referred to 
        in this subsection as the ``Secretary''), shall conduct and 
        complete a study on--
                    (A) the need for review of human subject 
                regulations specified in part 46 of title 45, Code of 
                Federal Regulations (or successor regulations), and 
                related guidance;
                    (B) the modernization of such regulations and 
                guidance to establish updated guidelines for 
                reimbursement of out-of-pocket expenses of human 
                subjects, compensation of human subjects for time spent 
                participating in the clinical trial, and incentives for 
                recruitment of human subjects; and
                    (C) the need for updated safe harbor rules under 
                section 1001.952 of title 42, Code of Federal 
                Regulations (or successor regulations) and section 
                1128B of the Social Security Act (commonly referred to 
                as the Federal Anti-Kickback Statute (42 U.S.C. 1320a-
                7b)) with respect to the assistance provided under this 
                subsection.
            (2) Reimbursement for costs associated with clinical trial 
        participation.--As a condition on receipt of any funding 
        provided through the National Institutes of Health to conduct a 
        clinical trial investigating a drug or device (as those terms 
        are defined in section 201 of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 321 et seq.)) or biological product (as 
        defined in section 351(i) of the Public Health Service Act (42 
        U.S.C. 262(i))) the Secretary shall require that the sponsor of 
        such clinical trial--
                    (A) works with institutional review boards and 
                program officers of the National Institutes of Health 
                to determine when reimbursement for the costs 
                associated with clinical trial participation is 
                warranted; and
                    (B) subject to paragraph (3), provides to clinical 
                trial participants reimbursement for expenses (using 
                funds other than funds supplied through the National 
                Institutes of Health) incurred as a result of that 
                participation, which may include--
                            (i) missed or forgone salary;
                            (ii) language assistance, including 
                        interpreter services;
                            (iii) food expenses;
                            (iv) childcare expenses;
                            (v) lodging expenses;
                            (vi) transportation expenses; or
                            (vii) other expenses as identified by the 
                        participant, subject to review by the clinical 
                        trial sponsor, at its discretion, on a case-by-
                        case basis.
            (3) Provision of costs associated with clinical trial 
        participation.--
                    (A) Application and documentation.--
                            (i) In general.--A sponsor of a clinical 
                        trial to which subsection (a)(1) applies, may 
                        require that, in order to receive payment or 
                        reimbursement as described in such paragraph, a 
                        participant complete an application and share 
                        with the sponsor such documentation of expenses 
                        described in such paragraph, as the sponsor may 
                        require.
                            (ii) Timing.--Not later than 30 days after 
                        the date on which a sponsor of a clinical trial 
                        receives an application under clause (i), the 
                        sponsor shall--
                                    (I) review the application; and
                                    (II) provide for reimbursement of 
                                eligible expenses documented in such 
                                application, as determined at the 
                                discretion of the clinical trial 
                                sponsor on a case-by-case basis.
                    (B) Enforcement.--A sponsor of a clinical trial to 
                which subsection (a)(1) applies, shall submit on an 
                annual basis, as part of the progress reports submitted 
                to the Secretary pursuant to section 402(j) of the 
                Public Health Service Act (42 U.S.C. 282(j)), during 
                the data collection period of the clinical trial, to 
                the Secretary an accounting of the payment or 
                reimbursements made to clinical trial participants 
                under subparagraph (A). Such data shall--
                            (i) include relevant aggregate data with 
                        respect to each population group specified in 
                        subsection (a)(2)(A)(i) when such data will not 
                        compromise the identities of study participants 
                        and in a manner consistent with applicable 
                        privacy protections; and
                            (ii) not later than 6 months after receipt 
                        by the Secretary, be published on a public 
                        website of the National Institutes of Health.
    (c) Public Awareness and Education Campaign.--
            (1) National campaign.--The Secretary of Health and Human 
        Services, acting through the Director of the National 
        Institutes of Health and the Commissioner of Food and Drugs 
        (referred to in this subsection as the ``Secretary''), in 
        consultation with the stakeholders specified in paragraph (5), 
        shall carry out a national campaign to increase the awareness 
        and knowledge of individuals in the United States with respect 
        to the need for diverse clinical trials among the demographic 
        groups identified pursuant to subsection (a)(1)(A).
            (2) Requirements.--The national campaign conducted shall 
        include--
                    (A) the development and distribution of written 
                educational materials, and the development and placing 
                of public service announcements, that are intended to 
                encourage individuals who are members of the 
                demographic groups identified pursuant to subsection 
                (a)(2)(A)(i)(I) to seek to participate in clinical 
                trials;
                    (B) such efforts as are reasonable and necessary to 
                ensure meaningful access by consumers with limited 
                English proficiency;
                    (C) the development and distribution of best 
                practices and training for recruiting underrepresented 
                study populations, including a method for sharing such 
                best practices among clinical trial sponsors, 
                providers, community-based organizations who assist 
                with recruitment, and with the public; and
                    (D) the conduct of focus groups to better 
                understand the concerns and fears of certain 
                underrepresented groups who may be reluctant to 
                participate in clinical trials.
            (3) Health inequities.--In developing the national campaign 
        under paragraph (1), the Secretary shall recognize and 
        address--
                    (A) health inequities among individuals who are 
                members of the population groups specified in 
                subsection (a)(2)(A)(i) with respect to access to care 
                and participation in clinical trials; and
                    (B) any barriers in access to care and 
                participation in clinical trials that are specific to 
                individuals who are members of such groups.
            (4) Grants.--The Secretary shall establish a program to 
        award grants to nonprofit private entities, including 
        community-based organizations and faith communities, 
        institutions of higher education eligible to receive funds 
        under section 371 of the Higher Education Act of 1965 (20 
        U.S.C. 1067q) and national organizations that serve 
        underrepresented populations and community pharmacies to enable 
        such entities--
                    (A) to test alternative outreach and education 
                strategies to increase the awareness and knowledge of 
                individuals in the United States, with respect to the 
                need for diverse clinical trials that reflect the race, 
                ethnicity, age, and gender or sex of patients with the 
                disease or condition being investigated; and
                    (B) to cover administrative costs of such entities 
                in assisting in diversifying clinical trials subject to 
                subsection (a).
            (5) Stakeholders specified.--The stakeholders specified in 
        this paragraph are the following:
                    (A) Representatives of the Health Resources 
                Services Administration, the Office on Minority Health 
                of the Department of Health and Human Services, the 
                Centers for Disease Control and Prevention, and the 
                National Institutes of Health.
                    (B) Community-based resources and advocates.
            (6) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this paragraph $10,000,000 for 
        each of fiscal years 2023 through 2026.
    (d) Definitions.--In this section:
            (1) Clinical trial.--The term ``clinical trial'' means a 
        research study in which one or more human subjects are 
        prospectively assigned to one or more interventions (which may 
        include placebo or other control) to evaluate the effects of 
        those interventions on health-related biomedical or behavioral 
        outcomes.
            (2) Sponsor.--The term ``sponsor'' has the meaning given 
        such term in section 50.3 of title 21, Code of Federal 
        Regulations (or successor regulations).

SEC. 7554. PATIENT EXPERIENCE DATA.

    (a) Policy.--Section 569C of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 360bbb-8c) is amended--
            (1) by redesignating subsections (b) and (c) as subsections 
        (c) and (d), respectively; and
            (2) by inserting after subsection (a) the following new 
        subsection:
    ``(b) Collection, Submission, and Use of Data.--
            ``(1) In general.--The Secretary shall--
                    ``(A) for any drug for which an exemption is 
                granted for investigational use under section 505(i) of 
                this Act or section 351(a) of the Public Health Service 
                Act, require the sponsor of the drug to collect 
                standardized patient experience data as part of the 
                clinical trials conducted pursuant to such exemption;
                    ``(B) require any application for the approval or 
                licensing of such drug under section 505(b) of this Act 
                or section 351(a) of the Public Health Service Act to 
                include--
                            ``(i) the standardized patient experience 
                        data so collected; and
                            ``(ii) such related information as the 
                        Secretary may require; and
                    ``(C) consider patient experience data and related 
                information that is submitted pursuant to subparagraph 
                (B) in deciding whether to approve or license, as 
                applicable, the drug involved.
            ``(2) Applicability.--Paragraph (1) applies only with 
        respect to drugs for which a request for an exemption described 
        in paragraph (1)(A) is submitted on or after the date of the 
        enactment of the Health Equity and Accountability Act of 2022, 
        or an application under section 505(b) of this Act or section 
        351(a) of the Public Health Service Act is filed, as 
        applicable, on or after the day that is 2 years after the date 
        of the enactment of the Health Equity and Accountability Act of 
        2022.''.
    (b) Regulations.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services, 
acting through the Commissioner of Food and Drugs, shall promulgate 
final regulations to implement section 569C(b) of the Federal Food, 
Drug, and Cosmetic Act, as added by this section.

   Subtitle M--Additional Provisions Addressing High Impact Minority 
                                Diseases

SEC. 7601. MEDICARE COVERAGE OF MULTI-CANCER EARLY DETECTION SCREENING 
              TESTS.

    (a) Coverage.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (GG);
                    (B) by striking the period at the end of 
                subparagraph (HH) and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(II) multi-cancer early detection screening tests 
                (as defined in subsection (lll));''; and
            (2) by adding at the end the following new subsection:
    ``(lll) Multi-Cancer Early Detection Screening Tests.--The term 
`multi-cancer early detection screening test' means any of the 
following tests, approved or cleared by the Food and Drug 
Administration, furnished to an individual for the purpose of early 
detection of cancer across many cancer types (as categorized in the 
Annual Report to the Nation on the Status of Cancer issued by the 
National Cancer Institute):
            ``(1) A genomic sequencing blood or blood product test that 
        includes the analysis of cell-free nucleic acids.
            ``(2) Such other equivalent tests (which are based on urine 
        or other sample of biological material) as the Secretary 
        determines appropriate.''.
    (b) Payment and Frequency Limit.--
            (1) Payment under fee schedule.--Section 1833(h) of the 
        Social Security Act (42 U.S.C. 1395l(h)) is amended--
                    (A) in paragraph (1)(A), by inserting after 
                ``(including'' the following: ``multi-cancer early 
                detection screening tests under section 1861(lll) and 
                including''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(10) No payment may be made under this part for a multi-
        cancer early detection screening test (as defined in section 
        1861(lll)) for an individual if such a test was furnished to 
        the individual during the previous 11 months.''.
            (2) Conforming amendment.--Section 1862(a) of the Social 
        Security Act (42 U.S.C. 1395y(a)) is amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (O), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (P), by striking the 
                        semicolon at the end and inserting ``, and''; 
                        and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(Q) in the case of multi-cancer early detection 
                screening tests (as defined in section 1861(lll)), 
                which are performed more frequently than is covered 
                under section 1833(h)(10);''; and
                    (B) in paragraph (7), by striking ``or (P)'' and 
                inserting ``(P), or (Q)''.
    (c) Rule of Construction Relating to Other Cancer Screening 
Tests.--Nothing in this section, including the amendments made by this 
section, shall be construed--
            (1) in the case of an individual who undergoes a multi-
        cancer early detection screening test, to affect coverage under 
        part B for other cancer screening tests covered under this 
        section, such as screening tests for breast, cervical, 
        colorectal, lung, or prostate cancer; or
            (2) in the case of an individual who undergoes another 
        cancer screening test, to affect coverage for a multi-cancer 
        early detection screening test or the use of such a test as a 
        diagnostic or confirmatory test for a result of the other 
        cancer screening test.

SEC. 7602. AMPUTATION REDUCTION AND COMPASSION ACT.

    (a) Peripheral Artery Disease Education Program.--Part P of title 
III of the Public Health Service Act (42 U.S.C. 280g et seq.) is 
amended by adding at the end the following new section:

``SEC. 399V-7. PERIPHERAL ARTERY DISEASE EDUCATION PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, in collaboration with 
the Administrator of the Centers for Medicare & Medicaid Services and 
the Administrator of the Health Resources and Services Administration, 
shall establish and coordinate a peripheral artery disease education 
program to support, develop, and implement educational initiatives and 
outreach strategies that inform health care professionals and the 
public about the existence of peripheral artery disease and methods to 
reduce amputations related to such disease, particularly with respect 
to at-risk populations.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2022 through 2026.''.
    (b) Medicare Coverage of Peripheral Artery Disease Screening Tests 
Furnished to At-Risk Beneficiaries Without Imposition of Cost Sharing 
Requirements.--
            (1) In general.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2)--
                            (i) in subparagraph (GG), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (HH), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(II) peripheral artery disease screening tests 
                furnished to at-risk beneficiaries (as such terms are 
                defined in subsection (lll)).''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(lll) Peripheral Artery Disease Screening Test; At-Risk 
Beneficiary.--(1) The term `peripheral artery disease screening test' 
means--
            ``(A) noninvasive physiologic studies of extremity arteries 
        (commonly referred to as ankle-brachial index testing);
            ``(B) arterial duplex scans of lower extremity arteries 
        vascular; and
            ``(C) such other items and services as the Secretary 
        determines, in consultation with relevant stakeholders, to be 
        appropriate for screening for peripheral artery disease for at-
        risk beneficiaries.
    ``(2) The term `at-risk beneficiary' means an individual entitled 
to, or enrolled for, benefits under part A and enrolled for benefits 
under part B--
            ``(A) who is 65 years of age or older;
            ``(B) who is at least 50 years of age but not older than 64 
        years of age with risk factors for atherosclerosis (such as 
        diabetes mellitus, a history of smoking, hyperlipidemia, and 
        hypertension) or a family history of peripheral artery disease;
            ``(C) who is younger than 50 years of age with diabetes 
        mellitus and one additional risk factor for atherosclerosis; or
            ``(D) with a known atherosclerotic disease in another 
        vascular bed such as coronary, carotid, subclavian, renal, or 
        mesenteric artery stenosis, or abdominal aortic aneurysm.
    ``(3) The Secretary shall, in consultation with appropriate 
organizations, establish standards regarding the frequency for 
peripheral artery disease screening tests described in subsection 
(s)(2)(II) for purposes of coverage under this title.''.
            (2) Inclusion of peripheral artery disease screening tests 
        in initial preventive physical examination.--Section 
        1861(ww)(2) of the Social Security Act (42 U.S.C. 1395x(ww)(2)) 
        is amended--
                    (A) in subparagraph (N), by moving the margins of 
                such subparagraph 2 ems to the left;
                    (B) by redesignating subparagraph (O) as 
                subparagraph (P); and
                    (C) by inserting after subparagraph (N) the 
                following new subparagraph:
                    ``(O) Peripheral artery disease screening tests 
                furnished to at risk-beneficiaries (as such terms are 
                defined in subsection (lll)).''.
            (3) Payment.--
                    (A) In general.--Section 1833(a) of the Social 
                Security Act (42 U.S.C. 1395l(a)) is amended--
                            (i) in paragraph (1)--
                                    (I) in subparagraph (N), by 
                                inserting ``and other than peripheral 
                                artery disease screening tests 
                                furnished to at-risk beneficiaries (as 
                                such terms are defined in section 
                                1861(lll))'' after ``other than 
                                personalized prevention plan services 
                                (as defined in section 1861(hhh)(1))'';
                                    (II) by striking ``and'' before 
                                ``(DD)''; and
                                    (III) by striking ``such 
                                service,;'' at the end and inserting 
                                the following: ``, and (EE) with 
                                respect to peripheral artery disease 
                                screening tests furnished to at-risk 
                                beneficiaries (as such terms are 
                                defined in section 1861(lll)), the 
                                amount paid shall be 100 percent of the 
                                lesser of the actual charge for the 
                                services or the amount determined under 
                                the payment basis determined under 
                                section 1848''; and
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (G), by 
                                striking ``and'' at the end;
                                    (II) in subparagraph (H), by 
                                striking the comma at the end and 
                                inserting ``; and''; and
                                    (III) by inserting after 
                                subparagraph (H) the following new 
                                subparagraph:
            ``(I) with respect to peripheral artery disease screening 
        tests (as defined in paragraph (1) of section 1861(lll)) 
        furnished by an outpatient department of a hospital to at-risk 
        beneficiaries (as defined in paragraph (2) of such section), 
        the amount determined under paragraph (1)(EE),''.
                    (B) No deductible.--Section 1833(b) of the Social 
                Security Act (42 U.S.C. 1395l(b)) is amended, in the 
                first sentence--
                            (i) by striking ``and'' before ``(12)''; 
                        and
                            (ii) by inserting ``, and (13) such 
                        deductible shall not apply with respect to 
                        peripheral artery disease screening tests 
                        furnished to at-risk beneficiaries (as such 
                        terms are defined in section 1861(lll))'' 
                        before the period at the end.
                    (C) Exclusion from prospective payment system for 
                hospital outpatient department services.--Section 
                1833(t)(1)(B)(iv) of the Social Security Act (42 U.S.C. 
                1395l(t)(1)(B)(iv)) is amended--
                            (i) by striking ``, or personalized'' and 
                        inserting ``, personalized''; and
                            (ii) by inserting ``, or peripheral artery 
                        disease screening tests furnished to at-risk 
                        beneficiaries (as such terms are defined in 
                        section 1861(lll))'' after ``personalized 
                        prevention plan services (as defined in section 
                        1861(hhh)(1))''.
                    (D) Conforming amendment.--Section 1848(j)(3) of 
                the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is 
                amended by striking ``(2)(FF) (including administration 
                of the health risk assessment) ,'' and inserting 
                ``(2)(FF) (including administration of the health risk 
                assessment), (2)(II)''.
            (4) Exclusion from coverage and medicare as secondary payer 
        for tests performed more frequently than allowed.--Section 
        1862(a)(1) of the Social Security Act (42 U.S.C. 1395y(a)(1)) 
        is amended--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(Q) in the case of peripheral artery disease 
                screening tests furnished to at-risk beneficiaries (as 
                such terms are defined in section 1861(lll)), which are 
                performed more frequently than is covered under such 
                section;''.
            (5) Authority to modify or eliminate coverage of certain 
        preventive services.--Section 1834(n) of the Social Security 
        Act (42 U.S.C. 1395m(n)) is amended--
                    (A) by redesignating subparagraphs (A) and (B) of 
                paragraph (1) as clauses (i) and (ii), respectively, 
                and moving the margins of such clauses, as so 
                redesignated, 2 ems to the right;
                    (B) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and moving the 
                margins of such subparagraphs, as so redesignated, 2 
                ems to the right;
                    (C) by striking ``Certain Preventive Services'' and 
                all that follows through ``any other provision of this 
                title'' and inserting: ``Certain Preventive Services.--
            ``(1) In general.--Notwithstanding any other provision of 
        this title''; and
                    (D) by adding at the end the following new 
                paragraph:
            ``(2) Inapplicability.--The Secretarial authority described 
        in paragraph (1) shall not apply with respect to preventive 
        services described in section 1861(ww)(2)(O).''.
            (6) Effective date.--The amendments made by this subsection 
        shall apply with respect to items and services furnished on or 
        after January 1, 2022.
    (c) Medicaid Coverage of Peripheral Artery Disease Screening Tests 
Furnished to At-Risk Beneficiaries Without Imposition of Cost Sharing 
Requirements.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (30), by striking ``and'' 
                        at the end;
                            (ii) by redesignating paragraph (31) as 
                        paragraph (32); and
                            (iii) by inserting after paragraph (30) the 
                        following new paragraph:
            ``(31) peripheral artery disease screening tests furnished 
        to at-risk beneficiaries (as such terms are defined in 
        subsection (hh)); and''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(hh) Peripheral Artery Disease Screening Test; At-Risk 
Beneficiary.--
            ``(1) Peripheral artery disease screening test.--The term 
        `peripheral artery disease screening test' means--
                    ``(A) noninvasive physiologic studies of extremity 
                arteries (commonly referred to as ankle-brachial index 
                testing);
                    ``(B) arterial duplex scans of lower extremity 
                arteries vascular; and
                    ``(C) such other items and services as the 
                Secretary determines, in consultation with relevant 
                stakeholders, to be appropriate for screening for 
                peripheral artery disease for at-risk beneficiaries.
            ``(2) At-risk beneficiary.--The term `at-risk beneficiary' 
        means an individual enrolled under a State plan (or a waiver of 
        such plan)--
                    ``(A) who is 65 years of age or older;
                    ``(B) who is at least 50 years of age but not older 
                than 64 years of age with risk factors for 
                atherosclerosis (such as diabetes mellitus, a history 
                of smoking, hyperlipidemia, and hypertension) or a 
                family history of peripheral artery disease;
                    ``(C) who is younger than 50 years of age with 
                diabetes mellitus and one additional risk factor for 
                atherosclerosis; or
                    ``(D) with a known atherosclerotic disease in 
                another vascular bed such as coronary, carotid, 
                subclavian, renal, or mesenteric artery stenosis, or 
                abdominal aortic aneurysm.
            ``(3) Frequency.--The Secretary shall, in consultation with 
        appropriate organizations, establish standards regarding the 
        frequency for peripheral artery disease screening tests 
        described in subsection (a)(31) for purposes of coverage under 
        a State plan under this title.''.
            (2) No cost sharing.--
                    (A) In general.--Subsections (a)(2) and (b)(2) of 
                section 1916 of the Social Security Act (42 U.S.C. 
                1396o) are each amended--
                            (i) in subparagraph (F), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (G), by striking ``; 
                        and'' and inserting ``, or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(H) peripheral artery disease screening tests 
                furnished to at-risk beneficiaries (as such terms are 
                defined in section 1905(hh)); and''.
                    (B) Application to alternative cost sharing.--
                Section 1916A(b)(3)(B) of the Social Security Act (42 
                U.S.C. 1396o-1(b)(3)(B)) is amended by adding at the 
                end the following new clause:
                            ``(xii) Peripheral artery disease screening 
                        tests furnished to at-risk beneficiaries (as 
                        such terms are defined in section 1905(hh)).''.
            (3) Mandatory coverage.--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 (31)''.
            (4) Conforming amendments.--
                    (A) Section 1902(nn)(3) of the Social Security Act 
                (42 U.S.C. 1396a(nn)(3)) is amended by striking 
                ``following paragraph (30)'' and inserting ``following 
                paragraph (32)''.
                    (B) Section 1905(a) of the Social Security Act (42 
                U.S.C. 1396d(a)) is amended by striking ``following 
                paragraph (30)'' and inserting ``following paragraph 
                (32)''.
    (d) Requirement for Group Health Plans and Health Insurance Issuers 
Offering Group or Individual Health Insurance Coverage To Provide 
Coverage for Peripheral Artery Disease Screening Tests Furnished to At-
Risk Enrollees Without Imposition of Cost Sharing Requirements.--
            (1) In general.--Subsection (a) of section 2713 of the 
        Public Health Service Act (42 U.S.C. 300gg-13) is amended to 
        read as follows:
    ``(a) Coverage of Preventive Health Services.--
            ``(1) In general.--A group health plan and a health 
        insurance issuer offering group or individual health insurance 
        coverage shall, at a minimum, provide coverage for and shall 
        not impose any cost sharing requirements for--
                    ``(A) evidence-based items or services that have in 
                effect a rating of `A' or `B' in the current 
                recommendations of the United States Preventive 
                Services Task Force;
                    ``(B) immunizations that have in effect a 
                recommendation from the Advisory Committee on 
                Immunization Practices of the Centers for Disease 
                Control and Prevention with respect to the individual 
                involved;
                    ``(C) with respect to infants, children, and 
                adolescents, evidence-informed preventive care and 
                screenings provided for in the comprehensive guidelines 
                supported by the Health Resources and Services 
                Administration;
                    ``(D) with respect to women, such additional 
                preventive care and screenings not described in 
                subparagraph (A) as provided for in comprehensive 
                guidelines supported by the Health Resources and 
                Services Administration for purposes of this 
                subparagraph; and
                    ``(E) with respect to at-risk enrollees, peripheral 
                artery disease screening tests.
            ``(2) Peripheral artery disease screening test; at-risk 
        enrollee.--For purposes of paragraph (1)(E):
                    ``(A) Peripheral artery disease screening test.--
                The term `peripheral artery disease screening test' 
                means--
                            ``(i) noninvasive physiologic studies of 
                        extremity arteries (commonly referred to as 
                        ankle-brachial index testing);
                            ``(ii) arterial duplex scans of lower 
                        extremity arteries vascular; and
                            ``(iii) such other items and services as 
                        the Secretary determines, in consultation with 
                        relevant stakeholders, to be appropriate for 
                        screening for peripheral artery disease for at-
                        risk enrollees.
                    ``(B) At-risk enrollee.--The term `at-risk 
                enrollee' means an individual enrolled in a group 
                health plan or group or individual health insurance 
                coverage--
                            ``(i) who is 65 years of age or older;
                            ``(ii) who is at least 50 years of age but 
                        not older than 64 years of age with risk 
                        factors for atherosclerosis (such as diabetes 
                        mellitus, a history of smoking, hyperlipidemia, 
                        and hypertension) or a family history of 
                        peripheral artery disease;
                            ``(iii) who is younger than 50 years of age 
                        with diabetes mellitus and one additional risk 
                        factor for atherosclerosis; or
                            ``(iv) with a known atherosclerotic disease 
                        in another vascular bed such as coronary, 
                        carotid, subclavian, renal, or mesenteric 
                        artery stenosis, or abdominal aortic aneurysm.
                    ``(C) Frequency.--The Secretary shall, in 
                consultation with appropriate organizations, establish 
                standards regarding the frequency for peripheral artery 
                disease screening tests described in paragraph (1)(E) 
                for purposes of coverage under this section.
            ``(3) Clarification regarding breast cancer screening, 
        mammography, and prevention recommendations.--For the purposes 
        of this Act, and for the purposes of any other provision of 
        law, the current recommendations of the United States 
        Preventive Service Task Force regarding breast cancer 
        screening, mammography, and prevention shall be considered the 
        most current other than those issued in or around November 
        2009.
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed to prohibit a plan or issuer from providing 
        coverage for services in addition to those recommended by the 
        United States Preventive Services Task Force or to deny 
        coverage for services that are not recommended by such Task 
        Force.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply with respect to plan years beginning on or after 
        January 1, 2022.
    (e) Disallowance of Payment for Nontraumatic Amputation Services 
Furnished Without Anatomical Testing Services.--Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended by adding at the end 
the following new subsection:
    ``(z) Disallowance of Payment for Nontraumatic Amputation Services 
Furnished Without Anatomical Testing Services.--
            ``(1) In general.--In the case of nontraumatic amputation 
        services furnished by a supplier on or after January 1, 2022, 
        to an individual entitled to, or enrolled for, benefits under 
        part A and enrolled for benefits under this part, for which 
        payment is made under this part, payment may only be made under 
        this part if--
                    ``(A) such supplier furnishes anatomical testing 
                services to such individual during the 3-month period 
                preceding the date on which such nontraumatic 
                amputation services is furnished; or
                    ``(B) such individual has a pre-existing 
                dysfunctional or unsalvageable limb, life-threatening 
                sepsis, intractable infection, extensive gangrene or 
                necrotic tissue loss beyond salvage, a poor functional 
                status, severe dementia, or a short life expectancy 
                after shared decision-making with a health care team 
                and patient, family, or caregiver.
            ``(2) Definitions.--In this subsection:
                    ``(A) Anatomical testing services.--The term 
                `anatomical testing services' means arterial duplex 
                scanning, computed tomography angiography, and magnetic 
                resonance angiography.
                    ``(B) Nontraumatic amputation services.--The term 
                `nontraumatic amputation services' means amputations as 
                a result of atherosclerotic vascular disease or a 
                related comorbidity of such disease (including 
                diabetes).''.
    (f) Development and Implementation of Quality Measures.--
            (1) Development.--The Secretary of Health and Human 
        Services (referred to in this subsection as the ``Secretary'') 
        shall, in consultation with relevant stakeholders, develop 
        quality measures for nontraumatic, lower-limb, major amputation 
        that utilize appropriate diagnostic screening (including 
        peripheral artery disease screening) in order to encourage 
        alternative treatments (including revascularization) in lieu of 
        such an amputation.
            (2) Implementation.--After appropriate testing and 
        validation of the measures developed under paragraph (1), the 
        Secretary shall incorporate such measures in quality reporting 
        programs for appropriate providers of services and suppliers 
        under the Medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.), including for purposes 
        of--
                    (A) the merit-based incentive payment system under 
                section 1848(q) of such Act (42 U.S.C. 1395w-4(q));
                    (B) incentive payments for participation in 
                eligible alternative payment models under section 
                1833(z) of such Act (42 U.S.C. 1395l(z));
                    (C) the shared savings program under section 1899 
                of such Act (42 U.S.C. 1395jjj);
                    (D) models under section 1115A of such Act (42 
                U.S.C. 1315a); and
                    (E) such other payment systems or models as the 
                Secretary may specify.

SEC. 7603. ELIMINATING THE COINSURANCE REQUIREMENT FOR CERTAIN 
              COLORECTAL CANCER SCREENING TESTS FURNISHED UNDER THE 
              MEDICARE PROGRAM.

    Section 1833(dd) of the Social Security Act (42 U.S.C. 1395l(dd)) 
is amended--
            (1) in paragraph (1), by striking ``and before January 1, 
        2030,''; and
            (2) in paragraph (2)--
                    (A) in subparagraph (A), by adding ``and'' at the 
                end;
                    (B) in subparagraph (B), by striking ``through 
                2026, 85 percent; and'' and inserting ``and each 
                subsequent year, 100 percent.''; and
                    (C) by striking subparagraph (C).

SEC. 7604. EXPANDING THE AVAILABILITY OF MEDICAL NUTRITION THERAPY 
              SERVICES UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)(V), by striking ``in the case of'' 
        and all that follows through ``organizations''; and
            (2) in subsection (vv)--
                    (A) in paragraph (1)--
                            (i) by striking ``disease management'' and 
                        inserting ``the prevention, management, or 
                        treatment of a disease or condition specified 
                        in paragraph (4)''; and
                            (ii) by striking ``by a physician'' and all 
                        that follows through the period at the end and 
                        inserting the following: ``by a--
                    ``(A) physician (as defined in subsection (r)(1));
                    ``(B) physician assistant;
                    ``(C) nurse practitioner;
                    ``(D) clinical nurse specialist (as defined in 
                subsection (aa)(5)(B)); or
                    ``(E) in the case of such services furnished to 
                manage such a disease or condition that is an eating 
                disorder, a clinical psychologist (as defined by the 
                Secretary).
        Such term shall not include any services furnished to an 
        individual for the prevention, management, or treatment of a 
        renal disease if such individual is receiving maintenance 
        dialysis for which payment is made under section 1881.''; and
                    (B) by adding at the end the following new 
                paragraph:
    ``(4) For purposes of paragraph (1), the diseases and conditions 
specified in this paragraph are the following:
            ``(A) Diabetes and prediabetes.
            ``(B) A renal disease.
            ``(C) Obesity (as defined for purposes of subsection 
        (yy)(2)(C) or as otherwise defined by the Secretary).
            ``(D) Hypertension.
            ``(E) Dyslipidemia.
            ``(F) Malnutrition.
            ``(G) Eating disorders.
            ``(H) Cancer.
            ``(I) Gastrointestinal diseases, including celiac disease.
            ``(J) HIV.
            ``(K) AIDS.
            ``(L) Cardiovascular disease.
            ``(M) Any other disease or condition--
                    ``(i) specified by the Secretary relating to 
                unintentional weight loss;
                    ``(ii) for which the Secretary determines the 
                services described in paragraph (1) to be medically 
                necessary and appropriate for the prevention, 
                management, or treatment of such disease or condition, 
                consistent with any applicable recommendations of the 
                United States Preventive Services Task Force; or
                    ``(iii) for which the Secretary determines the 
                services described in paragraph (1) are medically 
                necessary, consistent with either protocols established 
                by registered dietitians or nutrition professional 
                organizations or with accepted clinical guidelines 
                identified by the Secretary.''.
    (b) Exclusion Modification.--Section 1862(a)(1) is amended--
            (1) in subparagraph (O), by striking ``and'' at the end;
            (2) in subparagraph (P), by striking the semicolon at the 
        end and inserting ``, and''; and
            (3) by adding at the end the following new subparagraph:
            ``(Q) in the case of medical nutrition therapy services (as 
        defined in section 1861(vv)), which are not furnished for the 
        prevention, management, or treatment of a disease or condition 
        specified in paragraph (4) of such section;''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to items and services furnished on or after January 
1, 2023.

SEC. 7605. ENCOURAGING THE DEVELOPMENT AND USE OF DISARM ANTIMICROBIAL 
              DRUGS.

    (a) Additional Payment for DISARM Antimicrobial Drugs Under 
Medicare.--
            (1) In general.--Section 1886(d)(5) of the Social Security 
        Act (42 U.S.C. 1395ww(d)(5)) is amended by adding at the end 
        the following new subparagraph:
    ``(N)(i)(I) Effective for discharges beginning on or after October 
1, 2021, or such sooner date as specified by the Secretary, subject to 
subclause (II), the Secretary shall, after notice and opportunity for 
public comment (in the publications required by subsection (e)(5) for a 
fiscal year or otherwise), provide for an additional payment under a 
mechanism (separate from the mechanism established under subparagraph 
(K)), with respect to such discharges involving any DISARM 
antimicrobial drug, in an amount equal to--
            ``(aa) the amount payable under section 1847A for such drug 
        during the calendar quarter in which the discharge occurred; or
            ``(bb) if no amount for such drug is determined under 
        section 1847A, an amount to be determined by the Secretary in a 
        manner similar to the manner in which payment amounts are 
        determined under section 1847A based on information submitted 
        by the manufacturer or sponsor of such drug (as required under 
        clause (v)).
    ``(II) In determining the amount payable under section 1847A for 
purposes of items (aa) and (bb) of subclause (I), subparagraphs (A) and 
(B) of subsection (b)(1) of such section shall be applied by 
substituting `102 percent' for `106 percent' each place it appears and 
paragraph (8)(B) of such section shall be applied by substituting `2 
percent' for `6 percent'.
    ``(ii) For purposes of this subparagraph, a DISARM antimicrobial 
drug is--
            ``(I) a drug--
                    ``(aa) that--
                            ``(AA) is approved by the Food and Drug 
                        Administration;
                            ``(BB) is designated by the Food and Drug 
                        Administration as a qualified infectious 
                        disease product under subsection (d) of section 
                        505E of the Federal Food, Drug, and Cosmetic 
                        Act; and
                            ``(CC) has received an extension of its 
                        exclusivity period pursuant to subsection (a) 
                        of such section; and
                    ``(bb) that has been designated by the Secretary 
                pursuant to the process established under clause 
                (iv)(I)(bb); or
            ``(II) an antibacterial or antifungal biological product--
                    ``(aa) that is licensed for use, or an 
                antibacterial or antifungal biological product for 
                which an indication is first licensed for use, by the 
                Food and Drug Administration on or after June 5, 2014, 
                under section 351(a) of the Public Health Service Act 
                for human use to treat serious or life-threatening 
                infections, as determined by the Food and Drug 
                Administration, including those caused by, or likely to 
                be caused by--
                            ``(AA) an antibacterial or antifungal 
                        resistant pathogen, including novel or emerging 
                        infectious pathogens; or
                            ``(BB) a qualifying pathogen (as defined 
                        under section 505E(f) of the Federal Food, 
                        Drug, and Cosmetic Act); and
                    ``(bb) has been designated by the Secretary 
                pursuant to the process established under clause 
                (iv)(I)(bb).
    ``(iii) The mechanism established pursuant to clause (i) shall 
provide that the additional payment under clause (i) shall--
            ``(I) with respect to a discharge, only be made to a 
        subsection (d) hospital that, as determined by the Secretary--
                    ``(aa) is participating in the National Healthcare 
                Safety Network Antimicrobial Use and Resistance Module 
                of the Centers for Disease Control and Prevention; and
                    ``(bb) has an antimicrobial stewardship program 
                that aligns with the Core Elements of Hospital 
                Antibiotic Stewardship Programs of the Centers for 
                Disease Control and Prevention or the Antimicrobial 
                Stewardship Standard set by the Joint Commission; and
            ``(II) apply to discharges occurring on or after October 1 
        of the year in which the drug or biological product is 
        designated by the Secretary as a DISARM antimicrobial drug.
For purposes of this clause, in the case of a similar reporting program 
described in item (aa), a subsection (d) hospital shall be treated as 
participating in such a program if the entity maintaining such program 
identifies to the Secretary such hospital as so participating.
    ``(iv)(I) The mechanism established pursuant to clause (i) shall 
provide for a process for--
            ``(aa) a manufacturer or sponsor of a drug or biological 
        product to request the Secretary to designate the drug or 
        biological product as a DISARM antimicrobial drug; and
            ``(bb) the designation (and removal of such designation) by 
        the Secretary of drugs and biological products as DISARM 
        antimicrobial drugs.
    ``(II) A designation of a drug or biological product as a DISARM 
antimicrobial drug may be revoked by the Secretary if the Secretary 
determines that--
            ``(aa) the drug or biological product no longer meets the 
        requirements for a DISARM antimicrobial drug under clause (ii);
            ``(bb) the request for such designation contained an untrue 
        statement of material fact; or
            ``(cc) clinical or other information that was not available 
        to the Secretary at the time such designation was made shows 
        that--
                    ``(AA) such drug or biological product is unsafe 
                for use or not shown to be safe for use for individuals 
                who are entitled to benefits under part A; or
                    ``(BB) an alternative to such drug or biological 
                product is an advance that substantially improves the 
                diagnosis or treatment of such individuals.
    ``(III) Not later than October 1, 2021, the Secretary shall publish 
in the Federal Register a list of the DISARM antimicrobial drugs 
designated under this subparagraph pursuant to the process established 
under subclause (I)(bb). The Secretary shall annually update such list.
    ``(v)(I) For purposes of determining additional payment amounts 
under clause (i), a manufacturer or sponsor of a drug or biological 
product that submits a request described in clause (iv)(I)(aa) shall 
submit to the Secretary information described in section 
1927(b)(3)(A)(iii).
    ``(II) The penalties for failure to provide timely information 
under clause (i) of subparagraph (C) section 1927(b)(3) and for 
providing false information under clause (ii) of such subparagraph 
shall apply to manufacturers and sponsors of a drug or biological 
product under this section with respect to information under subclause 
(I) in the same manner as such penalties apply to manufacturers under 
such clauses with respect to information under subparagraph (A) of such 
section.
    ``(vi)(I) The mechanism established pursuant to clause (i) shall 
provide that--
            ``(aa) except as provided in item (bb), no additional 
        payment shall be made under this subparagraph for discharges 
        involving a DISARM antimicrobial drug if any additional 
        payments have been made for discharges involving such drug as a 
        new medical service or technology under subparagraph (K);
            ``(bb) additional payments may be made under this 
        subparagraph for discharges involving a DISARM antimicrobial 
        drug if any additional payments have been made for discharges 
        occurring prior to the date of enactment of this subparagraph 
        involving such drug as a new medical service or technology 
        under subparagraph (K); and
            ``(cc) no additional payment shall be made under 
        subparagraph (K) for discharges involving a DISARM 
        antimicrobial drug as a new medical service or technology if 
        any additional payments for discharges involving such drug have 
        been made under this subparagraph.''.
            (2) Conforming amendment.--Section 1886(d)(5)(K)(ii)(III) 
        of the Social Security Act (42 U.S.C. 1395ww(d)(5)(K)(ii)(III)) 
        is amended by striking ``provide'' and inserting ``subject to 
        subparagraph (N)(vii), provide''.
    (b) Authorization of Appropriations for the Centers for Disease 
Control and Prevention.--There is authorized to be appropriated to the 
Centers for Disease Control and Prevention $500,000,000, to remain 
available until expended, to support establishment and implementation 
of antimicrobial stewardship programs and data reporting capabilities 
to the Antimicrobial Use and Resistance option of the CDC National 
Healthcare Safety Network, especially in critical access hospitals, 
rural hospitals, and community hospitals, to support detection, 
surveillance, containment, and prevention of resistant pathogens in the 
United States and overseas.
    (c) Study and Reports on Removing Barriers to the Development of 
DISARM Antimicrobial Drugs.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall, in consultation with the Director of the National 
        Institutes of Health, the Commissioner of Food and Drugs, the 
        Administrator of the Centers for Medicare & Medicaid Services, 
        and the Director of the Centers for Disease Control and 
        Prevention, conduct a study over a 5-year period of the 
        barriers that prevent the development of DISARM antimicrobial 
        drugs (as defined in section 1886(d)(5)(N)(ii) of the Social 
        Security Act, as added by subsection (a)), including--
                    (A) patient outcomes in conjunction with the use of 
                DISARM drugs, including--
                            (i) duration of stay in the intensive care 
                        unit;
                            (ii) recidivism within 30 days; and
                            (iii) measures of additional follow up 
                        care;
                    (B) the effectiveness of antimicrobial stewardship 
                and surveillance programs, including--
                            (i) changes in the percentage of hospitals 
                        in the United States with an antimicrobial 
                        stewardship program in place that aligns with 
                        the Core Elements of Hospital Antibiotic 
                        Stewardship Programs, as outlined by the 
                        Centers for Disease Control and Prevention;
                            (ii) changes in inpatient care of 
                        clostridioides difficile infection; and
                            (iii) changes in inpatient rates of 
                        resistance to key pathogens; and
                    (C) considerations relating to Medicare payment 
                reform, including--
                            (i) changes in the number of qualified 
                        antimicrobial products approved;
                            (ii) changes in wholesale acquisition cost 
                        of individual qualified antimicrobial products 
                        over time;
                            (iii) changes in year-over-year volume of 
                        individual qualified antimicrobial products 
                        sold; and
                            (iv) the overall cost of qualified 
                        antimicrobial products to the Medicare program 
                        as a proportion of total Medicare part A 
                        spending.
            (2) Report.--Not later than 5 years after the date of the 
        enactment of this section, the Comptroller General shall submit 
        to Congress a report containing the results of the study 
        conducted under paragraph (1), together with recommendations 
        for such legislation and administrative action as the 
        Comptroller General determines appropriate.

SEC. 7606. TREAT AND REDUCE OBESITY ACT.

    (a) Authority To Expand Health Care Providers Qualified To Furnish 
Intensive Behavioral Therapy.--Section 1861(ddd) of the Social Security 
Act (42 U.S.C. 1395x(ddd)) is amended by adding at the end the 
following new paragraph:
            ``(4)(A) Subject to subparagraph (B), the Secretary may, in 
        addition to qualified primary care physicians and other primary 
        care practitioners, cover intensive behavioral therapy for 
        obesity furnished by any of the following:
                    ``(i) A physician (as defined in subsection (r)(1)) 
                who is not a qualified primary care physician.
                    ``(ii) Any other appropriate health care provider 
                (including a physician assistant, nurse practitioner, 
                or clinical nurse specialist (as those terms are 
                defined in subsection (aa)(5)), a clinical 
                psychologist, a registered dietitian or nutrition 
                professional (as defined in subsection (vv))).
                    ``(iii) An evidence-based, community-based 
                lifestyle counseling program approved by the Secretary.
            ``(B) In the case of intensive behavioral therapy for 
        obesity furnished by a provider described in clause (ii) or 
        (iii) of subparagraph (A), the Secretary may only cover such 
        therapy if such therapy is furnished--
                    ``(i) upon referral from, and in coordination with, 
                a physician or primary care practitioner operating in a 
                primary care setting or any other setting specified by 
                the Secretary; and
                    ``(ii) in an office setting, a hospital outpatient 
                department, a community-based site that complies with 
                the Federal regulations concerning the privacy of 
                individually identifiable health information 
                promulgated under section 264(c) of the Health 
                Insurance Portability and Accountability Act of 1996, 
                or another setting specified by the Secretary.
            ``(C) In order to ensure a collaborative effort, the 
        coordination described in subparagraph (B)(i) shall include the 
        health care provider or lifestyle counseling program 
        communicating to the referring physician or primary care 
        practitioner any recommendations or treatment plans made 
        regarding the therapy.''.
    (b) Medicare Part D Coverage of Obesity Medication.--
            (1) In general.--Section 1860D-2(e)(2)(A) of the Social 
        Security Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended, in the 
        first sentence--
                    (A) by striking ``and other than'' and inserting 
                ``other than''; and
                    (B) by inserting after ``benzodiazepines),'' the 
                following: ``and other than subparagraph (A) of such 
                section if the drug is used for the treatment of 
                obesity (as defined in section 1861(yy)(2)(C)) or for 
                weight loss management for an individual who is 
                overweight (as defined in section 1861(yy)(2)(F)(i)) 
                and has one or more related comorbidities,''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to plan years beginning on or after the date that 
        is 2 years after the date of the enactment of this section.
    (c) Report to Congress.--Not later than the date that is 1 year 
after the date of the enactment of this section, and every 2 years 
thereafter, the Secretary of Health and Human Services shall submit a 
report to Congress describing the steps the Secretary has taken to 
implement the provisions of, and amendments made by, this section. Such 
report shall also include recommendations for better coordination and 
leveraging of programs within the Department of Health and Human 
Services and other Federal agencies that relate in any way to 
supporting appropriate research and clinical care (such as any 
interactions between physicians and other health care providers and 
their patients) to treat, reduce, and prevent obesity in the adult 
population.

SEC. 7607. INCENTIVES, IMPROVEMENTS, AND OUTREACH TO INCREASE DIVERSITY 
              IN ALZHEIMER'S DISEASE RESEARCH.

    (a) Improving Access for and Outreach to Underrepresented 
Populations.--
            (1) Expanding access to alzheimer's research centers.--
                    (A) In general.--Section 445(a)(1) of the Public 
                Health Service Act (42 U.S.C. 285e-2(a)(1)) is 
                amended--
                            (i) by striking ``(a)(1) The Director of 
                        the Institute may'' and inserting the 
                        following:
    ``(a)(1) The Director of the Institute--
            ``(A) may'';
                            (ii) by striking ``disease.'' and inserting 
                        ``disease; and''; and
                            (iii) by adding at the end the following:
            ``(B) beginning January 1, 2022, shall enter into 
        cooperative agreements and make grants to public or private 
        nonprofit entities under this subsection for the planning, 
        establishment, and operation of new such centers that are 
        located in areas with a higher concentration of minority groups 
        (as determined under section 444(d)(3)(D)), such as entities 
        that are historically Black colleges and universities, 
        Hispanic-serving institutions, Tribal colleges and 
        universities, or centers of excellence for other minority 
        populations.''.
                    (B) Use of funding for clinics to operate clinical 
                trials.--Section 445(b) of the Public Health Service 
                Act (42 U.S.C. 285e-2(b)) is amended by adding at the 
                end the following:
    ``(3) Federal payments made under a cooperative agreement or grant 
under subsection (a) from funds made available under section 2(g) of 
the ENACT Act of 2021 shall, with respect to Alzheimer's disease, be 
used in part to establish and operate diagnostic and treatment clinics 
designed--
            ``(A) to meet the special needs of minority and rural 
        populations and other underserved populations; and
            ``(B) to operate clinical trials''.
            (2) Outreach.--
                    (A) Alzheimer's disease centers.--Section 445(b) of 
                the Public Health Service Act (42 U.S.C. 285e-2(b)), as 
                amended by paragraph (1)(B), is further amended by 
                adding at the end the following new paragraph:
    ``(4) Federal payments made under a cooperative agreement or grant 
under subsection (a) shall be used to establish engagement centers to 
carry out public outreach, education efforts, and dissemination of 
information for members of minority groups about clinical trial 
participation. Activities funded pursuant to the preceding sentence 
shall include--
            ``(A) using established mechanisms to encourage members of 
        minority groups to participate in clinical trials on 
        Alzheimer's disease;
            ``(B) expanding education efforts to make members of 
        minority groups aware of ongoing clinical trials;
            ``(C) working with trial sponsors to increase the number of 
        recruitment events for members of minority groups;
            ``(D) conducting outreach to national, State, and local 
        physician professional organizations, especially for members of 
        such organizations who are primary care physicians or 
        physicians who specialize in dementia, to increase awareness of 
        clinical research opportunities for members of minority groups; 
        and
            ``(E) using community-based participatory research 
        methodologies to engage with minority populations.''.
                    (B) Resource centers for minority aging research.--
                Section 444(c) of the Public Health Service Act (42 
                U.S.C. 285e-1(c)) is amended--
                            (i) by striking ``(c)'' and inserting 
                        ``(c)(1)''; and
                            (ii) by adding at the end the following new 
                        paragraph:
    ``(2) The Director, acting through the Resource Centers for 
Minority Aging Research of the Institute, shall carry out public 
outreach, education efforts, and dissemination of information for 
members of minority groups about participation in clinical research on 
Alzheimer's disease carried out or supported under this subpart.''.
    (b) Incentives To Increase Diversity in Alzheimer's Disease 
Research Through Principal Investigators and Researchers From 
Underrepresented Populations.--
            (1) Alzheimer's clinical research and training awards.--
        Section 445I of the Public Health Service Act (42 U.S.C. 285e-
        10a) is amended by adding at the end the following new 
        subsection:
    ``(d) Enhancing the Participation of Principal Investigators and 
Researchers Who Are Members of Underrepresented Populations.--
            ``(1) In general.--The Director shall enhance diversity in 
        the conduct or support of clinical research on Alzheimer's 
        disease under this subpart by encouraging the participation of 
        individuals from groups that are underrepresented in the 
        biomedical, clinical, behavioral, and social sciences as 
        principal investigators of such clinical research, as 
        researchers for such clinical research, or both.
            ``(2) Training for principal investigators.--The Director 
        of the Institute shall provide training for principal 
        investigators who are members of a minority group with respect 
        to skills for--
                    ``(A) the design and conduct of clinical research 
                and clinical protocols;
                    ``(B) applying for grants for clinical research; 
                and
                    ``(C) such other areas as the Director determines 
                to be appropriate.''.
            (2) Senior researcher awards.--Section 445B(a) of the 
        Public Health Service Act (42 U.S.C. 285e-4(a)) is amended by 
        inserting ``, including senior researchers who are members of a 
        minority group'' before the period at the end of the first 
        sentence.
    (c) Incentives To Increase Diversity in Alzheimer's Disease 
Research Through Trial Sites.--Section 444(d) of the Public Health 
Service Act (42 U.S.C. 285e-1(d)) is amended--
            (1) by striking ``(d)'' and inserting ``(d)(1)''; and
            (2) by adding at the end the following new paragraphs:
    ``(2) In conducting or supporting clinical research on Alzheimer's 
disease for purposes of this subpart, in addition to requirements 
otherwise imposed under this title, including under section 492B, the 
Director of the Institute shall increase the participation of members 
of minority groups in such clinical research through one or more of the 
activities described in paragraph (3).
    ``(3)(A) The Director of the Institute shall provide incentives for 
the support of clinical research on Alzheimer's disease with clinical 
trial sites established in areas with a higher concentration of 
minority groups, including rural areas if practicable.
    ``(B) In determining whether to conduct or support clinical 
research on Alzheimer's disease, the Director of the Institute shall 
encourage the conduct of clinical research with clinical trial sites in 
areas described in subparagraph (A) as a higher-level priority 
criterion among the criteria established to evaluate whether to conduct 
or support clinical research.
    ``(C) In determining the amount of funding to be provided for the 
conduct or support of such clinical research, the Director of the 
Institute shall provide additional funding for the conduct of such 
clinical research with clinical trial sites in areas described in 
subparagraph (A).
    ``(D) In determining whether an area is an area with a higher 
concentration of minority groups, the Director of the Institute--
            ``(i) shall consider the most recent data collected by the 
        Bureau of the Census; and
            ``(ii) may also consider--
                    ``(I) data from the Centers for Medicare & Medicaid 
                Services on the incidence of Alzheimer's disease in the 
                United States by region; and
                    ``(II) such other data as the Director determines 
                appropriate.
    ``(4) In order to facilitate the participation of members of 
minority groups in clinical research supported under this subpart, in 
addition to activities described in paragraph (3), the Director of the 
Institute shall--
            ``(A) ensure that such clinical research uses community-
        based participatory research methodologies; and
            ``(B) encourage the use of remote health technologies, 
        including telehealth, remote patient monitoring, and mobile 
        technologies, that reduce or eliminate barriers to 
        participation of members of minority groups in such clinical 
        research.
    ``(5)(A) Clinical research on Alzheimer's disease conducted or 
supported under this subpart shall ensure that such research includes 
outreach activities designed to increase the participation of members 
of minority groups in such research.
    ``(B)(i) Each applicant for a grant under this subpart for clinical 
research on Alzheimer's disease shall submit to the Director of the 
Institute in the application for such grant--
            ``(I) a budget for outreach activities to members of 
        minority populations with respect to participation in such 
        clinical research; and
            ``(II) a description of the plan to conduct such outreach.
    ``(ii) The Director of the Institute shall encourage applicants 
for, and recipients of, grants under this subpart to conduct clinical 
research on Alzheimer's disease to engage with community-based 
organizations to increase participation of minority populations in such 
research.
    ``(6) For purposes of this subpart:
            ``(A) The term `clinical research' includes a clinical 
        trial.
            ``(B) The term `minority group' has the meaning given such 
        term by reason of section 492B(g).''.
    (d) Participant Eligibility Criteria.--Section 445I of the Public 
Health Service Act (42 U.S.C. 285e-10a), as amended by subsection 
(b)(1), is further amended by adding at the end the following new 
subsection:
    ``(e) Participant Eligibility Criteria.--The Director of the 
Institute shall take such actions as are necessary to ensure that 
clinical research on Alzheimer's disease conducted or supported under 
this subpart is designed with eligibility criteria that ensure the 
clinical trial population reflects the diversity of the prospective 
patient population. Such actions may include the following:
            ``(1) Examination of criteria.--
                    ``(A) In general.--An examination of each exclusion 
                criterion to determine if the criterion is necessary to 
                ensure the safety of trial participants or to achieve 
                the study objectives.
                    ``(B) Modification of criteria.--In the case of an 
                exclusion criterion that is not necessary to ensure the 
                safety of trial participants or to achieve the study 
                objectives--
                            ``(i) encouraging the modification or 
                        elimination of the criterion; or
                            ``(ii) encouraging tailoring the criterion 
                        as narrowly as possible to avoid unnecessary 
                        limits to the population of the clinical study.
            ``(2) Requirement for strong justification for exclusion.--
        A review of each exclusion criterion to ensure that populations 
        are included in clinical trials, such as older adults, 
        individuals with a mild form of disease, individuals at the 
        extremes of the weight range, or children, unless there is a 
        strong clinical or scientific justification to exclude them.
            ``(3) Use of adaptive design.--Encouraging the use of an 
        adaptive clinical trial design that--
                    ``(A) starts with a defined population where there 
                are concerns about safety; and
                    ``(B) may expand to a broader population based on 
                initial data from the trial and external data.''.
    (e) Resource Center for Successful Strategies To Increase 
Participation of Underrepresented Populations in Alzheimer's Disease 
Clinical Research.--Section 444 of the Public Health Service Act (42 
U.S.C. 285e-1) is amended by adding at the end the following new 
subsection:
    ``(e)(1) Acting through the Office of Special Populations and in 
consultation with the Division of Extramural Activities, the Director 
of the Institute shall support resource information and technical 
assistance to grantees under section 445 (relating to Alzheimer's 
disease centers), other grantees, and prospective grantees, designed to 
increase the participation of minority populations in clinical research 
on Alzheimer's disease conducted or supported under this subpart.
    ``(2) The resource information and technical assistance provided 
under paragraph (1) shall include the maintenance of a central resource 
library in order to collect, prepare, analyze, and disseminate 
information relating to strategies and best practices used by 
recipients of grants under this subpart and other researchers in the 
development of the clinical research designed to increase the 
participation of minority populations in such clinical research.''.
    (f) Annual Reports.--Section 444 of the Public Health Service Act 
(42 U.S.C. 285e-1), as amended by subsection (e), is further amended by 
adding at the end the following new subsection:
    ``(f)(1)(A) The Director of the Institute shall submit annual 
reports to the Congress on the impact of the amendments made to this 
subpart by the ENACT Act of 2021.
    ``(B) The Secretary shall transmit a copy of each such report to 
the Advisory Council on Alzheimer's Research, Care, and Services 
established under section 2(e) of the National Alzheimer's Project Act 
(Public Law 111-375).
    ``(2) In each report under paragraph (1), the Director of the 
Institute shall include information and data on the following matters 
with respect to clinical trials on Alzheimer's disease conducted during 
the preceding year:
            ``(A) The number of participants who are members of a 
        minority group in such clinical trials.
            ``(B) The number of such clinical trials for which 
        incentives under subsection (d)(3) were made available, the 
        nature of such incentives, the amount of increased funding (if 
        any) made available for research on Alzheimer's disease, and 
        the training provided to principal investigators who are 
        members of a minority group and the amount of funding (if any) 
        for such training.
            ``(C) The number of such clinical trials for which the 
        principal investigator is a member of a minority group.
            ``(D) The number of such clinical trials for which a 
        significant percentage of researchers are members of a minority 
        group.
            ``(E) Modifications to patient eligibility criteria in 
        clinical trial designs under section 445I(e).
            ``(F) Outreach and education efforts conducted under 
        section 445(b)(3).
    ``(3) The Director of the Institute shall make each report under 
paragraph (1) available to the public, including through posting on the 
appropriate website of the Department of Health and Human Services.''.
    (g) Authorization of Appropriations.--For each of fiscal years 2022 
through 2026, there is authorized to be appropriated to the Secretary 
of Health and Human Services $60,000,000 to carry out the amendments 
made by this section, to remain available until expended.

               TITLE VIII--HEALTH INFORMATION TECHNOLOGY

SEC. 8001. DEFINITIONS.

    In this title:
            (1) Certified electronic health record technology.--The 
        term ``certified EHR technology'' has the meaning given such 
        term in section 3000 of the Public Health Service Act (42 
        U.S.C. 300jj).
            (2) EHR.--The term ``EHR'' means an electronic health 
        record.
            (3) Interoperability.--The term ``interoperability'' has 
        the meaning given such term in section 3000 of the Public 
        Health Service Act (42 U.S.C. 300jj). Evaluation and 
        measurement of interoperability shall consider exchange of 
        electronic health information, usability of exchanged 
        electronic health information, effective application and use of 
        the exchanged electronic health information, and impact on 
        outcomes of interoperability.
            (4) Access.--The term ``access'', with respect to health 
        information, means access described in section 164.524 of title 
        45, Code of Federal Regulations (or any successor regulations).
            (5) Certified electronic health record technology; ehr.--
        The terms ``certified electronic health record technology'' and 
        ``EHR'' include the health information infrastructure for 
        interoperability, access, exchange, and use of electronic 
        health information required under title XXX of the Public 
        Health Service Act (42 U.S.C. 300jj et seq.), and are not 
        limited to electronic health records maintained by doctors.

       Subtitle A--Reducing Health Disparities Through Health IT

SEC. 8101. HRSA ASSISTANCE TO HEALTH CENTERS FOR PROMOTION OF HEALTH 
              IT.

    The Secretary of Health and Human Services, acting through the 
Administrator of the Health Resources and Services Administration, 
shall expand and intensify the programs and activities of the 
Administration (directly or through grants or contracts) to provide 
technical assistance and resources to health centers (as defined in 
section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a))) to 
adopt and meaningfully use certified EHR technology for the management 
of chronic diseases and health conditions and reduction of health 
disparities. Funding initiatives may include establishing basic 
connectivity such as 5G internet for telemedicine capabilities, grant 
funding to implement the next generation EHR, and funding for 
technology hardware.

SEC. 8102. ASSESSMENT OF IMPACT OF HEALTH IT ON RACIAL AND ETHNIC 
              MINORITY COMMUNITIES; OUTREACH AND ADOPTION OF HEALTH IT 
              IN SUCH COMMUNITIES.

    (a) National Coordinator for Health Information Technology.--
            (1) In general.--Not later than 18 months after the date of 
        enactment of this Act, the National Coordinator for Health 
        Information Technology (referred to in this title as the 
        ``National Coordinator'') shall--
                    (A) conduct an evaluation of the level of 
                interoperability, access, use, and accessibility of 
                electronic health records in racial and ethnic minority 
                communities, focusing on whether patients in such 
                communities have providers who use electronic health 
                records, and the degree to which patients in such 
                communities can access, exchange, and use without 
                special effort their health information in those 
                electronic health records, and indicating whether such 
                providers--
                            (i) are participating in the Medicare 
                        program under title XVIII of the Social 
                        Security Act (42 U.S.C. 1395 et seq.) or a 
                        State plan under title XIX of such Act (42 
                        U.S.C. 1396 et seq.) (or a waiver of such 
                        plan);
                            (ii) have received incentive payments or 
                        incentive payment adjustments under Medicare 
                        and Medicaid Electronic Health Records 
                        Incentive Programs (as defined in subsection 
                        (c)(2));
                            (iii) are MIPS eligible professionals, as 
                        defined in paragraph (1)(C) of section 1848(q) 
                        of the Social Security Act (42 U.S.C. 1395w-
                        4(q)), for purposes of the Merit-Based 
                        Incentive Payment System under such section; or
                            (iv) have been recruited by any of the 
                        Health Information Technology Regional 
                        Extension Centers established under section 
                        3012 of the Public Health Service Act (42 
                        U.S.C. 300jj-32); and
                    (B) publish the results of such evaluation 
                including the race and ethnicity of such providers and 
                the populations served by such providers.
            (2) Certification criterion.--Not later than 1 year after 
        the date of enactment of this Act, the National Coordinator 
        shall--
                    (A) promulgate a certification criterion and module 
                of certified EHR technology that stratifies quality 
                measures for purposes of the Merit-Based Incentive 
                Payment System by disparity characteristics, including 
                race, ethnicity, language, gender, gender identity, 
                sexual orientation, socio-economic status, and 
                disability status, as such characteristics are defined 
                for purposes of certified EHR technology; and
                    (B) report to the Centers for Medicare & Medicaid 
                Services the quality measures stratified by race and at 
                least 2 other disparity characteristics.
    (b) National Center for Health Statistics.--As soon as practicable 
after the date of enactment of this Act, the Director of the National 
Center for Health Statistics shall provide to Congress a more detailed 
analysis of the data presented in National Center for Health Statistics 
data brief entitled ``Adoption of Certified Electronic Health Record 
Systems and Electronic Information Sharing in Physician Offices: United 
States, 2013 and 2014'' (NCHS Data Brief No. 236).
    (c) Centers for Medicare & Medicaid Services.--
            (1) In general.--As part of the process of collecting 
        information, with respect to a provider, at registration and 
        attestation for purposes of Medicare and Medicaid Electronic 
        Health Records Incentive Programs (as defined in paragraph (2)) 
        or the Merit-Based Incentive Payment System under section 
        1848(q) of the Social Security Act (42 U.S.C. 1395w-4(q)), the 
        Secretary of Health and Human Services shall collect the race 
        and ethnicity of such provider.
            (2) Medicare and medicaid electronic health records 
        incentive programs defined.--For purposes of paragraph (1), the 
        term ``Medicare and Medicaid Electronic Health Records 
        Incentive Programs'' means the incentive programs under section 
        1814(l)(3), subsections (a)(7) and (o) of section 1848, 
        subsections (l) and (m) of section 1853, subsections 
        (b)(3)(B)(ix)(I) and (n) of section 1886, and subsections 
        (a)(3)(F) and (t) of section 1903 of the Social Security Act 
        (42 U.S.C. 1395f(l)(3), 1395w-4, 1395w-23, 1395ww, and 1396b).
    (d) National Coordinator's Assessment of Impact of HIT.--Section 
3001(c)(6)(C) of the Public Health Service Act (42 U.S.C. 300jj-
11(c)(6)(C)) is amended--
            (1) in the heading by inserting ``, racial and ethnic 
        minority communities,'' after ``health disparities'';
            (2) by inserting ``, in communities with a high proportion 
        of individuals from racial and ethnic minority groups (as 
        defined in section 1707(g)), including people with disabilities 
        in such groups,'' after ``communities with health 
        disparities'';
            (3) by striking ``The National Coordinator'' and inserting 
        the following:
                            ``(i) In general.--The National 
                        Coordinator''; and
            (4) by adding at the end the following:
                            ``(ii) Criteria.--In any publication under 
                        clause (i), the National Coordinator shall 
                        include best practices for encouraging 
                        partnerships between the Federal Government, 
                        States, private entities, national nonprofit 
                        intermediaries, and community-based 
                        organizations to expand outreach and education 
                        for and the adoption of certified EHR 
                        technology in communities with a high 
                        proportion of individuals from racial and 
                        ethnic minority groups (as defined in section 
                        1707(g)), while also maintaining the 
                        accessibility requirements of section 508 of 
                        the Rehabilitation Act of 1973 to encourage 
                        patient involvement in patient health care. The 
                        National Coordinator shall--
                                    ``(I) not later than 6 months after 
                                the submission of the report required 
                                under section 8302 of the Health Equity 
                                and Accountability Act of 2022, 
                                establish criteria for evaluating the 
                                impact of health information technology 
                                on communities with a high proportion 
                                of individuals from racial and ethnic 
                                minority groups (as so defined) taking 
                                into account the findings in such 
                                report; and
                                    ``(II) not later than 1 year after 
                                the submission of such report, publish 
                                the results of an evaluation of such 
                                impact.''.

SEC. 8103. NONDISCRIMINATION AND HEALTH EQUITY IN HEALTH INFORMATION 
              TECHNOLOGY.

    (a) In General.--Covered entities shall ensure that electronic and 
information technology in their health programs or activities does not 
exclude individuals from participation in, deny individuals the 
benefits of, or subject individuals to discrimination under any health 
program or activity on the basis of race, color, national origin, sex, 
age, or disability.
    (b) Covered Entities.--In this section, the term ``covered entity'' 
means--
            (1) an entity that operates a health program or activity, 
        any part of which receives Federal financial assistance;
            (2) an entity established under title I of the Patient 
        Protection and Affordable Care Act (Public Law 114-148) that 
        administers a health program or activity; or
            (3) the Department of Health and Human Services.

SEC. 8104. LANGUAGE ACCESS IN HEALTH INFORMATION TECHNOLOGY.

    The National Coordinator shall--
            (1) not later than 18 months after the date of enactment of 
        this Act, propose a rule for providing access to patients, 
        through certified EHR technology, to their personal health 
        information in a computable format, including using patient 
        portals or third-party applications (as described in section 
        3009(e) of the Public Health Service Act (42 U.S.C. 300jj-
        19(e))), in the 10 most common non-English languages;
            (2) hold a public hearing to identify best practices for 
        carrying out paragraph (1); and
            (3) not later than 6 months after the public hearing under 
        paragraph (2), promulgate a final regulation with respect to 
        paragraph (1).

    Subtitle B--Modifications To Achieve Parity in Existing Programs

SEC. 8201. EXTENDING FUNDING TO STRENGTHEN THE HEALTH IT INFRASTRUCTURE 
              IN RACIAL AND ETHNIC MINORITY COMMUNITIES.

    Section 3011 of the Public Health Service Act (42 U.S.C. 300jj-31) 
is amended--
            (1) in subsection (a), in the matter preceding paragraph 
        (1), by inserting ``, including with respect to communities 
        with a high proportion of individuals from racial and ethnic 
        minority groups (as defined in section 1707(g))'' before the 
        colon at the end; and
            (2) by adding at the end the following new subsection:
    ``(e) Annual Report on Expenditures.--The National Coordinator 
shall report annually to Congress on activities and expenditures under 
this section.''.

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.

    Section 3014(e) of the Public Health Service Act (42 U.S.C. 300jj-
34(e)) is amended, in the matter preceding paragraph (1), by inserting 
``, including with respect to communities with a high proportion of 
individuals from racial and ethnic minority groups (as defined in 
section 1707(g))'' after ``health care provider to''.

SEC. 8203. AUTHORIZATION OF APPROPRIATIONS.

    Section 3018 of the Public Health Service Act (42 U.S.C. 300jj-38) 
is amended by striking ``fiscal years 2009 through 2013'' and inserting 
``fiscal years 2023 through 2028''.

              Subtitle C--Additional Research and Studies

SEC. 8301. DATA COLLECTION AND ASSESSMENTS CONDUCTED IN COORDINATION 
              WITH MINORITY-SERVING INSTITUTIONS.

    Section 3001(c)(6) of the Public Health Service Act (42 U.S.C. 
300jj-11(c)(6)) is amended by adding at the end the following new 
subparagraph:
                    ``(F) Data collection and assessments conducted in 
                coordination with minority-serving institutions.--
                            ``(i) In general.--In carrying out 
                        subparagraph (C) with respect to communities 
                        with a high proportion of individuals from 
                        racial and ethnic minority groups (as defined 
                        in section 1707(g)), the National Coordinator 
                        shall, to the greatest extent possible, 
                        coordinate with an entity described in clause 
                        (ii).
                            ``(ii) Minority-serving institutions.--For 
                        purposes of clause (i), an entity described in 
                        this clause is a historically black college or 
                        university, a Hispanic-serving institution, a 
                        Tribal College or University, or an Asian-
                        American-, Native American-, or Pacific 
                        Islander-serving institution with an accredited 
                        public health, health policy, or health 
                        services research program.''.

SEC. 8302. STUDY OF HEALTH INFORMATION TECHNOLOGY IN MEDICALLY 
              UNDERSERVED COMMUNITIES.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act, the Secretary of Health and Human Services shall--
            (1) enter into an agreement with the National Academies of 
        Sciences, Engineering, and Medicine to conduct a study on the 
        development, implementation, and effectiveness of health 
        information technology within medically underserved areas (as 
        described in subsection (c)); and
            (2) submit a report to Congress describing the results of 
        such study, including any recommendations for legislative or 
        administrative action.
    (b) Study.--The study described in subsection (a)(1) shall--
            (1) identify barriers to successful implementation of 
        health information technology in medically underserved areas;
            (2) survey a cross-section of individuals in medically 
        underserved areas and report their opinions about the various 
        topics of study;
            (3) examine the degree of interoperability among health 
        information technology and users of health information 
        technology in medically underserved areas, including patients, 
        providers, and community services;
            (4) examine the impact of health information technology on 
        providing quality care and reducing the cost of care to 
        individuals in such areas, including the impact of such 
        technology on improved health outcomes for individuals, 
        including which technology worked for which population and how 
        it improved health outcomes for that population;
            (5) examine the impact of health information technology on 
        improving health care-related decisions by both patients and 
        providers in such areas;
            (6) identify specific best practices for using health 
        information technology to foster the consistent provision of 
        physical accessibility and reasonable policy accommodations in 
        health care to individuals with disabilities in such areas;
            (7) assess the feasibility and costs associated with the 
        use of health information technology in such areas;
            (8) evaluate whether the adoption and use of qualified 
        electronic health records (as defined in section 3000 of the 
        Public Health Service Act (42 U.S.C. 300jj)) is effective in 
        reducing health disparities, including analysis of clinical 
        quality measures reported by providers who are participating in 
        the Medicare program under title XVIII of the Social Security 
        Act (42 U.S.C. 1395 et seq.) or a State plan under title XIX of 
        such Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan), 
        pursuant to programs to encourage the adoption and use of 
        certified EHR technology;
            (9) identify providers in medically underserved areas that 
        are not electing to adopt and use electronic health records and 
        determine what barriers are preventing those providers from 
        adopting and using such records; and
            (10) examine urban and rural community health systems and 
        determine the impact that health information technology may 
        have on the capacity of primary health providers in those 
        systems.
    (c) Medically Underserved Area.--The term ``medically underserved 
area'' means--
            (1) a population that has been designated as a medically 
        underserved population under section 330(b)(3) of the Public 
        Health Service Act (42 U.S.C. 254b(b)(3));
            (2) an area that has been designated as a health 
        professional shortage area under section 332 of the Public 
        Health Service Act (42 U.S.C. 254e);
            (3) an area or population that has been designated as a 
        medically underserved community under section 799B of the 
        Public Health Service Act (42 U.S.C. 295p); or
            (4) another area or population that--
                    (A) experiences significant barriers to accessing 
                quality health services; and
                    (B) has a high prevalence of diseases or conditions 
                described in title VII, with such diseases or 
                conditions having a disproportionate impact on racial 
                and ethnic minority groups (as defined in section 
                1707(g) of the Public Health Service Act (42 U.S.C. 
                300u-6(g))) or a subgroup of people with disabilities 
                who have specific functional impairments.

SEC. 8303. ASSESSMENT OF USE AND MISUSE OF DE-IDENTIFIED HEALTH DATA.

    (a) In General.--Not later than 18 months after the date of 
enactment of this Act, the Secretary of Health and Human Services 
shall--
            (1) enter into an agreement with the Office of the National 
        Coordinator to conduct a study, in consultation with relevant 
        stakeholders, on the impact of digital health technology on 
        medically underserved areas (as described in section 8302(c)); 
        and
            (2) submit a report to Congress describing the results of 
        such study, including any recommendations for legislative or 
        administrative action.
    (b) Study.--The study described in subsection (a)(1) shall--
            (1) examine the overall prevalence, and historical and 
        existing practices and their respective prevalence, of use and 
        misuse of de-identified protected health information, as 
        defined in section 160.103, title 45, Code of Federal 
        Regulations (or any successor regulations), to discriminate 
        against or benefit medically underserved areas;
            (2) identify best practices and tools to leverage the 
        benefits and prevent misuse of de-identified protected health 
        information to discriminate against medically underserved 
        areas;
            (3) examine the overall prevalence, and historical and 
        existing practices and their respective prevalence, of use and 
        misuse of de-identified personal health information other than 
        protected health information, as defined in section 160.103, 
        title 45, Code of Federal Regulations (or any successor 
        regulations), to discriminate against or benefit medically 
        underserved areas; and
            (4) identify best practices and tools to leverage the 
        benefits and prevent misuse of de-identified personal health 
        information other than protected health information to 
        discriminate against medically underserved areas.

      Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs

SEC. 8401. EXTENDING MEDICAID EHR INCENTIVE PAYMENTS TO REHABILITATION 
              FACILITIES, LONG-TERM CARE FACILITIES, AND HOME HEALTH 
              AGENCIES.

     (a) In General.--Section 1903(t)(2)(B) of the Social Security Act 
(42 U.S.C. 1396b(t)(2)(B)) is amended--
            (1) in clause (i), by striking ``, or'' and inserting a 
        semicolon;
            (2) in clause (ii), by striking the period at the end and 
        inserting a semicolon; and
            (3) by inserting after clause (ii) the following new 
        clauses:
            ``(iii) a rehabilitation facility (as defined in section 
        1886(j)(1)) that furnishes acute or subacute rehabilitation 
        services;
            ``(iv) a long-term care hospital (as defined in section 
        1886(d)(1)(B)(iv)); or
            ``(v) a home health agency (as defined in section 
        1861(o)).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to amounts expended under section 1903(a)(3)(F) of 
the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar 
quarters beginning on or after the date of the enactment of this Act.

SEC. 8402. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY FOR MEDICAID 
              ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS.

    (a) In General.--Section 1903(t)(3)(B)(v) of the Social Security 
Act (42 U.S.C. 1396b(t)(3)(B)(v)) is amended to read as follows:
                    ``(v) physician assistant.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to amounts expended under section 1903(a)(3)(F) of 
the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar 
quarters beginning on or after the date of the enactment of this Act.

          Subtitle E--Expanding Access to Telehealth Services

SEC. 8501. REMOVING GEOGRAPHIC REQUIREMENTS FOR TELEHEALTH SERVICES.

    Section 1834(m)(4)(C) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by inserting ``and clause (iii)'' after ``and (9)''; and
            (2) by adding at the end the following new clause:
                            ``(iii) Removal of geographic 
                        requirements.--The geographic requirements 
                        described in clause (i) shall not apply with 
                        respect to telehealth services furnished on or 
                        after the date of the enactment of this 
                        clause.''.

SEC. 8502. EXPANDING ORIGINATING SITES.

    (a) Expanding the Home as an Originating Site.--Section 
1834(m)(4)(C)(ii)(X) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(ii)(X)) is amended to read as follows:
                                    ``(X)(aa) Prior to the date of 
                                enactment of the Health Equity and 
                                Accountability Act of 2022, the home of 
                                an individual but only for purposes of 
                                section 1881(b)(3)(B) or telehealth 
                                services described in paragraph (7).
                                    ``(bb) On or after such date of 
                                enactment, the home of an 
                                individual.''.
    (b) Allowing Additional Originating Sites.--Section 
1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(ii)) is amended by adding at the end the following new 
subclause:
                                    ``(XII) Any other site determined 
                                appropriate by the Secretary at which 
                                an eligible telehealth individual is 
                                located at the time a telehealth 
                                service is furnished via a 
                                telecommunications system.''.
    (c) Parameters for New Originating Sites.--Section 1834(m)(4)(C) of 
the Social Security Act (42 U.S.C. 1395m(m)(4)(C)), as amended by 
section 102, is amended by adding at the end the following new clause:
                            ``(iv) Requirements for new sites.--
                                    ``(I) In general.--The Secretary 
                                may establish requirements for the 
                                furnishing of telehealth services at 
                                sites described in clause (ii)(XII) to 
                                provide for beneficiary and program 
                                integrity protections.
                                    ``(II) Clarification.--Nothing in 
                                this clause shall be construed to 
                                preclude the Secretary from 
                                establishing requirements for other 
                                originating sites described in clause 
                                (ii)''.
    (d) No Originating Site Facility Fee for New Sites.--Section 
1834(m)(2)(B)(ii) of the Social Security Act (42 U.S.C. 
1395m(m)(2)(B)(ii)) is amended--
            (1) in the heading, by striking ``if originating site is 
        the home'' and inserting ``for certain sites''; and
            (2) by striking ``paragraph (4)(C)(ii)(X)'' and inserting 
        ``subclause (X) or (XII) of paragraph (4)(C)''.

                TITLE IX--ACCOUNTABILITY AND EVALUATION

SEC. 9001. PROHIBITION ON DISCRIMINATION IN FEDERAL ASSISTED HEALTH 
              CARE SERVICES AND RESEARCH ON THE BASIS OF SEX (INCLUDING 
              SEXUAL ORIENTATION, GENDER IDENTITY, AND PREGNANCY, 
              INCLUDING TERMINATION OF PREGNANCY), RACE, COLOR, 
              NATIONAL ORIGIN, MARITAL STATUS, FAMILIAL STATUS, OR 
              DISABILITY STATUS.

    (a) In General.--No person in the United States shall, on the basis 
of sex (including sexual orientation, gender identity, and pregnancy, 
including termination of pregnancy), race, color, national origin, 
marital status, familial status, sexual orientation, gender identity, 
or disability status, be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under--
            (1) any health program or activity, including any health 
        research program or activity, receiving Federal financial 
        assistance, including credits, subsidies, or contracts of 
        insurance; or
            (2) any health program or activity that is administered by 
        an executive agency.
    (b) Definition.--In this section, the term ``familial status'' 
means, with respect to one or more individuals--
            (1) being domiciled with any individual related by blood or 
        affinity whose close association with the individual is the 
        equivalent of a family relationship;
            (2) being in the process of securing legal custody of any 
        individual; or
            (3) being pregnant.

SEC. 9002. TREATMENT OF MEDICARE PAYMENTS UNDER TITLE VI OF THE CIVIL 
              RIGHTS ACT OF 1964.

    For the purposes of title VI of the Civil Rights Act of 1964 (42 
U.S.C. 2000d-1 et seq.), a payment made under part A, B, C, or D of 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to a 
provider of services, physician, or other supplier (including a payment 
made to a subcontractor of the provider of services, physician, or 
other supplier) shall be deemed a grant, not a contract of insurance or 
guaranty.

SEC. 9003. ACCOUNTABILITY AND TRANSPARENCY WITHIN THE DEPARTMENT OF 
              HEALTH AND HUMAN SERVICES.

    Title XXXIV of the Public Health Service Act, as amended by titles 
I, II, III, and IV of this Act, is further amended by inserting after 
subtitle C the following:

               ``Subtitle E--Strengthening Accountability

``SEC. 3451. ELEVATION OF THE OFFICE FOR CIVIL RIGHTS AND HEALTH 
              EQUITY.

    ``(a) In General.--
            ``(1) Name of office.--Beginning on the date of enactment 
        of this Act, the Office for Civil Rights of the Department of 
        Health and Human Services shall be known as the `Office for 
        Civil Rights and Health Equity' of the Department of Health and 
        Human Services. Any reference to the Office for Civil Rights of 
        the Department of Health and Human Services in any law, 
        regulation, map, document, record, or other paper of the United 
        States shall be deemed to be a reference to the Office for 
        Civil Rights and Health Equity.
            ``(2) Head of office.--The head of the Office for Civil 
        Rights and Health Equity shall be the Director for Civil Rights 
        and Health Equity, to be appointed by the President. Any 
        reference to the Director of the Office for Civil Rights of the 
        Department of Health and Human Services in any law, regulation, 
        map, document, record, or other paper of the United States 
        shall be deemed to be a reference to the Director for Civil 
        Rights and Health Equity.
    ``(b) Purpose.--The Director for Civil Rights and Health Equity 
shall ensure that the health programs, activities, policies, projects, 
procedures, and operations of health entities that receive Federal 
financial assistance are in compliance with title VI of the Civil 
Rights Act of 1964, including through the following activities:
            ``(1) The development and implementation of an action plan 
        to address racial and ethnic health care disparities. Such plan 
        shall--
                    ``(A) address concerns relating to the Office for 
                Civil Rights and Health Equity as released by the 
                United States Commission on Civil Rights in the report 
                entitled `Health Care Challenge: Acknowledging 
                Disparity, Confronting Discrimination, and Ensuring 
                Equity' (September 1999), in conjunction with existing 
                and future reports of the National Academy of Medicine 
                (formerly known as the Institute of Medicine) including 
                the reports titled `Unequal Treatment: Confronting 
                Racial and Ethnic Disparities in Health Care', 
                `Crossing the Quality Chasm: A New Health System for 
                the 21st Century', `In the Nation's Compelling 
                Interest: Ensuring Diversity in the Health Care 
                Workforce', `The National Partnership for Action to End 
                Health Disparities', and `The Health of Lesbian, Gay, 
                Bisexual, and Transgender People', and other related 
                reports of the National Academies of Sciences, 
                Engineering, and Medicine;
                    ``(B) be issued in proposed form for public review 
                and comment; and
                    ``(C) be finalized taking into consideration any 
                comments or concerns that are received by the Office.
            ``(2) Investigative and enforcement actions against 
        intentional or in effect discrimination and policies and 
        practices that have a disparate impact on racial or ethnic 
        minorities and communities of color pursuant to section 9007 of 
        the Health Equity and Accountability Act of 2022.
            ``(3) The review of racial, ethnic, gender identity, sexual 
        orientation, sex, disability status, socioeconomic status, and 
        primary language health data collected by Federal health 
        agencies to assess health care disparities related to 
        intentional discrimination and policies and practices that have 
        a disparate impact on minorities. Such review shall include an 
        assessment of health disparities in communities with a 
        combination of these classes.
            ``(4) Outreach and education activities relating to 
        compliance with title VI of the Civil Rights Act, including the 
        process of filing a complaint.
            ``(5) The provision of technical assistance for health 
        entities to facilitate compliance with title VI of the Civil 
        Rights Act.
            ``(6) Coordination and oversight of activities of the civil 
        rights compliance offices established under section 3452.
            ``(7) Ensuring--
                    ``(A) at a minimum, compliance with the most recent 
                version of the Office of Management and Budget 
                statistical policy directive entitled `Standards for 
                Maintaining, Collecting, and Presenting Federal Data on 
                Race and Ethnicity'; and
                    ``(B) consideration of available data and language 
                standards such as--
                            ``(i) the standards for collecting, 
                        monitoring, and reporting data under section 
                        3101; and
                            ``(ii) the National Standards on Culturally 
                        and Linguistically Appropriate Services of the 
                        Office of Minority Health.
    ``(c) Funding and Staff.--The Secretary shall ensure the 
effectiveness of the Office for Civil Rights and Health Equity by 
ensuring that the Office is provided with--
            ``(1) adequate funding to enable the Office to carry out 
        its duties under this section; and
            ``(2) staff with expertise in--
                    ``(A) epidemiology;
                    ``(B) statistics;
                    ``(C) health quality assurance;
                    ``(D) minority health and health disparities;
                    ``(E) health equity;
                    ``(F) cultural and linguistic competency;
                    ``(G) civil rights; and
                    ``(H) social, political, mental, behavioral, 
                economic, and related determinants of health, including 
                education access and quality, health care access and 
                quality, neighborhood and built environment, and social 
                and community context.
    ``(d) Advisory Board.--
            ``(1) Establishment.--The Secretary, in collaboration with 
        the Director Civil Rights and Health Equity and the Deputy 
        Assistant Secretary for Minority Health, shall establish an 
        advisory board (in this subsection referred to as the `advisory 
        board') to report in accordance with paragraph (2).
            ``(2) Reports to congress.--Not later than December 31, 
        2023, and annually thereafter, the advisory board shall publish 
        and submit to the Office, other Federal agencies, and the 
        Congress a report that includes--
                    ``(A) the number of complaints filed during the 
                reporting period under title VI of the Civil Rights 
                Act, broken down by category;
                    ``(B) the number of such complaints investigated 
                and closed by the Office;
                    ``(C) the outcomes of such complaints investigated;
                    ``(D) the staffing levels of the Office including 
                staff credentials;
                    ``(E) the number of such complaints that are 
                pending (including backlogged complaints) in which 
                civil rights inequities can be demonstrated and an 
                explanation of why such complaints remain pending; and
                    ``(F) trends among filed complaints and other 
                systemic patterns or themes, including an analysis from 
                the Department of Justice about litigation concerning 
                such complaints.
            ``(3) Composition.--The members of the advisory board shall 
        include--
                    ``(A) representatives of stakeholders; and
                    ``(B) subject matter- and disciplinary-appropriate 
                experts.
    ``(e) 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 2023 through 2027.

``SEC. 3452. ESTABLISHMENT OF HEALTH PROGRAM OFFICES FOR CIVIL RIGHTS 
              WITHIN AGENCIES OF DEPARTMENT OF HEALTH AND HUMAN 
              SERVICES.

    ``(a) In General.--The Secretary shall establish civil rights 
compliance offices in each agency within the Department of Health and 
Human Services that administers health programs.
    ``(b) Purpose of Offices.--Each office established under subsection 
(a) shall ensure that recipients of Federal financial assistance under 
Federal health programs administer programs, and determine and 
implement policies, services, and activities, in a manner that--
            ``(1) does not discriminate, either intentionally or in 
        effect, on the basis of race, color, national origin, language, 
        ethnicity, sex, age, disability status, sexual orientation, or 
        gender identity; and
            ``(2) promotes the reduction and elimination of disparities 
        in health and health care based on race, color, national 
        origin, language, ethnicity, sex, age, disability status, 
        sexual orientation, or gender identity.
    ``(c) Powers and Duties.--The offices established in subsection (a) 
shall, with respect to the applicable agency, have the following powers 
and duties:
            ``(1) The establishment of compliance and program 
        participation standards for recipients of Federal financial 
        assistance under each program administered by the agency, 
        including the establishment of disparity reduction standards to 
        encompass disparities in health and health care related to 
        race, color, national origin, language, ethnicity, sex, age, 
        disability, sexual orientation, or gender identity.
            ``(2) The development and implementation of policies, 
        procedures, and program-specific guidelines that interpret and 
        apply Department of Health and Human Services guidance under 
        title VI of the Civil Rights Act of 1964 and section 1557 of 
        the Patient Protection and Affordable Care Act to each Federal 
        health program administered by the agency.
            ``(3) The development of a disparity-reduction impact 
        analysis methodology that shall--
                    ``(A) be applied to every rule issued by the agency 
                and published as part of the formal rulemaking process 
                under sections 555, 556, and 557 of title 5, United 
                States Code; and
                    ``(B) include an analysis of the intersecting forms 
                of discrimination.
            ``(4) Oversight of data collection, reporting, analysis, 
        and publication requirements for all recipients of Federal 
        financial assistance under each Federal health program 
        administered by the agency; compliance with, at a minimum, the 
        most recent version of the Office of Management and Budget 
        statistical policy directive entitled `Standards for 
        Maintaining, Collecting, and Presenting Federal Data on Race 
        and Ethnicity'; and consideration of available data and 
        language standards such as--
                    ``(A) the standards for collecting and reporting 
                data under section 3101;
                    ``(B) the National Standards on Culturally and 
                Linguistically Appropriate Services of the Office of 
                Minority Health; and
                    ``(C) the disaggregation of all health and health 
                care data by racial and ethnic minority population 
                group.
            ``(5) The conduct of publicly available studies regarding 
        discrimination within Federal health programs administered by 
        the agency as well as disparity reduction initiatives by 
        recipients of Federal financial assistance under Federal health 
        programs.
            ``(6) Annual reports 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 on the progress 
        in reducing disparities in health and health care through the 
        Federal programs administered by the agency.
    ``(d) Relationship to Office for Civil Rights in the Department of 
Justice.--
            ``(1) Department of health and human services.--The Office 
        for Civil Rights of the Department of Health and Human Services 
        shall provide standard-setting and compliance review 
        investigation support services to each civil rights compliance 
        office established under subsection (a), subject to paragraph 
        (2).
            ``(2) Department of justice.--The Office for Civil Rights 
        of the Department of Justice may, as appropriate, institute 
        formal proceedings when a civil rights compliance office 
        established under subsection (a) determines that a recipient of 
        Federal financial assistance is not in compliance with the 
        disparity reduction standards of the applicable agency.
    ``(e) Definition.--In this section, the term `Federal health 
programs' mean programs--
            ``(1) under the Social Security Act (42 U.S.C. 301 et seq.) 
        that pay for health care and services; and
            ``(2) under this Act that--
                    ``(A) provide Federal financial assistance for 
                health care, biomedical research, or health services 
                research; or
                    ``(B) are designed to improve the public's health, 
                including health service programs.''.

SEC. 9004. UNITED STATES COMMISSION ON CIVIL RIGHTS.

    (a) Coordination Within Department of Justice of Activities 
Regarding Health Disparities.--Section 3(a) of the Civil Rights 
Commission Act of 1983 (42 U.S.C. 1975a(a)) is amended--
            (1) in paragraph (1), by striking ``and'' at the end;
            (2) in paragraph (2), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
            ``(3) shall, with respect to activities carried out in 
        health care and correctional facilities toward the goal of 
        eliminating health disparities between the general population 
        and members of minority groups based on race or color, promote 
        coordination of such activities of--
                    ``(A) the Office for Civil Rights within the Office 
                of Justice Programs of the Department of Justice;
                    ``(B) the Office of Justice Programs within the 
                Department of Justice;
                    ``(C) the Office for Civil Rights within the 
                Department of Health and Human Services; and
                    ``(D) the Office of Minority Health within the 
                Department of Health and Human Services (headed by the 
                Deputy Assistant Secretary for Minority Health).''.
    (b) Authorization of Appropriations.--Section 5 of the Civil Rights 
Commission Act of 1983 (42 U.S.C. 1975c) is amended by striking the 
first sentence and inserting the following: ``For the purpose of 
carrying out this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2023, and such sums as may be necessary for 
each of the fiscal years 2024 through 2028.''.

SEC. 9005. SENSE OF CONGRESS CONCERNING FULL FUNDING OF ACTIVITIES TO 
              ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES.

    (a) Findings.--The Congress makes the following findings:
            (1) The health status of the population of the United 
        States is declining, and the United States currently ranks 
        below most industrialized nations in health status measured by 
        longevity, sickness, and mortality.
            (2) Racial and ethnic minority populations tend to have the 
        poorest health status and face substantial cultural, social, 
        political, and economic barriers to obtaining high-quality 
        health care.
            (3) Racial and ethnic minority populations experience and 
        suffer from the extreme and egregious health disparities and 
        inequities that are caused by racism, discrimination, and 
        implicit racial and ethnic bias in and throughout the health 
        care system.
            (4) Communities of color with intersecting identities and 
        backgrounds, including children, older adults, women, people 
        with disabilities, people with limited English proficiency, 
        immigrants, lesbian, gay, bisexual, transgender, queer, and 
        questioning populations, and people with lower incomes 
        experience significant personal and structural barriers to 
        obtaining affordable, high-quality health care.
            (5) Efforts to reduce and eliminate racial and ethnic 
        health disparities and inequities, and improve minority health, 
        have been limited by inadequate resources (funding, staffing, 
        and stewardship), a lack of prioritization, and a lack of 
        accountability from the Federal Government, particularly due to 
        stagnant or declining appropriations that are not in line with 
        the dire need faced by communities that are impacted.
    (b) Sense of Congress.--It is the sense of the Congress that--
            (1) health disparities negatively impact outcomes for 
        health and human security of the Nation;
            (2) reducing racial, ethnic, age, sexual, and gender 
        disparities in prevention and treatment are unique civil and 
        human rights challenges and, as such, Federal agencies and 
        health care entities and systems receiving Federal funds should 
        be accountable for their role in causing disparities and 
        inequity;
            (3) funding for the National Institute on Minority Health 
        and Health Disparities, the Office of Civil Rights in the 
        Department of Health and Human Services, the National Institute 
        of Nursing Research, and the Office of Minority Health should 
        be doubled by fiscal year 2023, to effectively address racial 
        and ethnic disparities elimination in health and health care as 
        a matter of health and national security;
            (4) adequate funding by fiscal year 2023, and subsequent 
        funding increases, should be provided for health and human 
        service professions training programs, the Racial and Ethnic 
        Approaches to Community Health Initiative at the Centers for 
        Disease Control and Prevention, the Minority HIV/AIDS 
        Initiative, the Excellence Centers to Eliminate Ethnic/Racial 
        Disparities Program at the Agency for Healthcare Research and 
        Quality, and the National Health Service Corps Scholarship 
        Program initiatives, programs, policies, projects, and 
        activities that are the backbone of the Nation's agenda to 
        eliminate racial and ethnic health disparities and inequities;
            (5) adequate funding for fiscal year 2023 and increased 
        funding for future years should be provided for the Racial and 
        Ethnic Approaches to Community Health Initiative's United 
        States Risk Factor Survey to ensure adequate data collection to 
        track health disparities, and there should be appropriate 
        avenues provided to disseminate findings to the general public;
            (6) current and newly created health disparity elimination 
        incentives, programs, agencies, and departments under this Act 
        (and the amendments made by this Act) should receive adequate 
        staffing and funding by fiscal year 2023; and
            (7) stewardship and accountability should be provided to 
        the Congress and the President for measurable and sustainable 
        progress toward health disparity elimination under programs 
        under this Act, including increased data collection and 
        reporting, capacity building for impacted communities, 
        technical assistance, training programs, and avenues to 
        disseminate program details and successes to the public and to 
        policymakers.

SEC. 9006. GAO AND NIH REPORTS.

    (a) GAO Report on NIH Grant Racial and Ethnic Diversity.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study on the racial and ethnic diversity 
        among the following groups:
                    (A) All applicants for grants, contracts, and 
                cooperative agreements awarded by the National 
                Institutes of Health during the period beginning on 
                January 1, 2023, and ending December 31, 2032.
                    (B) All recipients of such grants, contracts, and 
                cooperative agreements during such period.
                    (C) All members of the peer review panels of such 
                applicants and recipients, respectively.
            (2) Report.--Not later than 6 months after the date of 
        enactment of this Act, the Comptroller General shall complete 
        the study under paragraph (1) and submit to the Congress a 
        report containing the results of such study.
    (b) NIH Report on Certain Authority of National Institute on 
Minority Health and Health Disparities.--Not later than 6 months after 
the date of enactment of this Act, and biennially thereafter, the 
Director of the National Institutes of Health, in collaboration with 
the Director of the National Institute on Minority Health and Health 
Disparities, shall submit to the Congress a report that details and 
evaluates--
            (1) the steps taken during the applicable report period by 
        the Director of the National Institutes of Health to plan, 
        coordinate, review, and evaluate all minority health and health 
        disparity research that is conducted or supported by the 
        institutes and centers at the National Institutes of Health; 
        and
            (2) the outcomes of such steps.
    (c) GAO Report Related to Recipients of PPACA Funding.--Not later 
than one year after the date of enactment of this Act and biennially 
thereafter, the Comptroller General of the United States shall submit 
to the Congress a report that identifies--
            (1) the racial and ethnic diversity of community-based 
        organizations that applied for Federal enrollment funding 
        provided pursuant to the Patient Protection and Affordable Care 
        Act (Public Law 111-148) (including the amendments made by such 
        Act);
            (2) the percentage of such organizations that were awarded 
        such funding; and
            (3) the impact of such community-based organizations' 
        enrollment efforts on the insurance status of their 
        communities.
    (d) Annual Report on Activities of National Institute on Minority 
Health and Health Disparities.--The Director of the National Institute 
on Minority Health and Health Disparities shall prepare an annual 
report on the activities carried out or to be carried out by such 
institute, and shall submit each such report to the Committee on 
Health, Education, Labor, and Pensions of the Senate, the Committee on 
Energy and Commerce of the House of Representatives, the Secretary of 
Health and Human Services, and the Director of the National Institutes 
of Health. With respect to the fiscal year involved, the report shall--
            (1) describe and evaluate the progress made in health 
        disparities research conducted or supported by institutes and 
        centers of the National Institutes of Health;
            (2) summarize and analyze expenditures made for activities 
        with respect to health disparities research conducted or 
        supported by the National Institutes of Health;
            (3) include a separate statement applying the requirements 
        of paragraphs (1) and (2) specifically to minority health 
        disparities research; and
            (4) contain such recommendations as the Director of the 
        Institute considers appropriate.

SEC. 9007. INVESTIGATIVE AND ENFORCEMENT ACTIONS.

    (a) In General.--In carrying out the investigative and enforcement 
actions of section 3451(b)(2) of the Public Health Service Act, as 
added by section 9003 of this Act, the Director for Civil Rights and 
Health Equity shall pursue such investigative and enforcements actions 
pursuant to this section.
    (b) Administrative Complaint and Conciliation Process.--
            (1) Complaints and answers.--
                    (A) In general.--An aggrieved person may, not later 
                than 1 year after an alleged violation of subsection 
                (a) has occurred or concluded, file a complaint with 
                the Director alleging inequitable provision of health 
                care by a provider described in subsection (a).
                    (B) Complaint.--A complaint submitted pursuant to 
                subparagraph (A) shall be in writing and shall contain 
                such information and be in such form as the Director 
                requires.
                    (C) Oath or affirmation.--The complaint and any 
                answer made under this subsection shall be made under 
                oath or affirmation, and may be reasonably and fairly 
                modified at any time.
            (2) Response to complaints.--
                    (A) In general.--Upon the filing of a complaint 
                under this subsection, the following procedures shall 
                apply:
                            (i) Complainant notice.--The Director shall 
                        serve notice upon the complainant acknowledging 
                        receipt of such filing and advising the 
                        complainant of the time limits and procedures 
                        provided under this section.
                            (ii) Respondent notice.--The Director 
                        shall, not later than 30 days after receipt of 
                        such filing--
                                    (I) serve on the respondent a 
                                notice of the complaint, together with 
                                a copy of the original complaint; and
                                    (II) advise the respondent of the 
                                procedural rights and obligations of 
                                respondents under this section.
                            (iii) Answer.--The respondent may file, not 
                        later than 60 days after receipt of the notice 
                        from the Director, an answer to such complaint.
                            (iv) Investigative duties.--The Director 
                        shall--
                                    (I) make an investigation of the 
                                alleged inequitable provision of health 
                                care; and
                                    (II) complete such investigation 
                                within 180 days (unless it is 
                                impracticable to complete such 
                                investigation within 180 days) after 
                                the filing of the complaint.
                    (B) Investigations.--
                            (i) Pattern or practice.--In the course of 
                        investigating the complaint, the Director may 
                        seek records of care provided to patients other 
                        than the complainant if necessary to 
                        demonstrate or disprove an allegation of 
                        inequitable provision of health care or to 
                        determine whether there is a pattern or 
                        practice of such care.
                            (ii) Accounting for social determinants of 
                        health.--In investigating the complaint and 
                        reaching a determination on the validity of the 
                        complaint, the Director shall account for 
                        social determinants of health and the effect of 
                        such social determinants on health care 
                        outcomes.
                            (iii) Inability to complete 
                        investigation.--If the Director is unable to 
                        complete (or finds it is impracticable to 
                        complete) the investigation within 180 days 
                        after the filing of the complaint (or, if the 
                        Secretary takes further action under paragraph 
                        (6)(B) with respect to a complaint, within 180 
                        days after the commencement of such further 
                        action), the Director shall notify the 
                        complainant and respondent in writing of the 
                        reasons involved.
                            (iv) Report to state licensing 
                        authorities.--On concluding each investigation 
                        under this subparagraph, the Director shall 
                        provide to the State licensing authorities that 
                        were notified under subparagraph (A), 
                        information specifying the results of the 
                        investigation.
                    (C) Report.--
                            (i) Final report.--On completing each 
                        investigation under this paragraph, the 
                        Director shall prepare a final investigative 
                        report.
                            (ii) Modification of report.--A final 
                        report under this subparagraph may be modified 
                        if additional evidence is later discovered.
            (3) Conciliation.--
                    (A) In general.--During the period beginning on the 
                date on which a complaint is filed under this 
                subsection and ending on the date of final disposition 
                of such complaint (including during an investigation 
                under paragraph (2)(B)), the Director shall, to the 
                extent feasible, engage in conciliation with respect to 
                such complaint.
                    (B) Conciliation agreement.--A conciliation 
                agreement arising out of such conciliation shall be an 
                agreement between the respondent and the complainant, 
                and shall be subject to approval by the Director.
                    (C) Rights protected.--The Director shall approve a 
                conciliation agreement only if the agreement protects 
                the rights of the complainant and other persons 
                similarly situated.
                    (D) Publicly available agreement.--
                            (i) In general.--Subject to clause (ii), 
                        the Secretary shall make available to the 
                        public a copy of a conciliation agreement 
                        entered into pursuant to this subsection unless 
                        the complainant and respondent otherwise agree, 
                        and the Secretary determines, that disclosure 
                        is not required to further the purposes of this 
                        subsection.
                            (ii) Limitation.--A conciliation agreement 
                        that is made available to the public pursuant 
                        to clause (i) may not disclose individually 
                        identifiable health information.
            (4) Failure to comply with conciliation agreement.--
        Whenever the Director has reasonable cause to believe that a 
        respondent has breached a conciliation agreement, the Director 
        shall refer the matter to the Attorney General to consider 
        filing a civil action to enforce such agreement.
            (5) Written consent for disclosure of information.--Nothing 
        said or done in the course of conciliation under this 
        subsection may be made public, or used as evidence in a 
        subsequent proceeding under this subsection, without the 
        written consent of the parties to the conciliation.
            (6) Prompt judicial action.--
                    (A) In general.--If the Director determines at any 
                time following the filing of a complaint under this 
                subsection that prompt judicial action is necessary to 
                carry out the purposes of this subsection, the Director 
                may recommend that the Attorney General promptly 
                commence a civil action under subsection (d).
                    (B) Immediate suit.--If the Director determines at 
                any time following the filing of a complaint under this 
                subsection that the public interest would be served by 
                allowing the complainant to bring a civil action under 
                subsection (c) in a State or Federal court immediately, 
                the Director shall certify that the administrative 
                process has concluded and that the complainant may file 
                such a suit immediately.
            (7) Annual report.--Not later than 1 year after the date of 
        enactment of this Act, and annually thereafter, the Director 
        shall make publicly available a report detailing the activities 
        of the Office for Civil Rights and Health Equity under this 
        subsection, including--
                    (A) the number of complaints filed and the basis on 
                which the complaints were filed;
                    (B) the number of investigations undertaken as a 
                result of such complaints; and
                    (C) the disposition of all such investigations.
    (c) Enforcement by Private Persons.--
            (1) In general.--
                    (A) Civil action.--
                            (i) In suit.--A complainant under 
                        subsection (b) may commence a civil action to 
                        obtain appropriate relief with respect to an 
                        alleged violation of subsection (a), or for 
                        breach of a conciliation agreement under 
                        subsection (b), in an appropriate district 
                        court of the United States or State court--
                                    (I) not sooner than the earliest 
                                of--
                                            (aa) the date a 
                                        conciliation agreement is 
                                        reached under subsection (b);
                                            (bb) the date of a final 
                                        disposition of a complaint 
                                        under subsection (b); or
                                            (cc) 180 days after the 
                                        first day of the alleged 
                                        violation; and
                                    (II) not later than 2 years after 
                                the final day of the alleged violation.
                            (ii) Statute of limitations.--The 
                        computation of such 2-year period shall not 
                        include any time during which an administrative 
                        proceeding (including investigation or 
                        conciliation) under subsection (b) was pending 
                        with respect to a complaint under such 
                        subsection.
                    (B) Barring suit.--If the Director has obtained a 
                conciliation agreement under subsection (b) regarding 
                an alleged violation of subsection (a), no action may 
                be filed under this paragraph by the complainant 
                involved with respect to the alleged violation except 
                for the purpose of enforcing the terms of such an 
                agreement.
            (2) Relief which may be granted.--
                    (A) In general.--In a civil action under paragraph 
                (1), if the court finds that a violation of subsection 
                (a) or breach of a conciliation agreement has occurred, 
                the court may award to the plaintiff actual and 
                punitive damages, and may grant as relief, as the court 
                determines to be appropriate, any permanent or 
                temporary injunction, temporary restraining order, or 
                other order (including an order enjoining the defendant 
                from engaging in a practice violating subsection (a) or 
                ordering such affirmative action as may be 
                appropriate).
                    (B) Fees and costs.--In a civil action under 
                paragraph (1), the court, in its discretion, may allow 
                the prevailing party, other than the United States, a 
                reasonable attorney's fee and costs. The United States 
                shall be liable for such fees and costs to the same 
                extent as a private person.
            (3) Intervention by attorney general.--Upon timely 
        application, the Attorney General may intervene in a civil 
        action under paragraph (1), if the Attorney General certifies 
        that the case is of general public importance.
    (d) Enforcement by the Attorney General.--
            (1) Commencement of actions.--
                    (A) Pattern or practice cases.--The Attorney 
                General may commence a civil action in any appropriate 
                district court of the United States if the Attorney 
                General has reasonable cause to believe that any health 
                care provider covered by subsection (a)--
                            (i) is engaged in a pattern or practice 
                        that violates such subsection; or
                            (ii) is engaged in a violation of such 
                        subsection that raises an issue of significant 
                        public importance.
                    (B) Cases by referral.--The Director may determine, 
                based on a pattern of complaints, a pattern of 
                violations, a review of data reported by a health care 
                provider covered by subsection (a), or any other means, 
                that there is reasonable cause to believe a health care 
                provider is engaged in a pattern or practice that 
                violates subsection (a). If the Director makes such a 
                determination, the Director shall refer the related 
                findings to the Attorney General. If the Attorney 
                General finds that such reasonable cause exists, the 
                Attorney General may commence a civil action in any 
                appropriate district court of the United States.
            (2) Enforcement of subpoenas.--The Attorney General, on 
        behalf of the Director, or another party at whose request a 
        subpoena is issued under this subsection, may enforce such 
        subpoena in appropriate proceedings in the district court of 
        the United States for the district in which the person to whom 
        the subpoena was addressed resides, was served, or transacts 
        business.
            (3) Relief which may be granted in civil actions.--
                    (A) In general.--In a civil action under paragraph 
                (1), the court--
                            (i) may award such preventive relief, 
                        including a permanent or temporary injunction, 
                        temporary restraining order, or other order 
                        against the person responsible for a violation 
                        of subsection (a) as is necessary to assure the 
                        full enjoyment of the rights granted by this 
                        subsection;
                            (ii) may award such other relief as the 
                        court determines to be appropriate, including 
                        monetary damages, to aggrieved persons; and
                            (iii) may, to vindicate the public 
                        interest, assess punitive damages against the 
                        respondent--
                                    (I) in an amount not exceeding 
                                $500,000, for a first violation; and
                                    (II) in an amount not exceeding 
                                $1,000,000, for any subsequent 
                                violation.
                    (B) Fees and costs.--In a civil action under this 
                subsection, the court, in its discretion, may allow the 
                prevailing party, other than the United States, a 
                reasonable attorney's fee and costs. The United States 
                shall be liable for such fees and costs to the extent 
                provided by section 2412 of title 28, United States 
                Code.
            (4) Intervention in civil actions.--Upon timely 
        application, any person may intervene in a civil action 
        commenced by the Attorney General under paragraphs (1) and (2) 
        if the action involves an alleged violation of subsection (a) 
        with respect to which such person is an aggrieved person 
        (including a person who is a complainant under subsection (b)) 
        or a conciliation agreement to which such person is a party.

SEC. 9008. FEDERAL HEALTH EQUITY COMMISSION.

    (a) Establishment of Commission.--
            (1) In general.--There is established the Federal Health 
        Equity Commission (hereinafter in this section referred to as 
        the ``Commission'').
            (2) Membership.--
                    (A) In general.--The Commission shall be composed 
                of--
                            (i) 8 voting members appointed under 
                        subparagraph (B); and
                            (ii) the nonvoting, ex officio members 
                        listed in subparagraph (C).
                    (B) Voting members.--Not more than 4 of the members 
                described in subparagraph (A)(i) shall at any one time 
                be of the same political party. Such members shall have 
                recognized expertise in and personal experience with 
                racial and ethnic health inequities, health care needs 
                of vulnerable and marginalized populations, and health 
                equity as a vehicle for improving health status and 
                health outcomes. Such members shall be appointed to the 
                Commission as follows:
                            (i) Four members of the Commission shall be 
                        appointed by the President.
                            (ii) Two members of the Commission shall be 
                        appointed by the President pro tempore of the 
                        Senate, upon the recommendations of the 
                        majority leader and the minority leader of the 
                        Senate. Each member appointed to the Commission 
                        under this clause shall be appointed from a 
                        different political party.
                            (iii) Two members of the Commission shall 
                        be appointed by the Speaker of the House of 
                        Representatives upon the recommendations of the 
                        majority leader and the minority leader of the 
                        House of Representatives. Each member appointed 
                        to the Commission under this clause shall be 
                        appointed from a different political party.
                    (C) Ex officio member.--The Commission shall have 
                the following nonvoting, ex officio members:
                            (i) The Director for Civil Rights and 
                        Health Equity of the Department of Health and 
                        Human Services.
                            (ii) The Deputy Assistant Secretary for 
                        Minority Health of the Department of Health and 
                        Human Services.
                            (iii) The Director of the National 
                        Institute on Minority Health and Health 
                        Disparities.
                            (iv) The Chairperson of the Advisory 
                        Committee on Minority Health established under 
                        section 1707(c) of the Public Health Service 
                        Act (42 U.S.C. 300u-6(c)).
            (3) Terms.--The term of office of each member appointed 
        under paragraph (2)(B) of the Commission shall be 6 years.
            (4) Chairperson; vice chairperson.--
                    (A) Chairperson.--The President shall, with the 
                concurrence of a majority of the members of the 
                Commission appointed under paragraph (2)(B), designate 
                a Chairperson from among the members of the Commission 
                appointed under such paragraph.
                    (B) Vice chairperson.--
                            (i) Designation.--The Speaker of the House 
                        of Representatives shall, in consultation with 
                        the majority leaders and the minority leaders 
                        of the Senate and the House of Representatives 
                        and with the concurrence of a majority of the 
                        members of the Commission appointed under 
                        paragraph (2)(B), designate a Vice Chairperson 
                        from among the members of the Commission 
                        appointed under such paragraph. The Vice 
                        Chairperson may not be a member of the same 
                        political party as the Chairperson.
                            (ii) Duty.--The Vice Chairperson shall act 
                        in place of the Chairperson in the absence of 
                        the Chairperson.
            (5) Removal of members.--The President may remove a member 
        of the Commission only for neglect of duty or malfeasance in 
        office.
            (6) Quorum.--A majority of members of the Commission 
        appointed under paragraph (2)(B) shall constitute a quorum of 
        the Commission, but a lesser number of members may hold 
        hearings.
    (b) Duties of the Commission.--
            (1) In general.--The Commission shall--
                    (A) monitor and report on the implementation of 
                this Act; and
                    (B) investigate, monitor, and report on progress 
                towards health equity and the elimination of health 
                disparities.
            (2) Annual report.--The Commission shall--
                    (A) submit to the President and Congress at least 
                one report annually on health equity and health 
                disparities; and
                    (B) include in such report--
                            (i) a description of actions taken by the 
                        Department of Health and Human Services and any 
                        other Federal agency related to health equity 
                        or health disparities; and
                            (ii) recommendations on ensuring equitable 
                        health care and eliminating health disparities.
    (c) Powers.--
            (1) Hearings.--
                    (A) In general.--The Commission or, at the 
                direction of the Commission, any subcommittee or member 
                of the Commission, may, for the purpose of carrying out 
                this section, as the Commission or the subcommittee or 
                member considers advisable--
                            (i) hold such hearings, meet and act at 
                        such times and places, take such testimony, 
                        receive such evidence, and administer such 
                        oaths; and
                            (ii) require, by subpoena or otherwise, the 
                        attendance and testimony of such witnesses and 
                        the production of such books, records, 
                        correspondence, memoranda, papers, documents, 
                        tapes, and materials.
                    (B) Limitation on hearings.--The Commission may 
                hold a hearing under subparagraph (A)(i) only if the 
                hearing is approved--
                            (i) by a majority of the members of the 
                        Commission appointed under subsection 
                        (a)(2)(B); or
                            (ii) by a majority of such members present 
                        at a meeting when a quorum is present.
            (2) Issuance and enforcement of subpoenas.--
                    (A) Issuance.--A subpoena issued under paragraph 
                (1) shall--
                            (i) bear the signature of the Chairperson 
                        of the Commission; and
                            (ii) be served by any person or class of 
                        persons designated by the Chairperson for that 
                        purpose.
                    (B) Enforcement.--In the case of contumacy or 
                failure to obey a subpoena issued under paragraph (1), 
                the United States district court for the district in 
                which the subpoenaed person resides, is served, or may 
                be found may issue an order requiring the person to 
                appear at any designated place to testify or to produce 
                documentary or other evidence.
                    (C) Noncompliance.--Any failure to obey the order 
                of the court may be punished by the court as a contempt 
                of court.
            (3) Witness allowances and fees.--
                    (A) In general.--Section 1821 of title 28, United 
                States Code, shall apply to a witness requested or 
                subpoenaed to appear at a hearing of the Commission.
                    (B) Expenses.--The per diem and mileage allowances 
                for a witness shall be paid from funds available to pay 
                the expenses of the Commission.
            (4) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other agencies of the Federal Government.
            (5) Gifts.--The Commission may accept, use, and dispose of 
        gifts or donations of services or property.
    (d) Administrative Provisions.--
            (1) Staff.--
                    (A) Director.--There shall be a full-time staff 
                director for the Commission who shall--
                            (i) serve as the administrative head of the 
                        Commission; and
                            (ii) be appointed by the Chairperson with 
                        the concurrence of the Vice Chairperson.
                    (B) Other personnel.--The Commission may--
                            (i) appoint such other personnel as it 
                        considers advisable, subject to the provisions 
                        of title 5, United States Code, governing 
                        appointments in the competitive service, and 
                        the provisions of chapter 51 and subchapter III 
                        of chapter 53 of that title relating to 
                        classification and General Schedule pay rates; 
                        and
                            (ii) may procure temporary and intermittent 
                        services under section 3109(b) of title 5, 
                        United States Code, at rates for individuals 
                        not in excess of the daily equivalent paid for 
                        positions at the maximum rate for GS-15 of the 
                        General Schedule under section 5332 of title 5, 
                        United States Code.
            (2) Compensation of members.--
                    (A) Non-federal employees.--Each member of the 
                Commission who is not an officer or employee of the 
                Federal Government shall be compensated at a rate equal 
                to the daily equivalent of the annual rate of basic pay 
                prescribed for level IV of the Executive Schedule under 
                section 5315 of title 5, United States Code, for each 
                day (including travel time) during which the member is 
                engaged in the performance of the duties of the 
                Commission.
                    (B) Federal employees.--Each member of the 
                Commission who is an officer or employee of the Federal 
                Government shall serve without compensation in addition 
                to the compensation received for the services of the 
                member as an office or employee of the Federal 
                Government.
                    (C) Travel expenses.--A member of the Commission 
                shall be allowed travel expenses, including per diem in 
                lieu of subsistence, at rates authorized for an 
                employee of an agency under subchapter I of chapter 57 
                of title 5, United States Code, while away from the 
                home or regular place of business of the member in the 
                performance of the duties of the Commission.
            (3) Cooperation.--The Commission may secure directly from 
        any Federal department or agency such information as the 
        Commission considers necessary to carry out this Act. Upon 
        request of the Chairman of the Commission, the head of such 
        department or agency shall furnish such information to the 
        Commission.
    (e) Permanent Commission.--Section 14 of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall not apply to the Commission.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated for fiscal year 2022 and each fiscal year thereafter such 
sums as may be necessary to carry out the duties of the Commission.

  TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL 
                                JUSTICE

                         Subtitle A--In General

SEC. 10001. DEFINITIONS.

    In this title:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Environmental Protection Agency.
            (2) Agency.--The term ``Agency'' means the Environmental 
        Protection Agency.
            (3) Built environment.--The term ``built environment'' 
        means the components of the environment, and the location of 
        these components in a geographically defined space, that are 
        created or modified by individuals to form the physical and 
        social characteristics of a community or enhance quality of 
        human life, including--
                    (A) homes, schools, and places of work and worship;
                    (B) parks, recreation areas, and greenways;
                    (C) transportation systems;
                    (D) business, industry, and agriculture; and
                    (E) land-use plans, projects, and policies that 
                impact the physical or social characteristics of a 
                community, including access to services and amenities.
            (4) Determinants of health.--The term ``determinants of 
        health''--
                    (A) means the range of nonclinical factors 
                inclusive of personal, social, economic, and 
                environmental factors that directly influence health 
                status; and
                    (B) includes social determinants of health (which 
                are sometimes referred to as ``social and economic 
                determinants of health'', ``socioeconomic determinants 
                of health'', ``environmental determinants of health'', 
                ``social drivers of inequality'', or ``personal 
                determinants of health'').
            (5) Economic determinants of health.--The term ``economic 
        determinants of health'' means income and social status.
            (6) Environmental determinants of health.--The term 
        ``environmental determinants of health'' means the broad 
        physical (including manmade and natural), psychological, 
        social, spiritual, cultural, and aesthetic environment.
            (7) Personal determinants of health.--The term ``personal 
        determinants of health'' means an individual's behavior, 
        biology, and genetics.
            (8) Social determinants of health.--The term ``social 
        determinants of health'' means a subset of determinants of the 
        health of individuals and environments (such as communities, 
        neighborhoods, and societies) that describe an individual's or 
        group of people's social identity, describe the social and 
        economic resources to which such individual or group has 
        access, and describe the conditions in which an individual or 
        group of people works, lives, and plays.

SEC. 10002. FINDINGS.

    Congress finds as follows:
            (1) Social determinants of health are the greatest 
        predictors of health outcomes.
            (2) Social determinants of health, including health-related 
        behaviors, social and economic factors, and physical 
        environment factors account for 80 percent of health outcomes, 
        whereas clinical care accounts for 20 percent of improved 
        health outcomes. Yet, in 2017, public health spending 
        represented only 2.5 percent of all health spending in the 
        United States.
            (3) There are more opportunities to improve health for 
        everyone when we understand that health starts, first, not in a 
        medical setting, but in our families, in our schools and 
        workplaces, in our neighborhoods, in the air we breathe, and in 
        the water we drink.
            (4)(A) Healthy People 2030 identifies health and health 
        care quality as a function of not only access to health care, 
        but also the social determinants of health, categorized into 
        the following: neighborhoods and the built environment; social 
        and community context; education; and economic stability.
            (B) The following examples illustrate the nexus between the 
        unequal distribution of the social determinants of health and 
        health inequities:
                    (i) The built environment influences residents' 
                level of physical activity. Neighborhoods with high 
                levels of poverty are significantly less likely to have 
                places where children can be physically active, such as 
                parks, green spaces, and bike paths and lanes. 
                Neighborhoods and communities can provide opportunities 
                for physical activity and support active lifestyles 
                through accessible and safe parks and open spaces and 
                through land use policy, zoning, and healthy community 
                design.
                    (ii) Emotional and physical health and well-being 
                are directly impacted by perceived levels of safety, 
                such as unlit streets at night. Community members have 
                expressed that safety is not only a barrier to 
                accessing programs and services that increase quality 
                of life, but also a barrier to accessing physical 
                activity in their community through the built 
                environment.
                    (iii) Historical and institutional racism in the 
                United States has shaped the way in which social and 
                economic resources and exposure to health promoting 
                environments are distributed. Income, education, 
                occupation, neighborhood conditions, schools, 
                workplaces, the use of health and social services, and 
                experiences with the criminal justice system are all 
                highly patterned by race, with people of color 
                experiencing more that is health harming. Finding ways 
                to uncouple the link between race and access to 
                resources and healthy environments is a principal means 
                of reducing health inequities. Additionally, the 
                anticipation of racism itself causes higher 
                psychological and cardiovascular stress levels that are 
                linked to poor health outcomes. Remedying 
                discriminatory practices at the individual and systemic 
                levels will likely reduce health inequities caused by 
                this unequal distribution of stress.
                    (iv) Poor health among Native Americans has largely 
                been driven by post-colonial oppression and historical 
                trauma. The expropriation of native lands and 
                territories to the American state had severe 
                consequences on Native American health. This resulted 
                in the deprivation of traditional food sources--and 
                nutrients--for Native Americans and also the 
                destruction of traditional economies and community 
                organization. Today, Native Americans have twice the 
                rate of diabetes of non-Hispanic Whites. Recognition of 
                the origins of diabetes as having a social and 
                community context, rather than just individual 
                responsibility and genetic predisposition, will shape 
                better policy to provide food security.
                    (v) In the context of prisons, overcrowding has led 
                to the deterioration of the physical and mental health 
                of individuals after they leave prison. In particular, 
                the mass incarceration of African-American males as a 
                result of inequities within and treatment in the 
                criminal justice system has contributed to an 
                overburdening of certain infectious diseases within the 
                African-American community. As a social institution, 
                incarceration amplifies existing adverse health 
                conditions by concentrating diseases and harmful health 
                behaviors such as tobacco use, drug use, and violence.
                    (vi) Educational attainment is the strongest 
                predictor of adult mortality. It is a basic component 
                of socioeconomic status that shapes earning potential 
                to access resources that promote health. People with 
                more education are less likely to report that they are 
                in poor health, and are also less likely to have 
                diabetes and other chronic diseases.
                    (vii) Individuals with lower levels of educational 
                attainment are much more likely to report to be current 
                smokers. In 2017, smoking prevalence was 36.8 percent 
                among adults with a GED diploma, 23.1 percent with less 
                than a high school diploma, and 18.7 percent with a 
                high school diploma, while dropping significantly to 
                7.1 percent among adults with an undergraduate college 
                degree and 4.1 percent with a postgraduate college 
                degree.
                    (viii) Income inequality differences account for a 
                large part of health inequities. For example, children 
                living in poverty experience poorer housing conditions, 
                increased exposure to indoor allergens and toxins (such 
                as pesticides, lead, mercury, radon, air pollution, and 
                carcinogens), increased food insecurity, and more 
                psychological stress. These experiences culminate in 
                worse adult health as compared with children with 
                higher socioeconomic status. Specifically, children 
                living in lower socioeconomic neighborhoods have higher 
                rates of asthma due to higher rates of psychological 
                stress resulting from higher rates of violence. Food 
                insecurity is associated with obesity and racial and 
                ethnic minorities have higher rates of food insecurity.
                    (ix) Lesbian, gay, bisexual, transgender, queer or 
                questioning, intersex, and asexual or allied (referred 
                to in this section as ``LGBTQIA+'') individuals face 
                health inequities linked to societal stigma, 
                discrimination, and denial of their civil and human 
                rights. Discrimination against LGBTQIA+ individuals has 
                been associated with high rates of psychiatric 
                disorders, substance abuse, and suicide. Experiences of 
                violence and victimization are frequent for LGBTQIA+ 
                individuals, and have long-lasting effects on the 
                individual and the community. Personal, family, and 
                social acceptance of sexual orientation and gender 
                identity affects the mental health and personal safety 
                of LGBTQIA+ individuals.
                    (x) Individuals in older and cheaper housing are at 
                higher risks to be exposed to lead, particularly in 
                housing built prior to 1960. The threat of lead 
                poisoning disproportionally affects vulnerable 
                populations, with children living in poverty (5.6 
                percent) and Black children (5.6) experiencing the 
                highest rates. According to the Department of Housing 
                and Urban Development, about 3,600,000 homes nationwide 
                that house young children have lead hazards such as 
                contaminated drinking water, peeling paint, 
                contaminated dust, or toxic soil. The combined cost of 
                medical treatment and special education for lead 
                poisoned children averages about $5,600 per child per 
                year, and lead poisoning costs the United States an 
                estimated $50,000,000,000 annually.
                    (xi) According to the report Healthy People 2030, 
                individuals with disabilities, as a group, experience 
                health inequities in routine public health arenas such 
                as health behaviors, clinical preventive services, and 
                chronic conditions. Compared with individuals without 
                disabilities, individuals with disabilities are--
                            (I) less likely to receive recommended 
                        preventive health care services, such as 
                        routine teeth cleanings and cancer screenings;
                            (II) at a high risk for poor health 
                        outcomes such as obesity, hypertension, falls-
                        related injuries, and mood disorders such as 
                        depression; and
                            (III) more likely to engage in unhealthy 
                        behaviors that put their health at risk, such 
                        as cigarette smoking and inadequate physical 
                        activity.
            (5) Laws and regulations that improve opportunities to live 
        in safe neighborhoods with more social cohesion, attain higher 
        education, sustain stable employment, and bridge class 
        differences help foster the health and safety of individuals.
            (6) The global public health community has reached 
        consensus through the Rio Political Declaration of Social 
        Determinants of Health adopted by the World Health Organization 
        in October 2011 that ``[c]ollaboration in coordinated and 
        intersectoral policy actions has proven to be effective. Health 
        in All Policies, an initiative of the American Public Health 
        Association, together with intersectoral cooperation and 
        action, is one promising approach to enhance accountability in 
        other sectors of health, as well as the promotion of health 
        equity and more inclusive and productive societies.''.

SEC. 10003. HEALTH IMPACT ASSESSMENTS.

    (a) Findings.--Congress makes the following findings:
            (1) Health impact assessment is a tool to help planners, 
        health officials, decision makers, and the public make more 
        informed decisions about the potential health effects of 
        proposed plans, policies, programs, and projects in order to 
        maximize health benefits and minimize harms.
            (2) Health impact assessments foster community leadership, 
        ownership, and participation in decision-making processes.
            (3) Health impact assessments can build community support 
        and reduce opposition to a project or policy, thereby 
        facilitating economic growth by aiding the development of 
        consensus regarding new development proposals.
            (4) Health impact assessments facilitate collaboration 
        across sectors.
    (b) Purposes.--It is the purpose of this section to--
            (1) provide more information about the potential human 
        health effects of policy decisions and the distribution of 
        those effects;
            (2) improve how health is considered in planning and 
        decision-making processes; and
            (3) build stronger, healthier communities through the use 
        of health impact assessments.
    (c) Health Impact Assessments.--Part P of title III of the Public 
Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7254 
of this Act, is further amended by adding at the end the following:

``SEC. 399V-11. HEALTH IMPACT ASSESSMENTS.

    ``(a) Definitions.--In this section:
            ``(1) Administrator.--The term `Administrator' means the 
        Administrator of the Environmental Protection Agency.
            ``(2) Director.--The term `Director' means the Director of 
        the Centers for Disease Control and Prevention.
            ``(3) Health impact assessment.--The term `health impact 
        assessment' means a systematic process that uses an array of 
        data sources and analytic methods and considers input from 
        stakeholders to determine the potential effects of a proposed 
        policy, plan, program, or project on the health of a population 
        and the distribution of those effects within the population. 
        Such term includes identifying and recommending appropriate 
        actions on monitoring and maximizing potential benefits and 
        minimizing potential harms.
            ``(4) Health inequity.--The term `health inequity' means a 
        particular type of health difference that is closely linked 
        with social, economic, or environmental disadvantage and that 
        adversely affects groups of people who have systematically 
        experienced greater obstacles to health based on their racial 
        or ethnic group; religion; socioeconomic status; gender; age; 
        mental health; cognitive, sensory, or physical disability; 
        sexual orientation or gender identity; geographic location; 
        citizenship status; or other characteristics historically 
        linked to discrimination or exclusion.
    ``(b) Establishment.--The Secretary, acting through the Director 
and in collaboration with the Administrator, shall--
            ``(1) in consultation with the Director of the National 
        Center for Chronic Disease Prevention and Health Promotion and 
        relevant offices within the Department of Housing and Urban 
        Development, the Department of Transportation, and the 
        Department of Agriculture, establish a program at the National 
        Center for Environmental Health at the Centers for Disease 
        Control and Prevention focused on advancing the field of health 
        impact assessment that includes--
                    ``(A) collecting and disseminating best practices;
                    ``(B) administering capacity building grants to 
                States, Indian Tribes, and Tribal organizations to 
                support subgrantees in initiating health impact 
                assessments, in accordance with subsection (d);
                    ``(C) providing technical assistance;
                    ``(D) developing training tools and providing 
                training on conducting health impact assessment and the 
                implementation of built environment and health 
                indicators;
                    ``(E) making information available, as appropriate, 
                regarding the existence of other community healthy 
                living tools, checklists, and indices that help connect 
                public health to other sectors, and tools to help 
                examine the effect of the indoor built environment and 
                building codes on population health;
                    ``(F) conducting research and evaluations of health 
                impact assessments; and
                    ``(G) awarding competitive extramural research 
                grants;
            ``(2) develop guidance and guidelines to conduct health 
        impact assessments in accordance with subsection (c); and
            ``(3) establish a grant program to allow States, Indian 
        Tribes, and Tribal organizations to award subgrants to eligible 
        entities to conduct health impact assessments.
    ``(c) Guidance.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Health Equity and Accountability Act of 2022, 
        the Secretary, acting through the Director, shall issue final 
        guidance for conducting health impact assessments. In 
        developing such guidance the Secretary shall--
                    ``(A) consult with the Director of the National 
                Center for Environmental Health, the Director of the 
                National Center for Chronic Disease Prevention and 
                Health Promotion, and relevant offices within the 
                Department of Housing and Urban Development, the 
                Department of Transportation, and the Department of 
                Agriculture; and
                    ``(B) consider available international health 
                impact assessment guidance, North American health 
                impact assessment practice standards, and 
                recommendations from the National Academy of Science.
            ``(2) Content.--The guidance under this subsection shall 
        include--
                    ``(A) background on national and international 
                efforts to bridge urban planning, climate forecasting, 
                and public health institutions and disciplines, 
                including a review of health impact assessment best 
                practices internationally;
                    ``(B) evidence-based direct and indirect pathways 
                that link land-use planning, transportation, and 
                housing policy and objectives to human health outcomes;
                    ``(C) data resources and quantitative and 
                qualitative forecasting methods to evaluate both the 
                status of health determinants and health effects, 
                including identification of existing programs that can 
                disseminate these resources;
                    ``(D) best practices for inclusive public 
                involvement in conducting health impact assessments; 
                and
                    ``(E) technical assistance for other agencies 
                seeking to develop their own guidelines and procedures 
                for health impact assessment.
    ``(d) Grant Program.--
            ``(1) In general.--The Secretary, acting through the 
        Director and in collaboration with the Administrator, shall--
                    ``(A) award grants to States, Indian Tribes, and 
                Tribal organizations to award subgrants to eligible 
                entities for capacity building or to prepare health 
                impact assessments; and
                    ``(B) ensure that States, Indian Tribes, and Tribal 
                organizations receiving a grant under this subsection 
                further support training and technical assistance for 
                subgrantees under subparagraph (A) by funding and 
                overseeing appropriate experts on health impact 
                assessments from local, State, and Tribal governments, 
                the Federal Government, institutions of higher 
                education, and nonprofit organizations to provide such 
                training and technical assistance.
            ``(2) Applications for subgrants.--
                    ``(A) In general.--To be eligible to receive a 
                subgrant under this section, an eligible entity shall--
                            ``(i) be a community-based organization 
                        serving individuals or populations the health 
                        of which are, or will be, affected by an 
                        activity or a proposed activity; and
                            ``(ii) submit to the grantee an application 
                        in accordance with this subsection, at such 
                        time, in such manner, and containing such 
                        additional information as the Secretary (acting 
                        through the Director and in collaboration with 
                        the Administrator) and the grantee may require.
                    ``(B) Inclusion.--An application for a subgrant 
                under this subsection shall include--
                            ``(i) a list of proposed activities that 
                        require or would benefit from conducting a 
                        health impact assessment within six months of 
                        receiving the subgrant;
                            ``(ii) supporting documentation, including 
                        letters of support, from potential conductors 
                        of health impact assessments for the listed 
                        proposed activities;
                            ``(iii) an assessment by the applicant of 
                        the health of the population to be served 
                        through the subgrant; and
                            ``(iv) a description of potential adverse 
                        or positive effects on health that the proposed 
                        activities may create.
                    ``(C) Preference.--In awarding subgrants under this 
                subsection, States may give preference to eligible 
                entities that demonstrate the potential to 
                significantly improve population health or lower health 
                care costs as a result of potential health impact 
                assessment work.
            ``(3) Use of funds.--
                    ``(A) In general.--A State, Indian Tribe, or Tribal 
                organization receiving a grant under this subsection 
                shall use such grant to conduct health impact 
                assessment capacity building in support of a subgrantee 
                conducting a health impact assessment for a proposed 
                activity in accordance with this subsection.
                    ``(B) Purposes.--The purposes of a health impact 
                assessment under this subsection are--
                            ``(i) to facilitate the involvement of 
                        Tribal, State, and local public health 
                        officials in community planning, 
                        transportation, housing, and land use decisions 
                        and other decisions affecting the built 
                        environment to identify any potential health 
                        concern or health benefit relating to an 
                        activity or proposed activity;
                            ``(ii) to provide for an investigation of 
                        any health-related issue of concern raised in a 
                        planning process, an environmental impact 
                        assessment process, or policy appraisal 
                        relating to a proposed activity;
                            ``(iii) to describe and compare 
                        alternatives (including no-action alternatives) 
                        to a proposed activity to provide clarification 
                        with respect to the potential health outcomes 
                        associated with the proposed activity and, 
                        where appropriate, to the related benefit-cost 
                        or cost-effectiveness of the proposed activity 
                        and alternatives;
                            ``(iv) to contribute, when applicable, to 
                        the findings of a planning process, policy 
                        appraisal, or an environmental impact statement 
                        with respect to the terms and conditions of 
                        implementing a proposed activity or related 
                        mitigation recommendations, as necessary;
                            ``(v) to ensure that the disproportionate 
                        distribution of negative impacts among 
                        vulnerable populations is minimized as much as 
                        possible;
                            ``(vi) to engage affected community members 
                        and ensure adequate opportunity for public 
                        comment on all stages of the health impact 
                        assessment;
                            ``(vii) where appropriate, to consult with 
                        local and county health departments and 
                        appropriate organizations, including planning, 
                        transportation, and housing organizations, and 
                        provide them information and tools regarding 
                        how to conduct and integrate health impact 
                        assessment into their work; and
                            ``(viii) to inspect homes, water systems, 
                        and other elements that pose risks to lead 
                        exposure, with an emphasis on areas that pose a 
                        higher risk to children.
            ``(4) Assessments.--Health impact assessments carried out 
        using funds under this section shall--
                    ``(A) take appropriate health factors into 
                consideration as early as practicable during the 
                planning, review, or decision-making processes;
                    ``(B) assess the effect on the health of 
                individuals and populations of proposed policies, 
                projects, or plans that result in modifications to the 
                built environment; and
                    ``(C) assess the distribution of health effects 
                across various factors, such as race, income, 
                ethnicity, age, disability status, gender, and 
                geography.
            ``(5) Eligible activities.--
                    ``(A) In general.--A State, Indian Tribe, or Tribal 
                organization receiving a grant under this section shall 
                conduct an evaluation of any activity proposed to be 
                funded through the grant, including through a subgrant, 
                to determine whether such activity will have a 
                significant adverse or positive effect on the health of 
                the affected population to be served, based on the 
                criteria described in subparagraph (B).
                    ``(B) Criteria.--The criteria described in this 
                subparagraph include, as applicable to the proposed 
                activity, the following:
                            ``(i) Any substantial adverse effect or 
                        significant health benefit on health outcomes 
                        or factors known to influence health, including 
                        the following:
                                    ``(I) Physical activity.
                                    ``(II) Injury.
                                    ``(III) Mental health.
                                    ``(IV) Accessibility to health-
                                promoting goods and services.
                                    ``(V) Respiratory health.
                                    ``(VI) Chronic disease.
                                    ``(VII) Nutrition.
                                    ``(VIII) Land use changes that 
                                promote local, sustainable food 
                                sources.
                                    ``(IX) Infectious disease.
                                    ``(X) Health inequities.
                                    ``(XI) Existing air quality, ground 
                                or surface water quality or quantity, 
                                or noise levels.
                                    ``(XII) Lead exposure.
                                    ``(XIII) Drinking water quality and 
                                accessibility.
                            ``(ii) Other factors that may be 
                        considered, including--
                                    ``(I) the potential for a proposed 
                                activity to result in systems failure 
                                that leads to a public health 
                                emergency;
                                    ``(II) the probability that the 
                                proposed activity will result in a 
                                significant increase in tourism, 
                                economic development, or employment in 
                                the population to be served;
                                    ``(III) any other significant 
                                potential hazard or enhancement to 
                                human health, as determined by the 
                                grantee; or
                                    ``(IV) whether the evaluation of a 
                                proposed activity would duplicate 
                                another analysis or study being 
                                undertaken in conjunction with the 
                                proposed activity.
                    ``(C) Factors for consideration.--In evaluating a 
                proposed activity under subparagraph (A), a grantee may 
                take into consideration any reasonable, direct, 
                indirect, or cumulative effect that can be clearly 
                related to potential health effects and that is related 
                to the proposed activity, including the effect of any 
                action that is--
                            ``(i) included in the long-range plan 
                        relating to the proposed activity;
                            ``(ii) likely to be carried out in 
                        coordination with the proposed activity;
                            ``(iii) dependent on the occurrence of the 
                        proposed activity; or
                            ``(iv) likely to have a disproportionate 
                        impact on high-risk or vulnerable populations.
            ``(6) Requirements.--A health impact assessment prepared 
        with funds awarded under this subsection shall incorporate the 
        following, after conducting the screening phase (identifying 
        projects or policies for which a health impact assessment would 
        be valuable and feasible) through the application process:
                    ``(A) Scoping.--Identifying which health effects to 
                consider and the research methods to be utilized.
                    ``(B) Assessing risks and benefits.--Assessing the 
                baseline health status and factors known to influence 
                the health status in the affected community, which may 
                include aggregating and synthesizing existing health 
                assessment evidence and data from the community.
                    ``(C) Developing recommendations.--Suggesting 
                changes to proposals to promote positive or mitigate 
                adverse health effects.
                    ``(D) Reporting.--Synthesizing the assessment and 
                recommendations and communicating the results to 
                decision makers.
                    ``(E) Monitoring and evaluating.--Tracking the 
                decision and implementation effect on health 
                determinants and health status.
            ``(7) Plan.--A subgrantee under this section shall develop 
        and implement a plan, to be approved by the Secretary (acting 
        through the Director and in collaboration with the 
        Administrator) and the grantee, for meaningful and inclusive 
        stakeholder involvement in all phases of the health impact 
        assessment. Stakeholders may include community leaders, 
        community-based organizations, youth-serving organizations, 
        planners, public health experts, State and local public health 
        departments and officials, health care experts or officials, 
        housing experts or officials, and transportation experts or 
        officials.
            ``(8) Submission of findings.--A grantee under this section 
        shall submit the findings of any funded health impact 
        assessment activities to the Secretary and make these findings 
        publicly available.
            ``(9) Assessment of impacts.--A subgrantee under this 
        section shall ensure the assessment of the distribution of 
        health impacts (related to the proposed activity) across race, 
        ethnicity, income, age, gender, disability status, and 
        geography.
            ``(10) Conduct of assessment.--To the greatest extent 
        feasible, a health impact assessment shall be conducted under 
        this section in a manner that respects the needs and timing of 
        the decision-making process it evaluates.
            ``(11) Methodology.--In preparing a health impact 
        assessment funded under this subsection, a subgrantee under 
        this section shall follow the guidance published under 
        subsection (c).
    ``(e) Health Impact Assessment Database.--The Secretary, acting 
through the Director and in collaboration with the Administrator, shall 
establish, maintain, and make publicly available a health impact 
assessment database, including--
            ``(1) a catalog of health impact assessments received under 
        this section;
            ``(2) an inventory of tools used by subgrantees to conduct 
        health impact assessments; and
            ``(3) guidance for subgrantees with respect to the 
        selection of appropriate tools described in paragraph (2).
    ``(f) Evaluation of Grantee Activities.--The Secretary shall award 
competitive grants to Prevention Research Centers, or nonprofit 
organizations or academic institutions with expertise in health impact 
assessments to--
            ``(1) assist grantees and subgrantees with the provision of 
        training and technical assistance in the conducting of health 
        impact assessments;
            ``(2) evaluate the activities carried out with grants and 
        subgrants under subsection (d); and
            ``(3) assist the Secretary in disseminating evidence, best 
        practices, and lessons learned from grantees and subgrantees.
    ``(g) Report to Congress.--Not later than 1 year after the date of 
enactment of the Health Equity and Accountability Act of 2022, the 
Secretary shall submit to Congress a report concerning the evaluation 
of the programs under this section, including recommendations as to how 
lessons learned from such programs can be incorporated into future 
guidance documents developed and provided by the Secretary and other 
Federal agencies, as appropriate.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary.

``SEC. 399V-12. IMPLEMENTATION OF RESEARCH FINDINGS TO IMPROVE HEALTH 
              OUTCOMES THROUGH THE BUILT ENVIRONMENT.

    ``(a) Research Grant Program.--The Secretary, in collaboration with 
the Administrator of the Environmental Protection Agency (referred to 
in this section as the `Administrator'), shall award grants to public 
agencies or private nonprofit institutions to implement evidence-based 
programming to improve human health through improvements to the built 
environment and subsequently human health, by addressing--
            ``(1) levels of physical activity;
            ``(2) consumption of nutritional foods;
            ``(3) rates of crime;
            ``(4) air, water, and soil quality;
            ``(5) risk or rate of injury;
            ``(6) accessibility to health-promoting goods and services;
            ``(7) chronic disease rates;
            ``(8) community design;
            ``(9) housing;
            ``(10) transportation options; and
            ``(11) other factors, as the Secretary determines 
        appropriate.
    ``(b) Applications.--A public agency or private nonprofit 
institution desiring a grant under this section shall submit to the 
Secretary an application at such time, in such manner, and containing 
such agreements, assurances, and information as the Secretary, in 
consultation with the Administrator, may require.
    ``(c) Research.--The Secretary, in consultation with the 
Administrator, shall support, through grants awarded under this 
section, research that--
            ``(1) uses evidence-based research to improve the built 
        environment and human health;
            ``(2) examines--
                    ``(A) the scope and intensity of the impacts that 
                the built environment (including the various 
                characteristics of the built environment) has on human 
                health; or
                    ``(B) the distribution of such impacts by--
                            ``(i) location; and
                            ``(ii) population subgroup;
            ``(3) is used to develop--
                    ``(A) measures and indicators to address health 
                impacts and the connection of health to the built 
                environment;
                    ``(B) efforts to link the measures to 
                transportation, land use, and health databases; and
                    ``(C) efforts to enhance the collection of built 
                environment surveillance data;
            ``(4) distinguishes carefully between personal attitudes 
        and choices and external influences on behavior to determine 
        how much the association between the built environment and the 
        health of residents, versus the lifestyle preferences of the 
        people that choose to live in the neighborhood, reflects the 
        physical characteristics of the neighborhood; and
            ``(5)(A) identifies or develops effective intervention 
        strategies focusing on enhancements to the built environment 
        that promote increased use physical activity, access to 
        nutritious foods, or other health-promoting activities by 
        residents; and
            ``(B) in developing the intervention strategies under 
        subparagraph (A), ensures that the intervention strategies will 
        reach out to high-risk or vulnerable populations, including 
        low-income urban and rural communities and aging populations, 
        in addition to the general population.
    ``(d) Surveys.--The Secretary may allow recipients of grants under 
this section to use such grant funds to support the expansion of 
national surveys and data tracking systems to provide more detailed 
information about the connection between the built environment and 
health.
    ``(e) Priority.--In awarding grants under this section, the 
Secretary and the Administrator shall give priority to entities with 
programming that incorporates--
            ``(1) interdisciplinary approaches; or
            ``(2) the expertise of the public health, physical 
        activity, urban planning, land use, and transportation research 
        communities in the United States and abroad.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section. 
The Secretary may allocate not more than 20 percent of the amount so 
appropriated for a fiscal year for purposes of conducting research 
under subsection (c).''.

SEC. 10004. GRANT PROGRAM TO CONDUCT ENVIRONMENTAL HEALTH IMPROVEMENT 
              ACTIVITIES AND TO IMPROVE SOCIAL DETERMINANTS OF HEALTH.

    (a) Definitions.--In this section:
            (1) Director.--The term ``Director'' means the Director of 
        the Centers for Disease Control and Prevention, acting in 
        collaboration with the Administrator of the Environmental 
        Protection Agency and the Director of the National Institute of 
        Environmental Health Sciences.
            (2) Eligible entity.--The term ``eligible entity'' means a 
        State, Indian Tribe, Tribal organization, or local community 
        that--
                    (A) bears a disproportionate burden of exposure to 
                environmental health hazards;
                    (B) bears a disproportionate burden of exposure to 
                unhealthy living conditions, low standard housing 
                conditions, low socioeconomic status, poor nutrition, 
                less opportunity for educational attainment, 
                disproportionately high unemployment rates, or lower 
                literacy levels and access to information;
                    (C) has established a coalition--
                            (i) with not less than 1 community-based 
                        organization or demonstration program; and
                            (ii) with not less than 1--
                                    (I) public health entity;
                                    (II) health care provider 
                                organization;
                                    (III) academic institution, 
                                including any minority-serving 
                                institution (including a Hispanic-
                                serving institution, a historically 
                                Black college or university, or a 
                                Tribal College or University);
                                    (IV) child-serving institution; or
                                    (V) landlord or housing provider 
                                working on lead remediation;
                    (D) ensures planned activities and funding streams 
                are coordinated to improve community health; and
                    (E) submits an application in accordance with 
                subsection (c).
    (b) Establishment.--The Director shall establish a grant program 
under which eligible entities shall receive grants to conduct 
environmental health improvement activities and to improve social 
determinants of health.
    (c) Application.--To receive a grant under this section, an 
eligible entity shall submit an application to the Director at such 
time, in such manner, and accompanied by such information as the 
Director may require.
    (d) Use of Grant Funds.--An eligible entity may use a grant under 
this section--
            (1) to promote environmental health;
            (2) to address environmental health inequities among all 
        populations, including children; and
            (3) to address racial and ethnic inequities in social 
        determinants of health.
    (e) Amount of Cooperative Agreement.--The Director shall award 
grants to eligible entities at the following 3 funding levels:
            (1) Level 1 cooperative agreements.--
                    (A) In general.--An eligible entity awarded a grant 
                under this paragraph shall use the funds to identify 
                environmental health problems and solutions by--
                            (i) establishing a planning and 
                        prioritizing council in accordance with 
                        subparagraph (B); and
                            (ii) conducting an environmental health 
                        assessment in accordance with subparagraph (C).
                    (B) Planning and prioritizing council.--
                            (i) In general.--A planning and 
                        prioritizing council established under 
                        subparagraph (A)(i) (referred to in this 
                        paragraph as a ``PPC'') shall assist the 
                        environmental health assessment process and 
                        environmental health promotion activities of 
                        the eligible entity.
                            (ii) Membership.--Membership of a PPC shall 
                        consist of representatives from various 
                        organizations within public health, planning, 
                        development, and environmental services and 
                        shall include stakeholders from vulnerable 
                        groups such as children, the elderly, disabled, 
                        and minority ethnic groups that are often not 
                        actively involved in democratic or decision-
                        making processes.
                            (iii) Duties.--A PPC shall--
                                    (I) identify key stakeholders and 
                                engage and coordinate potential 
                                partners in the planning process;
                                    (II) establish a formal advisory 
                                group to plan for the establishment of 
                                services;
                                    (III) conduct an in-depth review of 
                                the nature and extent of the need for 
                                an environmental health assessment, 
                                including a local epidemiological 
                                profile, an evaluation of the service 
                                provider capacity of the community, and 
                                a profile of any target populations; 
                                and
                                    (IV) define the components of care 
                                and form essential programmatic 
                                linkages with related providers in the 
                                community.
                    (C) Environmental health assessment.--
                            (i) In general.--A PPC shall carry out an 
                        environmental health assessment to identify 
                        environmental health concerns.
                            (ii) Assessment process.--The PPC shall--
                                    (I) define the goals of the 
                                assessment;
                                    (II) generate the environmental 
                                health issue list;
                                    (III) analyze issues with a systems 
                                framework;
                                    (IV) develop appropriate community 
                                environmental health indicators;
                                    (V) rank the environmental health 
                                issues;
                                    (VI) set priorities for action;
                                    (VII) develop an action plan;
                                    (VIII) implement the plan; and
                                    (IX) evaluate progress and planning 
                                for the future.
                    (D) Evaluation.--Each eligible entity that receives 
                a grant under this paragraph shall evaluate, report, 
                and disseminate program findings and outcomes.
                    (E) Technical assistance.--The Director may provide 
                such technical and other non-financial assistance to 
                eligible entities as the Director determines to be 
                necessary.
            (2) Level 2 cooperative agreements.--
                    (A) Eligibility.--
                            (i) In general.--The Director shall award 
                        grants under this paragraph to eligible 
                        entities that have already--
                                    (I) established broad-based 
                                collaborative partnerships; and
                                    (II) completed environmental 
                                assessments.
                            (ii) No level 1 requirement.--To be 
                        eligible to receive a grant under this 
                        paragraph, an eligible entity is not required 
                        to have successfully completed a Level 1 
                        Cooperative Agreement (as described in 
                        paragraph (1)).
                    (B) Use of grant funds.--An eligible entity awarded 
                a grant under this paragraph shall use the funds to 
                further activities to carry out environmental health 
                improvement activities, including--
                            (i) addressing community environmental 
                        health priorities in accordance with paragraph 
                        (1)(C)(ii), including--
                                    (I) geography;
                                    (II) the built environment;
                                    (III) air quality;
                                    (IV) water quality;
                                    (V) land use;
                                    (VI) solid waste;
                                    (VII) housing;
                                    (VIII) violence;
                                    (IX) socioeconomic status;
                                    (X) ethnicity, social construct, 
                                and language preference;
                                    (XI) educational attainment;
                                    (XII) employment;
                                    (XIII) food safety, accessibility, 
                                and affordability;
                                    (XIV) nutrition;
                                    (XV) health care services; and
                                    (XVI) injuries;
                            (ii) building partnerships between 
                        planning, public health, and other sectors, 
                        including child-serving institutions, to 
                        address how the built environment impacts food 
                        availability and access and physical activity 
                        to promote healthy behaviors and lifestyles and 
                        reduce overweight and obesity, musculoskeletal 
                        diseases, respiratory conditions, infectious 
                        diseases, dental, oral, and mental health 
                        conditions, poverty, and related co-
                        morbidities;
                            (iii) establishing programs to address--
                                    (I) how environmental and social 
                                conditions of work and living choices 
                                influence physical activity and dietary 
                                intake; or
                                    (II) how the conditions described 
                                in subclause (I) influence the concerns 
                                and needs of people who have impaired 
                                mobility and use assistance devices, 
                                including wheelchairs, lower limb 
                                prostheses, and hip, knee, and other 
                                joint replacements; and
                            (iv) convening intervention and 
                        demonstration programs that examine the role of 
                        the social environment in connection with the 
                        physical and chemical environment in--
                                    (I) determining access to 
                                nutritional food;
                                    (II) improving physical activity to 
                                reduce overweight, obesity, and co-
                                morbidities and increase quality of 
                                life; and
                                    (III) location and access to 
                                medical facilities.
            (3) Level 3 cooperative agreements.--
                    (A) In general.--An eligible entity awarded a grant 
                under this paragraph shall use the funds to identify 
                and address racial and ethnic inequities in social 
                determinants of health by creating demonstration 
                programs that assess the feasibility of establishing a 
                federally funded comprehensive program and describe key 
                outcomes that address racial and ethnic inequities in 
                social determinants of health.
                    (B) Program design.--
                            (i) Evaluation.--No later than 1 year after 
                        enactment of this Act, the Director shall 
                        evaluate the best practices of existing 
                        programs from the private, public, community 
                        based, and academically supported initiatives 
                        focused on reducing inequities in the social 
                        determinants of health for racial and ethnic 
                        populations.
                            (ii) Demonstration projects.--Not later 
                        than two years after the date of enactment of 
                        this Act, the Director shall implement at least 
                        12 demonstration projects, including at least 
                        one project for each major racial and ethnic 
                        minority group, each of which is unique to the 
                        cultural and linguistic needs of each of the 
                        following groups:
                                    (I) Native Americans and Alaska 
                                Natives.
                                    (II) Asian Americans.
                                    (III) African Americans/Blacks.
                                    (IV) Hispanic/Latino-Americans.
                                    (V) Native Hawaiians and Pacific 
                                Islanders.
                                    (VI) Middle Eastern and Northern 
                                African communities.
                            (iii) Report to congress.--No later than 2 
                        years after the implementation of the initial 
                        demonstration projects under this paragraph, 
                        the Director shall submit to Congress a report 
                        which includes--
                                    (I) a description of each 
                                demonstration project and design;
                                    (II) an evaluation of the cost-
                                effectiveness of each project's 
                                prevention and treatment efforts;
                                    (III) an evaluation of the cultural 
                                and linguistic appropriateness of each 
                                project by racial and ethnic group; and
                                    (IV) an evaluation of the 
                                beneficiary's health status improvement 
                                under the demonstration project.
                            (iv) Any other information deemed 
                        appropriate by the director.--The Director 
                        shall require eligible entities awarded a grant 
                        under this paragraph to report any other 
                        information the Director determines appropriate 
                        to be shared by or developed by such entity, 
                        including the following:
                                    (I) Developing models and 
                                evaluating methods that improve the 
                                cultural and linguistically appropriate 
                                services provided through the Centers 
                                for Disease Control and Prevention to 
                                target individuals impacted by health 
                                inequities based on their race, 
                                ethnicity, gender, and sexual 
                                orientation.
                                    (II) Promoting the collaboration 
                                between primary and specialty care 
                                health care providers and patients, to 
                                ensure patients impacted by health 
                                inequities based on race, ethnicity, 
                                gender, or sexual orientation are 
                                receiving comprehensive and organized 
                                treatment and care.
                                    (III) Educating health care 
                                professionals on the causes and effects 
                                of inequities in the social 
                                determinants of health in relation to 
                                minority and racial and ethnic 
                                communities and the need for culturally 
                                and linguistically appropriate care in 
                                the prevention and treatment of high-
                                impact diseases.
                                    (IV) Encouraging collaboration 
                                among community- and patient-based 
                                organizations which work to address 
                                inequities in the social determinants 
                                of health in relation to high-impact 
                                diseases in minority and racial and 
                                ethnic populations.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            (1) $25,000,000 for fiscal year 2023; and
            (2) such sums as may be necessary for fiscal years 2024 
        through 2026.

SEC. 10005. ADDITIONAL RESEARCH ON THE RELATIONSHIP BETWEEN THE BUILT 
              ENVIRONMENT AND THE HEALTH OF COMMUNITY RESIDENTS.

    (a) Definition of Eligible Institution.--In this section, the term 
``eligible institution'' means a public or private nonprofit 
institution that submits to the Secretary of Health and Human Services 
(in this section referred to as the ``Secretary'') and the 
Administrator of the Environmental Protection Agency (in this section 
referred to as the ``Administrator'') an application for a grant under 
the grant program authorized under subsection (b)(2) at such time, in 
such manner, and containing such agreements, assurances, and 
information as the Secretary and Administrator may require.
    (b) Research Grant Program.--
            (1) Definition of health.--In this section, the term 
        ``health'' includes--
                    (A) levels of physical activity;
                    (B) degree of mobility due to factors such as 
                musculoskeletal diseases, arthritis, and obesity;
                    (C) consumption of nutritional foods;
                    (D) rates of crime;
                    (E) air, water, and soil quality;
                    (F) risk of injury;
                    (G) accessibility to health care services;
                    (H) levels of educational attainment; and
                    (I) other indicators as determined appropriate by 
                the Secretary.
            (2) Grants.--The Secretary, in collaboration with the 
        Administrator, shall provide grants to eligible institutions to 
        conduct and coordinate research on the built environment and 
        its influence on individual and population-based health.
            (3) Research.--The Secretary shall support research that--
                    (A) investigates and defines the causal links 
                between all aspects of the built environment and the 
                health of residents;
                    (B) examines--
                            (i) the extent of the impact of the built 
                        environment (including the various 
                        characteristics of the built environment) on 
                        the health of residents;
                            (ii) the variation in the health of 
                        residents by--
                                    (I) location (such as inner cities, 
                                inner suburbs, outer suburbs, 
                                reservations, and rural areas); and
                                    (II) population subgroup (including 
                                children, young adults, the elderly, 
                                the disadvantaged); or
                            (iii) the importance of the built 
                        environment to the total health of residents, 
                        which is the primary variable of interest from 
                        a public health perspective;
                    (C) is used to develop--
                            (i) measures to address health and the 
                        connection of health to the built environment; 
                        and
                            (ii) efforts to link the measures to travel 
                        and health databases;
                    (D) distinguishes carefully between personal 
                attitudes and choices and external influences on 
                observed behavior to determine how much an observed 
                association between the built environment and the 
                health of residents, versus the lifestyle preferences 
                of the people that choose to live in the neighborhood, 
                reflects the physical characteristics of the 
                neighborhood; and
                    (E)(i) identifies or develops effective 
                intervention strategies to promote better health among 
                residents with a focus on behavioral interventions and 
                enhancements of the built environment that promote 
                increased use by residents; and
                    (ii) in developing the intervention strategies 
                under clause (i), ensures that the intervention 
                strategies will reach out to high-risk populations, 
                including racial and ethnic minorities, low-income 
                urban and rural communities, and children.
            (4) Priority.--In providing assistance under the grant 
        program authorized under paragraph (2), the Secretary and the 
        Administrator shall give priority to research that 
        incorporates--
                    (A) minority-serving institutions as grantees;
                    (B) interdisciplinary approaches; or
                    (C) the expertise of the public health, physical 
                activity, nutrition and health care (including child 
                health), urban planning, and transportation research 
                communities in the United States and abroad.

SEC. 10006. ENVIRONMENT AND PUBLIC HEALTH RESTORATION.

    (a) Findings.--Congress finds that--
            (1) humans share an environment with a wide variety of 
        habitats and ecosystems that nurture and sustain a diversity of 
        species;
            (2) the abundance of natural resources in the environment 
        forms the basis for the economy and has greatly contributed to 
        human development throughout history;
            (3) the accelerated pace of human development over the last 
        several hundred years has significantly impacted--
                    (A) the natural environment and its resources;
                    (B) the health and diversity of plant and animal 
                life;
                    (C) the availability of critical habitats;
                    (D) the quality of the air and water; and
                    (E) the global climate;
            (4) the intervention of the Federal Government is necessary 
        to minimize and mitigate human impact on the environment--
                    (A) for the benefit of public health;
                    (B) to maintain air quality and water quality;
                    (C) to sustain the diversity of plants and animals;
                    (D) to combat global climate change; and
                    (E) to protect the environment;
            (5) laws and regulations in the United States have been 
        enacted and promulgated to minimize and mitigate human impact 
        on the environment for the benefit of public health, to 
        maintain air quality and water quality, to sustain wildlife, 
        and to protect the environment; and
            (6) attempts to repeal or weaken key environmental 
        safeguards pose dangers to the public health, air quality, 
        water quality, wildlife, and the environment.
    (b) Statement of Policy.--It is the policy of the Federal 
Government to work in conjunction with States, territories, Tribal 
governments, international organizations, and foreign governments as a 
steward of the environment for the benefit of public health, to 
maintain air quality and water quality, to sustain the diversity of 
plant and animal species, to combat global climate change, and to 
protect the environment for future generations.
    (c) Study and Report on Public Health or Environmental Impact of 
Revised Rules, Regulations, Laws, or Other Agency Decisions.--
            (1) Study.--Not later than 30 days after the date of 
        enactment of this Act, the President shall seek to enter into 
        an arrangement under which the National Academy of Sciences 
        shall conduct a study to determine the effects on public 
        health, air quality, water quality, wildlife, and the 
        environment of the following regulations, laws, and other 
        agency decisions:
                    (A) Clean water.--
                            (i) The final rule of the Environmental 
                        Protection Agency and the Corps of Engineers 
                        entitled ``Final Revisions to the Clean Water 
                        Act Regulatory Definitions of `Fill Material' 
                        and `Discharge of Fill Material''' and 
                        published in the Federal Register on May 9, 
                        2002 (67 Fed. Reg. 31129).
                            (ii) The final rule of the Environmental 
                        Protection Agency entitled ``National Pollutant 
                        Discharge Elimination System Permit Regulation 
                        for Concentrated Animal Feeding Operations: 
                        Removal of Vacated Elements in Response to 2011 
                        Court Decision'' and published in the Federal 
                        Register on July 30, 2012 (77 Fed. Reg. 44494).
                            (iii) The final rule entitled ``Withdrawal 
                        of Revisions to the Water Quality Planning and 
                        Management Regulation and Revisions to the 
                        National Pollutant Discharge Elimination System 
                        Program in Support of Revisions to the Water 
                        Quality Planning and Management Regulation'' 
                        and published in the Federal Register on March 
                        19, 2003 (68 Fed. Reg. 13608).
                            (iv) The final rule of the Environmental 
                        Protection Agency entitled ``Consolidated 
                        Permit Regulations: RCRA Hazardous Waste; SDWA 
                        Underground Injection Control; CWA National 
                        Pollutant Discharge Elimination System; CWA 
                        Section 404 Dredge or Fill Programs; and CAA 
                        Prevention of Significant Deterioration'' and 
                        published in the Federal Register on May 19, 
                        1980 (45 Fed. Reg. 33290), with respect to the 
                        definition of the ``waters of the United 
                        States''.
                            (v) The final rule of the Corps of 
                        Engineers and the Environmental Protection 
                        Agency entitled ``Definition of `Waters of the 
                        United States'--Recodification of Pre-Existing 
                        Rules'' and published in the Federal Register 
                        on October 22, 2019 (84 Fed. Reg. 56626).
                            (vi) The final rule of the Corps of 
                        Engineers and the Environmental Protection 
                        Agency entitled ``The Navigable Waters 
                        Protection Rule: Definition of `Waters of the 
                        United States''' and published in the Federal 
                        Register on April 21, 2020 (85 Fed. Reg. 
                        22250).
                    (B) Forests and land management.--
                            (i) The Healthy Forests Restoration Act of 
                        2003 (16 U.S.C. 6501 et seq.).
                            (ii) The application of section 553(e) of 
                        title 5, United States Code, such that a State 
                        may petition for a special rule for the 
                        National Forest System inventoried roadless 
                        areas within the State.
                            (iii) The final rules entitled ``National 
                        Forest System Land Management Planning'' (77 
                        Fed. Reg. 21162) and ``National Forest System 
                        Land Management Planning'' (81 Fed. Reg. 
                        90723), published on April 19, 2013, and 
                        December 15, 2016, respectively.
                            (iv) The final rule entitled ``Oil Shale 
                        Management--General'' and published on January 
                        15, 2009 (73 Fed. Reg. 69414).
                            (v) The record of decision described in the 
                        notice of availability entitled ``Notice of 
                        Availability of Approved Land Use Plan 
                        Amendments/Record of Decision for Allocation of 
                        Oil Shale and Tar Sands Resources on Lands 
                        Administered by the Bureau of Land Management 
                        in Colorado, Utah, and Wyoming and Final 
                        Programmatic Environmental Impact Statement'' 
                        and published on April 1, 2013 (78 Fed. Reg. 
                        19518).
                    (C) Scientific review.--The final rule entitled 
                ``Interagency Cooperation Under the Endangered Species 
                Act'' (December 16, 2008) (73 Fed. Reg. 76272), as 
                amended by the final rule entitled ``Endangered and 
                Threatened Wildlife and Plants; Regulations for 
                Interagency Cooperation'' (August 27, 2019) (84 Fed. 
                Reg. 44976).
            (2) Method.--In conducting the study under paragraph (1), 
        the National Academy of Sciences may use and compare existing 
        scientific studies regarding the regulations, laws, and other 
        agency decisions described in paragraph (1).
            (3) Report.--Not later than 270 days after the date on 
        which the President enters into the arrangement under paragraph 
        (1), the National Academy of Sciences shall make publicly 
        available and shall submit to Congress and to the head of each 
        department and agency of the Federal Government that issued, 
        implements, or would implement a regulation, law, or other 
        agency decision described in paragraph (1), a report that 
        includes--
                    (A) a description of the effects of each 
                regulation, law, or other agency decision described in 
                paragraph (1) on public health, air quality, water 
                quality, wildlife, and the environment, compared to the 
                impact of preexisting regulations, laws, or other 
                agency decisions in effect, as applicable, including--
                            (i) any negative impacts to air quality or 
                        water quality;
                            (ii) any negative impacts to wildlife;
                            (iii) any delays in hazardous waste cleanup 
                        that are projected to be hazardous to public 
                        health; and
                            (iv) any other negative impact on public 
                        health or the environment; and
                    (B) any recommendations that the National Academy 
                of Sciences considers appropriate to maintain, restore, 
                or improve in whole or in part protections for public 
                health, air quality, water quality, wildlife, and the 
                environment for each of the regulations, laws, and 
                other agency decisions described in paragraph (1), 
                which may include recommendations for the adoption of 
                any regulation or law in place or proposed prior to 
                January 1, 2001.
    (d) Department and Agency Revision of Existing Rules, Regulations, 
or Laws.--Not later than 180 days after the date on which the report is 
submitted pursuant to subsection (c)(3), the head of each department or 
agency that has issued or implemented a regulation, law, or other 
agency decision described in subsection (c)(1) shall submit to Congress 
a plan describing the steps the department or agency will take, or has 
taken, to restore or improve protections for public health and the 
environment in whole or in part that were in existence prior to the 
issuance of the applicable regulation, law, or other agency decision.

SEC. 10007. GAO REPORT ON HEALTH EFFECTS OF DEEPWATER HORIZON OIL RIG 
              EXPLOSION IN THE GULF COAST.

    (a) Study.--The Comptroller General of the United States shall 
conduct a study on the type and scope of health care services 
administered through the Department of Health and Human Services 
addressing the provision of health care to racial and ethnic 
minorities, including residents, cleanup workers, and volunteers, 
affected by the blowout and explosion of the mobile offshore drilling 
unit Deepwater Horizon that occurred on April 20, 2010, and resulting 
hydrocarbon releases into the environment.
    (b) Specific Components.--In carrying out subsection (a), the 
Comptroller General of the United States shall--
            (1) assess the type, size, and scope of programs 
        administered by the Secretary of Health and Human Services that 
        focus on the provision of health care to communities on the 
        Gulf Coast;
            (2) identify the merits and disadvantages associated with 
        each of the programs;
            (3) perform an analysis of the costs and benefits of the 
        programs; and
            (4) determine whether there is any duplication of programs.
    (c) Report.--Not later than 180 days after the date of enactment of 
this Act, the Comptroller General of the United States shall submit to 
Congress a report that includes--
            (1) the findings of the study conducted under subsection 
        (a); and
            (2) recommendations for improving access to health care for 
        racial and ethnic minorities.

SEC. 10008. ESTABLISH AN INTERAGENCY COUNSEL AND GRANT PROGRAMS ON 
              SOCIAL DETERMINANTS OF HEALTH.

    (a) Findings; Purposes.--
            (1) Findings.--Congress finds the following:
                    (A) There is a significant body of evidence showing 
                that economic and social conditions have a powerful 
                impact on individual and population health outcomes and 
                well-being, as well as medical costs.
                    (B) State, local, and Tribal governments and the 
                service delivery partners of such governments face 
                significant challenges in coordinating benefits and 
                services delivered through the Medicaid program and 
                other social services programs because of the 
                fragmented and complex nature of Federal and State 
                funding and administrative requirements.
                    (C) The Federal Government should prioritize and 
                proactively assist State and local governments to 
                strengthen the capacity of State and local governments 
                to improve health and social outcomes for individuals, 
                thereby improving cost-effectiveness and return on 
                investment.
            (2) Purposes.--The purposes of this section are as follows:
                    (A) To establish effective, coordinated Federal 
                technical assistance to help State and local 
                governments to improve outcomes and cost-effectiveness 
                of, and return on investment from, health and social 
                services programs.
                    (B) To build a pipeline of State and locally 
                designed, cross-sector interventions and strategies 
                that generate rigorous evidence about how to improve 
                health and social outcomes, and increase the cost-
                effectiveness of, and return on investment from, 
                Federal, State, local, and Tribal health and social 
                services programs.
                    (C) To enlist State and local governments and the 
                service providers of such governments as partners in 
                identifying Federal statutory, regulatory, and 
                administrative challenges in improving the health and 
                social outcomes of, cost-effectiveness of, and return 
                on investment from, Federal spending on individuals 
                enrolled in Medicaid.
                    (D) To develop strategies to improve health and 
                social outcomes without denying services to, or 
                restricting the eligibility of, vulnerable populations.
    (b) Social Determinants Accelerator Council.--
            (1) Establishment.--The Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary''), in 
        coordination with the Administrator of the Centers for Medicare 
        & Medicaid Services (referred to in this section as the 
        ``Administrator''), shall establish an interagency council, to 
        be known as the Social Determinants Accelerator Interagency 
        Council (referred to in this section as the ``Council'') to 
        achieve the purposes listed in subsection (b)(2).
            (2) Membership.--
                    (A) Federal composition.--The Council shall be 
                composed of at least one designee from each of the 
                following Federal agencies:
                            (i) The Office of Management and Budget.
                            (ii) The Department of Agriculture.
                            (iii) The Department of Education.
                            (iv) The Indian Health Service.
                            (v) The Department of Housing and Urban 
                        Development.
                            (vi) The Department of Labor.
                            (vii) The Department of Transportation.
                            (viii) Any other Federal agency the Chair 
                        of the Council determines necessary.
                    (B) Designation.--
                            (i) In general.--The head of each agency 
                        specified in subparagraph (A) shall designate 
                        at least one employee described in clause (ii) 
                        to serve as a member of the Council.
                            (ii) Responsibilities.--An employee 
                        described in this clause shall be a senior 
                        employee of the agency--
                                    (I) whose responsibilities relate 
                                to authorities, policies, and 
                                procedures with respect to the health 
                                and well-being of individuals receiving 
                                medical assistance under a State plan 
                                (or a waiver of such plan) under title 
                                XIX of the Social Security Act (42 
                                U.S.C. 1396 et seq.); or
                                    (II) who has authority to implement 
                                and evaluate transformative initiatives 
                                that harness data or conduct rigorous 
                                evaluation to improve the impact and 
                                cost-effectiveness of federally funded 
                                services and benefits.
                    (C) HHS representation.--In addition to the 
                designees under subparagraph (A), the Council shall 
                include designees from at least 3 agencies within the 
                Department of Health and Human Services, including the 
                Centers for Medicare & Medicaid Services, at least one 
                of whom shall meet the criteria under subparagraph 
                (B)(ii).
                    (D) OMB role.--The Director of the Office of 
                Management and Budget shall facilitate the timely 
                resolution of Federal Government-wide and multiagency 
                issues to help the Council achieve consensus 
                recommendations described under this section.
                    (E) Non-federal composition.--The Comptroller 
                General of the United States may designate up to 6 
                Council designees--
                            (i) who have relevant subject matter 
                        expertise, including expertise implementing and 
                        evaluating transformative initiatives that 
                        harness data and conduct evaluations to improve 
                        the impact and cost-effectiveness of Federal 
                        Government services; and
                            (ii) that each represent--
                                    (I) State, local, and Tribal health 
                                and human services agencies;
                                    (II) public housing authorities or 
                                State housing finance agencies;
                                    (III) State and local government 
                                budget offices;
                                    (IV) State Medicaid agencies; or
                                    (V) national consumer advocacy 
                                organizations.
                    (F) Chair.--
                            (i) In general.--The Secretary shall select 
                        the Chair of the Council from among the members 
                        of the Council.
                            (ii) Initiating guidance.--The Chair, on 
                        behalf of the Council, shall identify and 
                        invite individuals from diverse entities to 
                        provide the Council with advice and information 
                        pertaining to addressing social determinants of 
                        health, including--
                                    (I) individuals from State and 
                                local government health and human 
                                services agencies;
                                    (II) individuals from State 
                                Medicaid agencies;
                                    (III) individuals from State and 
                                local government budget offices;
                                    (IV) individuals from public 
                                housing authorities or State housing 
                                finance agencies;
                                    (V) individuals from nonprofit 
                                organizations, small businesses, and 
                                philanthropic organizations;
                                    (VI) advocates;
                                    (VII) researchers; and
                                    (VIII) any other individuals the 
                                Chair determines to be appropriate.
            (3) Duties.--The duties of the Council are--
                    (A) to make recommendations to the Secretary and 
                the Administrator regarding the criteria for making 
                awards under this section;
                    (B) to identify Federal authorities and 
                opportunities for use by States or local governments to 
                improve coordination of funding and administration of 
                Federal programs, the beneficiaries of whom include 
                individuals, and which may be unknown or underutilized, 
                and to make information on such authorities and 
                opportunities publicly available;
                    (C) to provide targeted technical assistance to 
                States developing a social determinants accelerator 
                plan under this section, including identifying 
                potential statutory or regulatory pathways for 
                implementation of the plan and assisting in identifying 
                potential sources of funding to implement the plan;
                    (D) to report to Congress annually on the subjects 
                set forth in this section;
                    (E) to develop and disseminate evaluation 
                guidelines and standards that can be used to reliably 
                assess the impact of an intervention or approach that 
                may be implemented pursuant to this section on 
                outcomes, cost-effectiveness of, and return on 
                investment from Federal, State, local, and Tribal 
                governments, and to facilitate technical assistance, 
                where needed, to help to improve State and local 
                evaluation designs and implementation;
                    (F) to seek feedback from State, local, and Tribal 
                governments, including through an annual survey by an 
                independent third party, on how to improve the 
                technical assistance the Council provides to better 
                equip State, local, and Tribal governments to 
                coordinate health and social service programs;
                    (G) to solicit applications for grants under this 
                section; and
                    (H) to coordinate with other cross-agency 
                initiatives focused on improving the health and well-
                being of low-income and at-risk populations in order to 
                prevent unnecessary duplication between agency 
                initiatives.
            (4) Schedule.--Not later than 60 days after the date of the 
        enactment of this Act, the Council shall convene to develop a 
        schedule and plan for carrying out the duties described in this 
        section, including solicitation of applications for the grants 
        under this section.
            (5) Report to congress.--The Council shall submit an annual 
        report to Congress, which shall include--
                    (A) a list of the Council members;
                    (B) activities and expenditures of the Council;
                    (C) summaries of the interventions and approaches 
                that will be supported by State, local, and Tribal 
                governments that received a grant under this section, 
                including--
                            (i) the best practices and evidence-based 
                        approaches such governments plan to employ to 
                        achieve the purposes listed in this section; 
                        and
                            (ii) a description of how the practices and 
                        approaches will impact the outcomes, cost-
                        effectiveness of, and return on investment 
                        from, Federal, State, local, and Tribal 
                        governments with respect to such purposes;
                    (D) the feedback received from State and local 
                governments on ways to improve the technical assistance 
                of the Council, including findings from a third-party 
                survey and actions the Council plans to take in 
                response to such feedback; and
                    (E) the major statutory, regulatory, and 
                administrative challenges identified by State, local, 
                and Tribal governments that received a grant under 
                subsection (d), and the actions that Federal agencies 
                are taking to address such challenges.
            (6) FACA applicability.--The Federal Advisory Committee Act 
        (5 U.S.C. App.) shall not apply to the Council.
            (7) Council procedures.--The Secretary, in consultation 
        with the Comptroller General of the United States and the 
        Director of the Office of Management and Budget, shall 
        establish procedures for the Council to--
                    (A) ensure that adequate resources are available to 
                effectively execute the responsibilities of the 
                Council;
                    (B) effectively coordinate with other relevant 
                advisory bodies and working groups to avoid unnecessary 
                duplication;
                    (C) create transparency to the public and Congress 
                with regard to Council membership, costs, and 
                activities, including through use of modern technology 
                and social media to disseminate information; and
                    (D) avoid conflicts of interest that would 
                jeopardize the ability of the Council to make decisions 
                and provide recommendations.
    (c) Social Determinants Accelerator Grants to States or Local 
Governments.--
            (1) Grants to states, local governments, and tribes.--Not 
        later than 180 days after the date of the enactment of this 
        Act, the Administrator, in consultation with the Secretary and 
        the Council, shall award on a competitive basis not more than 
        25 grants to eligible applicants described in this subsection, 
        for the development of social determinants accelerator plans, 
        as described in this subsection.
            (2) Eligible applicant.--An eligible applicant described in 
        this subsection is a State, local, or Tribal health or human 
        services agency that--
                    (A) demonstrates the support of relevant parties 
                across relevant State, local, or Tribal jurisdictions; 
                and
                    (B) in the case of an applicant that is a local 
                government agency, provides to the Secretary a letter 
                of support from the lead State health or human services 
                agency for the State in which the local government is 
                located.
            (3) Amount of grant.--The Administrator, in coordination 
        with the Council, shall determine the total amount that the 
        Administrator will make available to each grantee under this 
        subsection.
            (4) Application.--An eligible applicant seeking a grant 
        under this subsection shall include in the application the 
        following information:
                    (A) The target population (or populations) that 
                would benefit from implementation of the social 
                determinants accelerator plan proposed to be developed 
                by the applicant.
                    (B) A description of the objective or objectives 
                and outcome goals of such proposed plan, which shall 
                include at least one health outcome and at least one 
                other important social outcome.
                    (C) The sources and scope of inefficiencies that, 
                if addressed by the plan, could result in improved 
                cost-effectiveness of or return on investment from 
                Federal, State, local, and Tribal governments.
                    (D) A description of potential interventions that 
                could be designed or enabled using such proposed plan.
                    (E) The State, local, and Tribal governments, 
                academic institutions, nonprofit organizations, 
                community-based organizations, and other public and 
                private sector partners that would participate in the 
                development of the proposed plan and subsequent 
                implementation of programs or initiatives included in 
                such proposed plan.
                    (F) Such other information as the Administrator, in 
                consultation with the Secretary and the Council, 
                determines necessary to achieve the purposes of this 
                section.
            (5) Use of funds.--A recipient of a grant under this 
        subsection may use funds received through the grant for the 
        following purposes:
                    (A) To convene and coordinate with relevant 
                government entities and other stakeholders across 
                sectors to assist in the development of a social 
                determinant accelerator plan.
                    (B) To identify populations of individuals 
                receiving medical assistance under a State plan (or a 
                waiver of such plan) under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.) who may benefit 
                from the proposed approaches to improving the health 
                and well-being of such individuals through the 
                implementation of the proposed social determinants 
                accelerator plan.
                    (C) To engage qualified research experts to advise 
                on relevant research and to design a proposed 
                evaluation plan, in accordance with the standards and 
                guidelines issued by the Administrator.
                    (D) To collaborate with the Council to support the 
                development of social determinants accelerator plans.
                    (E) To prepare and submit a final social 
                determinants accelerator plan to the Council.
            (6) Contents of plans.--A social determinant accelerator 
        plan developed under this subsection shall include the 
        following:
                    (A) A description of the target population (or 
                populations) that would benefit from implementation of 
                the social determinants accelerator plan, including an 
                analysis describing the projected impact on the well-
                being of individuals described in paragraph (5)(B).
                    (B) A description of the interventions or 
                approaches designed under the social determinants 
                accelerator plan and the evidence for selecting such 
                interventions or approaches.
                    (C) The objectives and outcome goals of such 
                interventions or approaches, including at least one 
                health outcome and at least one other important social 
                outcome.
                    (D) A plan for accessing and linking relevant data 
                to enable coordinated benefits and services for the 
                jurisdictions described in this section and an 
                evaluation of the proposed interventions and 
                approaches.
                    (E) A description of the State, local, and Tribal 
                governments, academic institutions, nonprofit 
                organizations, or any other public or private sector 
                organizations that would participate in implementing 
                the proposed interventions or approaches, and the role 
                each would play to contribute to the success of the 
                proposed interventions or approaches.
                    (F) The identification of the funding sources that 
                would be used to finance the proposed interventions or 
                approaches.
                    (G) A description of any financial incentives that 
                may be provided, including outcome-focused contracting 
                approaches to encourage service providers and other 
                partners to improve outcomes of, cost-effectiveness of, 
                and return on investment from, Federal, State, local, 
                or Tribal government spending.
                    (H) The identification of the applicable Federal, 
                State, local, or Tribal statutory and regulatory 
                authorities, including waiver authorities, to be 
                leveraged to implement the proposed interventions or 
                approaches.
                    (I) A description of potential considerations that 
                would enhance the impact, scalability, or 
                sustainability of the proposed interventions or 
                approaches and the actions the grant awardee would take 
                to address such considerations.
                    (J) A proposed evaluation plan, to be carried out 
                by an independent evaluator, to measure the impact of 
                the proposed interventions or approaches on the 
                outcomes of, cost-effectiveness of, and return on 
                investment from, Federal, State, local, and Tribal 
                governments.
                    (K) Precautions for ensuring that vulnerable 
                populations will not be denied access to Medicaid or 
                other essential services as a result of implementing 
                the proposed plan.
    (d) Funding.--
            (1) In general.--Out of any money in the Treasury not 
        otherwise appropriated, there is appropriated to carry out this 
        section $25,000,000 to remain available for obligation until 
        the date that is 5 years after the date of enactment of this 
        section.
            (2) Reservation of funds.--
                    (A) In general.--Of the funds made available under 
                paragraph (1), the Secretary shall reserve not less 
                than 20 percent to award grants to eligible applicants 
                for the development of social determinants accelerator 
                plans under this section intended to serve rural 
                populations.
                    (B) Exception.--In the case of a fiscal year for 
                which the Secretary determines that there are not 
                sufficient eligible applicants to award up to 25 grants 
                under subsection (d) that are intended to serve rural 
                populations and the Secretary cannot satisfy the 20-
                percent requirement, the Secretary may reserve an 
                amount that is less than 20 percent of amounts made 
                available under paragraph (1) to award grants for such 
                purpose.
            (3) Rule of construction.--Nothing in this section shall 
        prevent Federal agencies represented on the Council from 
        contributing additional funding from other sources to support 
        activities to improve the effectiveness of the Council.

SEC. 10009. CORRECTING HURTFUL AND ALIENATING NAMES IN GOVERNMENT 
              EXPRESSION (CHANGE).

    (a) Short Title.--This section may be cited as the ``Correcting 
Hurtful and Alienating Names in Government Expression (CHANGE) Act''.
    (b) Definitions.--In this section:
            (1) Employee.--The term ``employee'' has the meaning given 
        the term in section 2105 of title 5, United States Code.
            (2) Executive agency.--The term ``Executive agency'' has 
        the meaning given the term in section 105 of title 5, United 
        States Code.
            (3) Officer.--The term ``officer'' has the meaning given 
        the term in section 2104 of title 5, United States Code.
            (4) Prohibited term.--The term ``prohibited term'' means--
                    (A) the term ``alien'', when used to refer to an 
                individual who is not a citizen or national of the 
                United States; and
                    (B) the term ``illegal alien'', when used to refer 
                to an individual who--
                            (i) is unlawfully present in the United 
                        States; or
                            (ii) lacks a lawful immigration status in 
                        the United States.
    (c) Modernization of Language Referring to Individuals Who Are Not 
Citizens or Nationals of the United States.--
            (1) In general.--Except as provided in paragraph (2), on 
        and after the date of enactment of this Act, an Executive 
        agency may not use a prohibited term in any proposed or final 
        rule, regulation, interpretation, publication, other document, 
        display, or sign issued by the Executive agency.
            (2) Exception.--An Executive agency may use a prohibited 
        term under paragraph (1) if the Executive agency uses the 
        prohibited term while quoting or reproducing text written by a 
        source that is not an officer or employee of the Executive 
        agency.
    (d) Uniform Definition.--
            (1) In general.--Chapter 1 of title 1, United States Code, 
        is amended by adding at the end the following:
``Sec. 9. Definition of `foreign national'
    ``In determining the meaning of any Act of Congress or any ruling, 
regulation, or interpretation of an administrative bureau or agency of 
the United States, the term `foreign national' means any individual 
that is not an individual who--
            ``(1) is a citizen of the United States; or
            ``(2) though not a citizen of the United States, owes 
        permanent allegiance to the United States.''.
            (2) Technical amendment.--The table of sections for chapter 
        1 of title 1, United States Code, is amended by adding at the 
        end the following:

``9. Definition of `foreign national'.''.
    (e) References.--Any reference in any Federal statute, rule, 
regulation, Executive order, publication, or other document of the 
United States--
            (1) to the term ``alien'', when used to refer to an 
        individual who is not a citizen or national of the United 
        States, is deemed to refer to the term ``foreign national''; 
        and
            (2) to the term ``illegal alien'' is deemed to refer to the 
        term ``undocumented foreign national'', when used to refer to 
        an individual who--
                    (A) is unlawfully present in the United States; or
                    (B) lacks a lawful immigration status in the United 
                States.

SEC. 10010. ANDREW KEARSE ACCOUNTABILITY FOR DENIAL OF MEDICAL CARE.

    (a) In General.--Chapter 13 of title 18, United States Code, is 
amended by adding at the end the following:
``Sec. 250. Medical attention for individuals in Federal custody 
              displaying medical distress
    ``(a) Definitions.--In this section--
            ``(1) the term `appropriate Inspector General', with 
        respect to a covered official, means--
                    ``(A) the Inspector General of the Federal agency 
                that employs the covered official; or
                    ``(B) in the case of a covered official employed by 
                a Federal agency that does not have an Inspector 
                General, the Inspector General of the Department of 
                Justice;
            ``(2) the term `covered official' means--
                    ``(A) a Federal law enforcement officer (as defined 
                in section 115);
                    ``(B) an officer or employee of the Bureau of 
                Prisons; or
                    ``(C) an officer or employee of the United States 
                Marshals Service; and
            ``(3) the term `medical distress' includes breathing 
        difficulties.
    ``(b) Requirement.--
            ``(1) Offense.--It shall be unlawful for a covered official 
        to negligently fail to obtain or provide immediate medical 
        attention to an individual in Federal custody who displays 
        medical distress in the presence of the covered official, if 
        the individual suffers unnecessary pain, injury, or death as a 
        result of that failure.
            ``(2) Penalty.--A covered official who violates paragraph 
        (1) shall be fined under this title, imprisoned for not more 
        than 1 year, or both.
            ``(3) State civil enforcement.--Whenever an attorney 
        general of a State has reasonable cause to believe that a 
        resident of the State has been aggrieved by a violation of 
        paragraph (1) by a covered official, the attorney general, or 
        another official, agency, or entity designated by the State, 
        may bring a civil action in any appropriate district court of 
        the United States to obtain appropriate equitable and 
        declaratory relief.
    ``(c) Inspector General Investigation.--
            ``(1) In general.--The appropriate Inspector General shall 
        investigate any instance in which--
                    ``(A) a covered official fails to obtain or provide 
                immediate medical attention to an individual in Federal 
                custody who displays medical distress in the presence 
                of the covered official; and
                    ``(B) the individual suffers unnecessary pain, 
                injury, or death as a result of the failure to obtain 
                or provide immediate medical attention.
            ``(2) Referral for prosecution.--If an Inspector General, 
        in conducting an investigation under paragraph (1), concludes 
        that the covered official acted negligently in failing to 
        obtain or provide immediate medical attention to the individual 
        in Federal custody, the Inspector General shall refer the case 
        to the Attorney General for prosecution under this section.
            ``(3) Confidential complaint process.--The Inspector 
        General of a Federal agency that employs covered officials 
        shall establish a process under which an individual may 
        confidentially submit a complaint to the Inspector General 
        regarding an incident described in paragraph (1) involving a 
        covered official employed by the Federal agency (or, in the 
        case of the Inspector General of the Department of Justice, 
        involving a covered official employed by a Federal agency that 
        does not have an Inspector General).
    ``(d) Training.--The head of an agency that employs covered 
officials shall provide training to each such covered official on 
obtaining or providing medical assistance to individuals in medical 
distress.''.
    (b) Technical and Conforming Amendment.--The table of sections for 
chapter 13 of title 18, United States Code, is amended by adding at the 
end the following:

``250. Medical attention for individuals in Federal custody displaying 
                            medical distress.''.

SEC. 10011. INVESTING IN COMMUNITY HEALING.

    (a) Findings.--Congress finds the following:
            (1) According to the Bureau of Justice Statistics, African 
        Americans are more likely to have face-to-face contact with law 
        enforcement and are 2.5 times more likely to experience a 
        threat or use of nonfatal force by police.
            (2) Research shows that young men who have experienced 
        these law enforcement practices display higher levels of 
        stress, anxiety, and trauma associated with the interaction.
            (3) Witnessing or experiencing invasive encounters with law 
        enforcement can also be an everyday stressor for racial and 
        ethnic minorities, leading to physiological and psychological 
        strain.
            (4) Racial and ethnic minorities face inequities in 
        accessing mental health services.
            (5) Addressing the stigma in some communities of color 
        associated with receiving mental health services and informing 
        individuals about available treatment can encourage better 
        utilization of these services.
    (b) Sense of Congress.--It is the sense of the Congress that it is 
imperative that a comprehensive public health approach to addressing 
trauma and mental health care be focused on care delivery that is 
culturally sensitive and competent.
    (c) Research on Adverse Health Effects Associated With Interactions 
With Law Enforcement.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary''), acting 
        through the Director of the Office of Minority Health of the 
        Centers for Disease Control and Prevention (established 
        pursuant to section 1707A of the Public Health Service Act (42 
        U.S.C. 300u-6a)), shall conduct research on the adverse health 
        effects associated with interactions with law enforcement.
            (2) Effects among racial and ethnic minorities.--The 
        research under paragraph (1) shall include research on--
                    (A) the health consequences, both individual and 
                community-wide, of trauma related to violence committed 
                by law enforcement among racial and ethnic minorities; 
                and
                    (B) the disproportionate burden of morbidity and 
                mortality associated with such trauma.
            (3) Report.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall--
                    (A) complete the research under this subsection; 
                and
                    (B) submit to the Congress a report on the 
                findings, conclusions, and recommendations resulting 
                from such research.
    (d) Grants for Increasing Racial and Ethnic Minority Access to 
High-Quality Trauma Support Services and Mental Health Care.--
            (1) In general.--The Secretary, acting through the 
        Assistant Secretary for Mental Health and Substance Use, shall 
        award grants to eligible entities to establish or expand 
        programs for the purpose of increasing racial and ethnic 
        minority access to high-quality trauma support services and 
        mental health care.
            (2) Eligible entities.--To seek a grant under this 
        subsection, an entity shall be a community-based program or 
        organization that--
                    (A) provides culturally competent programs and 
                resources that are aligned with evidence-based 
                practices for trauma-informed care; and
                    (B) has demonstrated expertise in serving 
                communities of color or can partner with a program that 
                has such demonstrated expertise.
            (3) Use of funds.--As a condition on receipt of a grant 
        under this subsection, a grantee shall agree to use the grant 
        to increase racial and ethnic minority access to high-quality 
        trauma support services and mental health care, such as by--
                    (A) establishing and maintaining community-based 
                programs providing evidence-based services in trauma-
                informed care and culturally specific services and 
                other resources;
                    (B) developing innovative culturally specific 
                strategies and projects to enhance access to trauma-
                informed care and resources for racial and ethnic 
                minorities who face obstacles to using more traditional 
                services and resources (such as obstacles in geographic 
                access to providers, insurance coverage, and access to 
                audio and video technologies);
                    (C) working with State and local governments and 
                social service agencies to develop and enhance 
                effective strategies to provide culturally specific 
                services to racial and ethnic minorities;
                    (D) increasing communities' capacity to provide 
                culturally specific resources and support for 
                communities of color;
                    (E) working in cooperation with the community to 
                develop education and prevention strategies 
                highlighting culturally specific issues and resources 
                regarding racial and ethnic minorities;
                    (F) providing culturally specific programs for 
                racial and ethnic minorities exposed to law enforcement 
                violence; and
                    (G) examining the dynamics of culture and its 
                impact on victimization and healing.
            (4) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to eligible entities 
        proposing to serve communities that have faced high rates of 
        community trauma, including from exposure to law enforcement 
        violence, intergenerational poverty, civil unrest, 
        discrimination, or oppression.
            (5) Grant period.--The period of a grant under this 
        subsection shall be 4 years.
            (6) Evaluation.--Not later than 6 months after the end of 
        the period of all grants under this subsection, the Secretary 
        shall--
                    (A) conduct an evaluation of the programs funded by 
                a grant under this subsection;
                    (B) include in such evaluation an assessment of the 
                outcomes of each such program; and
                    (C) submit a report on the results of such 
                evaluation to the Congress.
            (7) Authorization of appropriations.--To carry out this 
        subsection, there is authorized to be appropriated $20,000,000 
        for each of fiscal years 2023 through 2027.
    (e) Behavioral and Mental Health Outreach Education Strategy.--
            (1) In general.--The Secretary shall, in coordination with 
        advocacy and behavioral and mental health organizations serving 
        racial and ethnic minority groups, develop and implement an 
        outreach and education strategy to promote behavioral and 
        mental health, and reduce stigma associated with mental health 
        conditions, among racial and ethnic minorities.
            (2) Design.--The strategy under this subsection shall be 
        designed to--
                    (A) meet the diverse cultural and language needs of 
                racial and ethnic minority groups;
                    (B) provide information on evidence-based, 
                culturally and linguistically appropriate and adapted 
                interventions and treatments;
                    (C) increase awareness of symptoms of mental 
                illness among racial and ethnic minority groups; and
                    (D) ensure full participation of, and engage, both 
                consumers and community members in the development and 
                implementation of materials.
            (3) Report.--Not later than 1 year after the date of 
        enactment of this Act, the Secretary shall submit to the 
        Congress, and make publicly available, a report detailing the 
        outreach and education strategy that is developed and 
        implemented under this subsection and the results of such 
        implementation.

SEC. 10012. ENVIRONMENTAL JUSTICE MAPPING AND DATA COLLECTION.

    (a) Findings.--Congress finds that--
            (1) environmental hazards causing adverse health outcomes 
        have disproportionately affected environmental justice 
        communities as a result of systemic injustices relating to 
        factors that include race and income;
            (2) environmental justice communities have increased 
        vulnerability to the adverse effects of climate change and need 
        significant investment to face current and future environmental 
        hazards;
            (3) the Federal Government has lacked a cohesive and 
        consistent strategy to carry out the responsibilities of 
        Federal agencies described in Executive Order 12898 (42 U.S.C. 
        4321 note; relating to Federal actions to address environmental 
        justice in minority populations and low-income populations);
            (4) it is necessary that the Federal Government 
        meaningfully engage environmental justice communities in the 
        process of developing a robust strategy to address 
        environmental justice, including high levels of review, input, 
        and consent;
            (5) there is a lack of nationwide high-quality data 
        relating to environmental justice concerns, such as 
        socioeconomic factors, air pollution, water pollution, soil 
        pollution, and public health, and a failure to update the 
        existing data with adequate frequency;
            (6) there is no nationally consistent method to identify 
        environmental justice communities based on the cumulative 
        effects of socioeconomic factors, pollution burden, and public 
        health;
            (7) a method described in paragraph (6) is needed to 
        correct for racist and unjust practices leading to historical 
        and current environmental injustices through the targeted 
        investment in environmental justice communities of at least 40 
        percent of the funds provided for a clean energy transition and 
        other related investments, including transportation 
        infrastructure, housing infrastructure, and water quality 
        infrastructure;
            (8) funds targeted for environmental justice communities 
        should include set-asides for technical assistance and capacity 
        building for environmental justice communities to access the 
        funds;
            (9) particular oversight and care are necessary when 
        investing in environmental justice communities to ensure that 
        existing issues are not exacerbated and new issues are not 
        created, particularly issues relating to pollution burden and 
        the displacement of residents;
            (10) several States, academic institutions, and nonprofit 
        organizations have engaged in cumulative impact environmental 
        justice mapping efforts that can serve as references for a 
        Federal mapping effort;
            (11) many environmental justice communities, such as 
        communities in ``Cancer Alley'' in the State of Louisiana, have 
        been clearly affected by extreme environmental hazards such 
        that the communities--
                    (A) are identifiable before the establishment of 
                the tool under paragraph (2) of subsection (d) and the 
                completion of the data gap audit under paragraph (4) of 
                that subsection; and
                    (B) should be eligible for programs targeted toward 
                environmental justice communities that have faced 
                extreme environmental hazards before the establishment 
                of that tool and the completion of that audit;
            (12) in addition to investment in environmental justice 
        communities, pollution reduction is essential to achieving 
        equitable access to a healthy and clean environment and an 
        equitable energy system; and
            (13) specific policy and permitting decisions and 
        investments may rely on different combinations of data sets and 
        indicators relating to environmental justice, and race alone 
        may be considered a criterion when assessing the susceptibility 
        of a community to environmental injustice.
    (b) Definitions.--In this section:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Environmental Protection Agency.
            (2) Advisory council.--The term ``advisory council'' means 
        the advisory council established under subsection (c)(4)(B)(i).
            (3) Committee.--The term ``Committee'' means the 
        Environmental Justice Mapping Committee established by 
        subsection (c)(1).
            (4) Environmental justice.--The term ``environmental 
        justice'' means the fair treatment and meaningful involvement 
        of all people regardless of race, color, culture, national 
        origin, or income, with respect to the development, 
        implementation, and enforcement of environmental laws, 
        regulations, and policies to ensure that each person enjoys--
                    (A) the same degree of protection from 
                environmental and health hazards; and
                    (B) equal access to any Federal agency action 
                relating to the development, implementation, and 
                enforcement of environmental laws, regulations, and 
                policies for the purpose of having a healthy 
                environment in which to live, learn, work, and 
                recreate.
            (5) Environmental justice community.--The term 
        ``environmental justice community'' means a community with 
        significant representation of communities of color, low-income 
        communities, or Tribal and indigenous communities, that 
        experiences, or is at risk of experiencing, higher or more 
        adverse human health or environmental effects, as compared to 
        other communities.
            (6) Ground-truthing.--The term ``ground-truthing'' means a 
        community fact-finding process by which residents of a 
        community supplement technical information with local knowledge 
        for the purpose of better informing policy and project 
        decisions.
            (7) Relevant stakeholder.--The term ``relevant 
        stakeholder'' means--
                    (A) a representative of a regional, State, Tribal, 
                or local government agency;
                    (B) a representative of a nongovernmental 
                organization with experience in areas that may include 
                Tribal relations, environmental conservation, city and 
                regional planning, and public health;
                    (C) a representative of a labor union;
                    (D) a representative or member of--
                            (i) an environmental justice community; or
                            (ii) a community-based organization for an 
                        environmental justice community;
                    (E) an individual with expertise in cumulative 
                impacts, geospatial data, and environmental justice, 
                particularly such an individual from an academic or 
                research institution; and
                    (F) an advocate with experience in environmental 
                justice who represents an environmental justice 
                community.
    (c) Establishment of Committee.--
            (1) In general.--There is established a committee, to be 
        known as the ``Environmental Justice Mapping Committee''.
            (2) Membership.--
                    (A) In general.--The Committee shall be composed of 
                not fewer than 1 representative of each of the 
                following:
                            (i) Of the Environmental Protection 
                        Agency--
                                    (I) the Office of Air and 
                                Radiation;
                                    (II) the Office of Chemical Safety 
                                and Pollution Prevention;
                                    (III) the Office of International 
                                and Tribal Affairs;
                                    (IV) the Office of Land and 
                                Emergency Management;
                                    (V) the Office of Water;
                                    (VI) the Office of Environmental 
                                Justice;
                                    (VII) the Office of Research and 
                                Development; and
                                    (VIII) the Office of Public 
                                Engagement and Environmental Education.
                            (ii) The Council on Environmental Quality.
                            (iii) Of the Department of Commerce--
                                    (I) the Office of Oceanic and 
                                Atmospheric Research, including not 
                                fewer than 1 representative of the 
                                Climate Program Office;
                                    (II) the Economics and Statistics 
                                Administration, including not fewer 
                                than 1 representative of the Bureau of 
                                Economic Analysis; and
                                    (III) the National Institute of 
                                Standards and Technology.
                            (iv) Of the Department of Health and Human 
                        Services--
                                    (I) the Centers for Disease Control 
                                and Prevention, not including the 
                                Agency for Toxic Substances and Disease 
                                Registry;
                                    (II) the Agency for Toxic 
                                Substances and Disease Registry;
                                    (III) the Administration for 
                                Children and Families;
                                    (IV) of the National Institutes of 
                                Health--
                                            (aa) the National Institute 
                                        of Environmental Health 
                                        Sciences;
                                            (bb) the National Institute 
                                        of Mental Health; and
                                            (cc) the National Institute 
                                        on Minority Health and Health 
                                        Disparities; and
                                    (V) the Office for Civil Rights.
                            (v) Of the Department of the Interior--
                                    (I) the Bureau of Indian Affairs;
                                    (II) the Office of Civil Rights; 
                                and
                                    (III) the United States Geological 
                                Survey.
                            (vi) The Forest Service.
                            (vii) The Department of Housing and Urban 
                        Development.
                            (viii) The Department of Energy.
                            (ix) The Department of Transportation.
                            (x) The Department of Justice.
                            (xi) The Federal Energy Regulatory 
                        Commission.
                            (xii) The Department of the Treasury.
                            (xiii) Such other Federal departments, 
                        agencies, and offices as the Administrator 
                        determines to be appropriate, particularly 
                        offices relating to public engagement.
                    (B) Selection of representatives.--The head of a 
                department or agency described in subparagraph (A) 
                shall, in appointing to the Committee a representative 
                of the department or agency, select a representative--
                            (i) of a component of the department or 
                        agency that is among the components that are 
                        the most relevant to the responsibilities of 
                        the Committee; or
                            (ii) who has expertise in areas relevant to 
                        those responsibilities, such as demographic 
                        indicators relating to socioeconomic hardship, 
                        environmental justice, public engagement, 
                        public health, exposure to pollution, future 
                        climate and extreme weather mapping, affordable 
                        energy, sustainable transportation, and access 
                        to water, food, and green space.
                    (C) Co-chairs.--
                            (i) In general.--The members of the 
                        Committee shall select 3 members to serve as 
                        co-chairs of the Committee--
                                    (I) 1 of whom shall be a 
                                representative of the Environmental 
                                Protection Agency;
                                    (II) 1 of whom shall be a 
                                representative of the Council on 
                                Environmental Quality; and
                                    (III) 1 of whom shall have 
                                substantial experience in public 
                                engagement.
                            (ii) Terms.--Each co-chair shall serve for 
                        a term of not more than 3 years.
                            (iii) Responsibilities of co-chairs.--The 
                        co-chairs of the Committee shall--
                                    (I) determine the agenda of the 
                                Committee, in consultation with other 
                                members of the Committee;
                                    (II) direct the work of the 
                                Committee, including the oversight of a 
                                meaningful public engagement process; 
                                and
                                    (III) convene meetings of the 
                                Committee not less frequently than once 
                                each fiscal quarter.
            (3) Administrative support.--
                    (A) In general.--The Administrator shall provide 
                technical and administrative support to the Committee.
                    (B) Funding.--The Administrator may carry out 
                subparagraph (A) using, in addition to any amounts made 
                available under subsection (f), amounts authorized to 
                be appropriated to the Administrator before the date of 
                enactment of this Act and available for obligation as 
                of that date of enactment.
            (4) Consultation.--
                    (A) In general.--In carrying out the duties of the 
                Committee, the Committee shall consult with relevant 
                stakeholders.
                    (B) Advisory council.--
                            (i) In general.--The Committee shall 
                        establish an advisory council composed of a 
                        balanced proportion of relevant stakeholders, 
                        at least \1/2\ of whom shall represent 
                        environmental justice communities.
                            (ii) Chair.--The advisory council shall be 
                        chaired by an environmental justice advocate or 
                        other relevant stakeholder with substantial 
                        experience in environmental justice.
                            (iii) Requirements.--Consultation described 
                        in subparagraph (A) shall include--
                                    (I) early and regular engagement 
                                with the advisory council, including in 
                                carrying out public engagement under 
                                subparagraph (C); and
                                    (II) consideration of the 
                                recommendations of the advisory 
                                council.
                            (iv) Recommendations not used.--If the 
                        Committee does not use a recommendation of the 
                        advisory council, not later than 60 days after 
                        the date on which the Committee receives notice 
                        of the recommendation, the Committee shall--
                                    (I) make available to the public on 
                                an internet website of the 
                                Environmental Protection Agency a 
                                written report describing the rationale 
                                of the Committee for not using the 
                                recommendation; and
                                    (II) submit the report described in 
                                subclause (I) to the Committee on 
                                Environment and Public Works of the 
                                Senate and the Committee on Energy and 
                                Commerce of the House of 
                                Representatives.
                            (v) Outreach.--The advisory council may 
                        carry out public outreach activities using 
                        amounts made available under subsection (f) to 
                        supplement public engagement carried out by the 
                        Committee under subparagraph (C).
                    (C) Public engagement.--
                            (i) In general.--The Committee shall, 
                        throughout the process of carrying out the 
                        duties of the Committee described in subsection 
                        (d)--
                                    (I) meaningfully engage with 
                                relevant stakeholders, particularly--
                                            (aa) members and 
                                        representatives of 
                                        environmental justice 
                                        communities;
                                            (bb) environmental justice 
                                        advocates; and
                                            (cc) individuals with 
                                        expertise in cumulative impacts 
                                        and geospatial data; and
                                    (II) ensure that the input of the 
                                stakeholders described in subclause (I) 
                                is central to the activities of the 
                                Committee.
                            (ii) Plan.--
                                    (I) In general.--In carrying out 
                                clause (i), the Committee shall develop 
                                a plan, in consultation with the 
                                advisory council, for comprehensive 
                                public engagement with, and 
                                incorporation of feedback from, 
                                environmental justice advocates and 
                                members of environmental justice 
                                communities.
                                    (II) Strategies to overcome 
                                barriers to public engagement.--The 
                                plan developed under subclause (I) 
                                shall include strategies to overcome 
                                barriers to public engagement, 
                                including--
                                            (aa) language barriers;
                                            (bb) transportation 
                                        barriers;
                                            (cc) economic barriers; and
                                            (dd) lack of internet 
                                        access.
                                    (III) Consideration.--In developing 
                                the plan under subclause (I), the 
                                Committee shall consider the diverse 
                                and varied experiences of environmental 
                                justice communities relating to the 
                                scope and types of environmental 
                                hazards and socioeconomic injustices.
                            (iii) Consultation and solicitation of 
                        public comment.--
                                    (I) In general.--In carrying out 
                                clause (i), not less frequently than 
                                once each fiscal quarter, the Committee 
                                shall consult with the advisory council 
                                and solicit meaningful public comment, 
                                particularly from relevant 
                                stakeholders, on the activities of the 
                                Committee.
                                    (II) Requirements.--The Committee 
                                shall carry out subclause (I) through 
                                means including--
                                            (aa) public notice of a 
                                        meeting of the Committee 
                                        occurring during the applicable 
                                        fiscal quarter, which shall 
                                        include--

                                                    (AA) notice in 
                                                publications relevant 
                                                to environmental 
                                                justice communities;

                                                    (BB) notification 
                                                to environmental 
                                                justice communities 
                                                through direct means, 
                                                such as community 
                                                centers and schools; 
                                                and

                                                    (CC) direct 
                                                outreach to known 
                                                environmental justice 
                                                groups;

                                            (bb) public broadcast of 
                                        that meeting, including 
                                        soliciting and receiving 
                                        comments by virtual means; and
                                            (cc) public availability of 
                                        a transcript of that meeting 
                                        through publication on an 
                                        accessible website.
                                    (III) Languages.--The Committee 
                                shall provide each notice, 
                                notification, direct outreach, 
                                broadcast, and transcript described in 
                                subclause (II) in each language 
                                commonly used in the applicable 
                                environmental justice community, 
                                including through oral interpretation, 
                                if applicable.
                            (iv) Funding.--Of amounts made available 
                        under subsection (f), the Administrator shall 
                        make available to the Committee such sums as 
                        are necessary for participation by relevant 
                        stakeholders in public engagement under this 
                        paragraph, as determined by the Administrator, 
                        in consultation with the advisory council.
    (d) Duties of Committee.--
            (1) In general.--The Committee shall--
                    (A) establish a tool described in paragraph (2) to 
                identify environmental justice communities, including 
                the identification of--
                            (i) criteria to be used in the tool; and
                            (ii) a methodology to determine the 
                        cumulative impacts of those criteria;
                    (B) assess and address data gaps in accordance with 
                paragraph (4); and
                    (C) collect data for the environmental justice data 
                repository established under subsection (e).
            (2) Establishment of tool.--
                    (A) In general.--The Committee, in consultation 
                with relevant stakeholders and the advisory council, 
                shall establish an interactive, transparent, 
                integrated, and Federal Government-wide tool for 
                assessing and mapping environmental justice communities 
                based on the cumulative impacts of all indicators 
                selected by the Committee to be integrated into the 
                tool.
                    (B) Requirements.--In establishing the tool under 
                subparagraph (A), the Committee shall--
                            (i) integrate into the tool multiple data 
                        layers of indicators that fall into categories 
                        including--
                                    (I) demographics, particularly 
                                relating to socioeconomic hardship and 
                                social stressors, such as--
                                            (aa) race and ethnicity;
                                            (bb) low income;
                                            (cc) high unemployment;
                                            (dd) low levels of home 
                                        ownership;
                                            (ee) high rent burden;
                                            (ff) high transportation 
                                        burden;
                                            (gg) low levels of 
                                        educational attainment;
                                            (hh) linguistic isolation;
                                            (ii) energy insecurity or 
                                        high utility rate burden;
                                            (jj) food insecurity;
                                            (kk) health insurance 
                                        status and access to 
                                        healthcare; and
                                            (ll) membership in an 
                                        Indian Tribe;
                                    (II) public health, particularly 
                                data that are indicative of sensitive 
                                populations, such as--
                                            (aa) rates of asthma;
                                            (bb) rates of 
                                        cardiovascular disease;
                                            (cc) child leukemia or 
                                        other cancers that correlate 
                                        with environmental hazards;
                                            (dd) low birth weight;
                                            (ee) maternal mortality;
                                            (ff) rates of lead 
                                        poisoning; and
                                            (gg) rates of diabetes;
                                    (III) pollution burdens, such as 
                                pollution burdens created by--
                                            (aa) toxic chemicals;
                                            (bb) air pollutants;
                                            (cc) water pollutants;
                                            (dd) soil contaminants; and
                                            (ee) perfluoroalkyl and 
                                        polyfluoroalkyl substances; and
                                    (IV) environmental effects, such as 
                                effects created by proximity to--
                                            (aa) risk management plan 
                                        sites;
                                            (bb) hazardous waste 
                                        facilities;
                                            (cc) sites on the National 
                                        Priorities List developed by 
                                        the President in accordance 
                                        with section 105(a)(8)(B) of 
                                        the Comprehensive Environmental 
                                        Response, Compensation, and 
                                        Liability Act of 1980 (42 
                                        U.S.C. 9605(a)(8)(B)); and
                                            (dd) fossil fuel 
                                        infrastructure;
                            (ii) investigate how further indicators of 
                        vulnerability to the impacts of climate change 
                        (including proximity and exposure to sea level 
                        rise, wildfire smoke, flooding, drought, rising 
                        average temperatures, extreme storms, and 
                        extreme heat, and financial burdens from flood 
                        and fire insurance) should be incorporated into 
                        the tool as an additional set of layers;
                            (iii) identify and consider the effects of 
                        other indicators relating to environmental 
                        justice for integration into the tool as 
                        layers, including--
                                    (I) safe, sufficient, and 
                                affordable drinking water, sanitation, 
                                and stormwater services;
                                    (II) access to and the quality of--
                                            (aa) green space and tree 
                                        canopy cover;
                                            (bb) healthy food;
                                            (cc) affordable energy and 
                                        water;
                                            (dd) transportation;
                                            (ee) reliable communication 
                                        systems, such as broadband 
                                        internet;
                                            (ff) child care;
                                            (gg) high-quality public 
                                        schools, early childhood 
                                        education, and child care; and
                                            (hh) health care 
                                        facilities;
                                    (III) length of commute;
                                    (IV) indoor air quality in 
                                multiunit dwellings;
                                    (V) mental health;
                                    (VI) labor market categories, 
                                particularly relating to essential 
                                workers; and
                                    (VII) each type of utility expense;
                            (iv) consider the implementation of 
                        specific regional indicators, with the 
                        potential--
                                    (I) to create regionally and 
                                locally downscaled maps in addition to 
                                a national map;
                                    (II) to provide incentives for 
                                States to collect data and conduct 
                                additional analyses to capture 
                                conditions specific to their 
                                localities;
                                    (III) to provide resources for and 
                                engage in ground-truthing to identify 
                                and verify important data with 
                                community members; and
                                    (IV) to develop companion resources 
                                for, and provide technical support to, 
                                regional, State, local, or Tribal 
                                governments to create their own maps 
                                and environmental justice scores with 
                                relevant regional, State, local, and 
                                Tribal data;
                            (v) identify a methodology to account for 
                        the cumulative impacts of all indicators 
                        selected by the Committee under clause (i), in 
                        addition to other indicators as the Committee 
                        determines to be necessary, to provide relative 
                        environmental justice scores for regions that 
                        are--
                                    (I) as small as practicable to 
                                identify communities; and
                                    (II) not larger than a census 
                                tract;
                            (vi) ensure that the tool is capable of 
                        providing maps of environmental justice 
                        communities based on environmental justice 
                        scores described in clause (v);
                            (vii) ensure that users of the tool are 
                        able to map available layers together or 
                        independently as desired;
                            (viii) implement a method for users of the 
                        tool to generate a map and environmental 
                        justice score based on a subset of indicators, 
                        particularly for the purpose of using the tool 
                        in addressing various policy needs, permitting 
                        processes, and investment goals;
                            (ix) make the tool customizable to address 
                        specific policy needs, permitting processes, 
                        and investment goals;
                            (x) account for conditions that are not 
                        captured by the quantitative data used to 
                        develop the 1 or more maps and environmental 
                        justice scores comprising the tool, by--
                                    (I) developing and executing a plan 
                                to perform outreach to relevant 
                                communities; and
                                    (II) establishing a mechanism by 
                                which communities can self-identify as 
                                environmental justice communities to be 
                                included in the tool, which may include 
                                citing qualitative data on conditions 
                                for which quantitative data are 
                                lacking, such as cultural loss in 
                                Tribal communities;
                            (xi) consider that the tool--
                                    (I) will be used across the Federal 
                                Government in screening Federal 
                                policies, permitting processes, and 
                                investments for environmental and 
                                climate justice impacts; and
                                    (II) may be used to assess 
                                communities for pollution reduction 
                                programs; and
                            (xii) carry out such other activities as 
                        the Committee determines to be appropriate.
            (3) Transparency and updates.--
                    (A) In general.--
                            (i) Notice and comment.--The Committee 
                        shall establish the tool described in paragraph 
                        (2) after providing notice and an opportunity 
                        for public comment.
                            (ii) Hearings.--In carrying out clause (i), 
                        the Committee shall hold hearings, which shall 
                        be time- and language-appropriate, in 
                        communities affected by environmental justice 
                        issues in geographically disparate States and 
                        Tribal areas.
                    (B) Updates.--
                            (i) Annual updates.--The Committee shall 
                        update the tool described in paragraph (2) not 
                        less frequently than annually to account for 
                        data sets that are updated annually.
                            (ii) Other updates.--Not less frequently 
                        than once every 3 years, the Committee shall--
                                    (I) update the indicators, 
                                methodology, or both for the tool 
                                described in paragraph (2); and
                                    (II) reevaluate data submitted by 
                                Federal departments and agencies that 
                                is used for the tool.
                            (iii) Reports.--After the initial 
                        establishment of the tool described in 
                        paragraph (2) and each update under clause (i) 
                        or (ii), the Committee shall publish a report 
                        describing--
                                    (I) the process for identifying 
                                indicators relating to environmental 
                                justice in the development of the tool;
                                    (II) the methodology described in 
                                paragraph (2)(B)(v); and
                                    (III) the use of public input and 
                                community engagement in that process.
                    (C) Training tutorials and sessions.--
                            (i) In general.--The Committee shall--
                                    (I) develop virtual training 
                                tutorials and sessions for 
                                environmental justice communities for 
                                the use of the tool described in 
                                paragraph (2); and
                                    (II) where practicable, provide in-
                                person training sessions for 
                                environmental justice communities for 
                                the use of that tool.
                            (ii) Languages.--The tutorials and sessions 
                        under clause (i) shall be made available in 
                        each language commonly used in the applicable 
                        environmental justice community.
                    (D) Public availability.--
                            (i) In general.--The Committee shall make 
                        available to the public on an internet website 
                        of the Environmental Protection Agency--
                                    (I) the tool described in paragraph 
                                (2);
                                    (II) each update under clauses (i) 
                                and (ii) of subparagraph (B);
                                    (III) each report under 
                                subparagraph (B)(iii); and
                                    (IV) the training tutorials and 
                                sessions developed under subparagraph 
                                (C)(i)(I).
                            (ii) Accessibility.--The Committee shall 
                        make the tool, updates, and reports described 
                        in clause (i) accessible to the public by 
                        publication in relevant languages and with 
                        accessibility functions, as appropriate.
                            (iii) Requirement.--In carrying out clause 
                        (i)(I), the Committee shall take measures to 
                        prevent the tool from being misused to 
                        discriminate against environmental justice 
                        communities, such as by providing safeguards 
                        against the use of downscaled data that may 
                        enable the identification of individuals.
            (4) Data gap audit.--
                    (A) In general.--In establishing the tool described 
                in paragraph (2), the Committee shall direct relevant 
                Federal departments and agencies to conduct an audit of 
                data collected by the department or agency to identify 
                any data that are relevant to environmental justice 
                concerns, including data relating to--
                            (i) public health metrics;
                            (ii) toxic chemicals;
                            (iii) socioeconomic demographics;
                            (iv) air quality;
                            (v) water quality; and
                            (vi) killings of individuals by law 
                        enforcement officers.
                    (B) Requirements.--An audit described in 
                subparagraph (A) shall--
                            (i) examine the granularity and 
                        accessibility of the data;
                            (ii) address the need for improved air 
                        quality monitoring; and
                            (iii) include recommendations to other 
                        Federal departments and agencies on means to 
                        improve the quality, granularity, and 
                        transparency of, and public involvement in, 
                        data collection and dissemination.
                    (C) Improvements.--The Committee shall direct a 
                Federal department or agency, in conducting an audit 
                under subparagraph (A), to address gaps in existing 
                data collection that will assist the Committee in 
                establishing and operating the tool described in 
                paragraph (2), including by providing to the department 
                or agency--
                            (i) benchmarks to meet in addressing the 
                        gaps;
                            (ii) instructions for consistency in data 
                        formatting that will allow for inclusion of 
                        data in the environmental justice data 
                        repository described in subsection (e); and
                            (iii) best practices for collecting data in 
                        collaboration with local organizations and 
                        partners, such as engaging in ground-truthing.
                    (D) Reports.--Not later than 180 days after a 
                Federal department or agency has conducted an audit 
                under subparagraph (A), the Committee shall--
                            (i) make available to the public on an 
                        internet website of the Environmental 
                        Protection Agency a report describing the 
                        findings and conclusions of the audit, 
                        including the progress made by the Federal 
                        department or agency in addressing 
                        environmental justice data gaps; and
                            (ii) submit the report described in clause 
                        (i) to--
                                    (I) the Committee on Environment 
                                and Public Works of the Senate;
                                    (II) the Committee on Health, 
                                Education, Labor, and Pensions of the 
                                Senate;
                                    (III) the Committee on Energy and 
                                Commerce of the House of 
                                Representatives; and
                                    (IV) the Committee on Education and 
                                Labor of the House of Representatives.
    (e) Environmental Justice Data Repository.--
            (1) In general.--The Administrator shall establish an 
        environmental justice data repository to maintain--
                    (A) the data collected by the Committee through the 
                establishment of the tool described in subsection 
                (d)(2) and the audits conducted under subsection 
                (d)(4)(A); and
                    (B) any subnational data collected under paragraph 
                (3)(B).
            (2) Updates.--The Administrator shall update the data in 
        the data repository described in paragraph (1) as frequently as 
        practicable, including every year if practicable, but not less 
        frequently than once every 3 years.
            (3) Availability; inclusion of subnational data.--The 
        Administrator--
                    (A) shall make the data repository described in 
                paragraph (1) available to regional, State, local, and 
                Tribal governments; and
                    (B) may collaborate with the governments described 
                in subparagraph (A) to include within that data 
                repository subnational data in existence before the 
                establishment of the tool described in subsection 
                (e)(2) and the completion of the audits under 
                subsection (e)(4)(A).
            (4) Requirement.--The Administrator shall take measures to 
        prevent the data in the data repository described in paragraph 
        (1) from being misused to discriminate against environmental 
        justice communities, such as by providing safeguards against 
        the use of downscaled data that may enable the identification 
        of individuals.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to the Administrator to carry out this section, including 
any necessary administrative costs of the Committee--
            (1) $20,000,000 for each of fiscal years 2023 and 2024; and
            (2) $18,000,000 for each of fiscal years 2025 through 2027.
    (g) Effect.--Nothing in any provision of this section relating to 
the tool described in subsection (d)(2) prohibits a State from 
developing a map relating to environmental justice or pollution burden 
that relies on different data, or analyzes data differently, than that 
tool.

SEC. 10013. ANTIRACISM IN PUBLIC HEALTH.

    (a) Findings.--Congress makes the following findings:
            (1) For centuries, structural racism, defined by the 
        National Museum of African American History and Culture as an 
        ``overarching system of racial bias across institutions and 
        society,'' in the United States has negatively affected 
        communities of color, especially Black, Latinx, Asian American, 
        Pacific Islander, and American Indian and Alaska Native people, 
        to expand and reinforce White supremacy.
            (2) Structural racism determines the conditions in which 
        people are born, grow, work, live, and age and determine 
        people's access to quality housing, education, food, 
        transportation, and political power, and other social 
        determinants of health.
            (3) Structural racism serves as a major barrier to 
        achieving health equity and eliminating racial and ethnic 
        inequities in health outcomes that exist at alarming rates and 
        are determined by a wider set of forces and systems.
            (4) Due to structural racism in the United States, people 
        of color are more likely to suffer from chronic health 
        conditions (such as heart disease, diabetes, asthma, hepatitis, 
        and hypertension) and infectious diseases (such as HIV/AIDS, 
        and COVID-19) compared to their White counterparts.
            (5) Due to structural racism in maternal health care in the 
        United States, Black and American Indian and Alaska Native 
        infants are more than twice as likely to die than White 
        infants, Black women are 3 to 4 times more likely to die from 
        pregnancy-related causes than White women, and American Indian 
        and Alaska Native women are 5 times more likely to die from 
        pregnancy-related causes than White women. This trend persists 
        even when adjusting for income and education.
            (6) Due to structural racism in the United States, Non-
        Hispanic Black women have the highest rates for 22 of 25 severe 
        morbidity indicators used by the Center for Disease Control and 
        Prevention (CDC).
            (7) Due to structural racism in the United States, people 
        of color comprise a disproportionate percentage of persons with 
        disabilities in the United States.
            (8) Due to structural racism in the United States, Black 
        men are up to three and a half times as likely to be killed by 
        police as White men, and 1 in every 1,000 Black men will die as 
        a result of police violence. Policing has adverse effects on 
        mental health in Black communities.
            (9) Due to the confluence of structural racism and factors 
        such as gender, class, and sexual orientation or gender 
        identity, commonly referred to as intersectionality, Black and 
        Latinx transgender women are more likely to die due to violence 
        and homicide than their White counterparts.
            (10) Due to structural racism, inequitable access to 
        quality health care and long-term services and supports also 
        disproportionately burdens communities of color; people of 
        color and immigrants are less likely to be insured and are more 
        likely to live in medically underserved areas.
            (11) Due to structural racism, older adults of color are 
        also more likely to be admitted to nursing homes and assisted 
        living facilities and to reside in those of poor quality, and 
        when older adults of color do receive home and community based 
        services, Medicaid spends less money on their services and they 
        are more likely to be hospitalized than older White adults.
            (12) In addition, the Federal Government's failure to honor 
        the unique political status of American Indian and Alaska 
        Native people, to respect the inherent sovereignty of Tribal 
        Nations, and to uphold its trust and treaty obligations to 
        Tribal Nations and American Indian and Alaska Native people, is 
        an ongoing and unjust manifestation of centuries of oppression, 
        with the consequence of adverse health outcomes for Native 
        peoples.
            (13) The COVID-19 pandemic has exposed the devastating 
        impact of structural racism on the United States ability to 
        ensure equitable health outcomes for people of color, and made 
        these communities more likely to suffer from severe outcomes 
        due to the coronavirus infection.
            (14) Racial and ethnic inequity in public health is a 
        result of systematic, personally mediated, and internalized 
        racism and racist public and private policies and practices, 
        and dismantling structural racism is integral to addressing 
        public health.
    (b) Definitions.--In this section:
            (1) Antiracism.--The term ``antiracism'' is a collection of 
        antiracist policies that lead to racial equity, and are 
        substantiated by antiracist ideas.
            (2) Antiracist.--The term ``antiracist'' is any measure 
        that produces or sustains racial equity between racial groups.
    (c) Public Health Research and Investment in Dismantling Structural 
Racism.--Part B of title III of the Public Health Service Act (42 
U.S.C. 243 et seq.) is amended by adding at the end the following:

``SEC. 320B. NATIONAL CENTER ON ANTIRACISM AND HEALTH.

    ``(a) In General.--
            ``(1) National center.--There is established within the 
        Centers for Disease Control and Prevention a center to be known 
        as the `National Center on Antiracism and Health' (referred to 
        in this section as the `Center'). The Director of the Centers 
        for Disease Control and Prevention shall appoint a director to 
        head the Center who has experience living in and working with 
        racial and ethnic minority communities. The Center shall 
        promote public health by--
                    ``(A) declaring racism a public health crisis and 
                naming racism as an historical and present threat to 
                the physical and mental health and well-being of the 
                United States and world;
                    ``(B) aiming to develop new knowledge in the 
                science and practice of antiracism, including by 
                identifying the mechanisms by which racism operates in 
                the provision of health care and in systems that impact 
                health and well-being;
                    ``(C) transferring that knowledge into practice, 
                including by developing interventions that dismantle 
                the mechanisms of racism and replace such mechanisms 
                with equitable structures, policies, practices, norms, 
                and values so that a healthy society can be realized; 
                and
                    ``(D) contributing to a national and global 
                conversation regarding the impacts of racism on the 
                health and well-being of the United States and world.
            ``(2) General duties.--The Secretary, acting through the 
        Center, shall undertake activities to carry out the mission of 
        the Center as described in paragraph (1), such as the 
        following:
                    ``(A) Conduct research into, collect, analyze and 
                make publicly available data on, and provide leadership 
                and coordination for the science and practice of 
                antiracism, the public health impacts of structural 
                racism, and the effectiveness of intervention 
                strategies to address these impacts. Topics of research 
                and data collection under this subparagraph may include 
                identifying and understanding--
                            ``(i) policies and practices that have a 
                        disparate impact on the health and well-being 
                        of communities of color;
                            ``(ii) the public health impacts of 
                        implicit racial bias, White supremacy, 
                        weathering, xenophobia, discrimination, and 
                        prejudice;
                            ``(iii) the social determinants of health 
                        resulting from structural racism, including 
                        poverty, housing, employment, political 
                        participation, and environmental factors; and
                            ``(iv) the intersection of racism and other 
                        systems of oppression, including as related to 
                        age, sexual orientation, gender identity, and 
                        disability status.
                    ``(B) Award noncompetitive grants and cooperative 
                agreements to eligible public and nonprofit private 
                entities, including State, local, territorial, and 
                Tribal health agencies and organizations, for the 
                research and collection, analysis, and reporting of 
                data on the topics described in subparagraph (A).
                    ``(C) Establish, through grants or cooperative 
                agreements, at least 3 regional centers of excellence, 
                located in racial and ethnic minority communities, in 
                antiracism for the purpose of developing new knowledge 
                in the science and practice of antiracism in health by 
                researching, understanding, and identifying the 
                mechanisms by which racism operates in the health 
                space, racial and ethnic inequities in health care 
                access and outcomes, the history of successful 
                antiracist movements in health, and other antiracist 
                public health work.
                    ``(D) Establish a clearinghouse within the Centers 
                for Disease Control and Prevention for the collection 
                and storage of data generated under the programs 
                implemented under this section for which there is not 
                an otherwise existing surveillance system at the 
                Centers for Disease Control and Prevention. Such data 
                shall--
                            ``(i) be comprehensive and disaggregated, 
                        to the extent practicable, by including racial, 
                        ethnic, primary language, sex, gender identity, 
                        sexual orientation, age, socioeconomic status, 
                        and disability disparities;
                            ``(ii) be made publicly available;
                            ``(iii) protect the privacy of individuals 
                        whose information is included in such data; and
                            ``(iv) comply with privacy protections 
                        under the regulations promulgated under section 
                        264(c) of the Health Insurance Portability and 
                        Accountability Act of 1996.
                    ``(E) Provide information and education to the 
                public on the public health impacts of structural 
                racism and on antiracist public health interventions.
                    ``(F) Consult with other Centers and National 
                Institutes within the Centers for Disease Control and 
                Prevention, including the Office of Minority Health and 
                Health Equity and the Center for State, Tribal, Local, 
                and Territorial Support, to ensure that scientific and 
                programmatic activities initiated by the agency 
                consider structural racism in their designs, 
                conceptualizations, and executions, which shall 
                include--
                            ``(i) putting measures of racism in 
                        population-based surveys;
                            ``(ii) establishing a Federal Advisory 
                        Committee on racism and health for the Centers 
                        for Disease Control and Prevention;
                            ``(iii) developing training programs, 
                        curricula, and seminars for the purposes of 
                        training public health professionals and 
                        researchers around issues of race, racism, and 
                        antiracism;
                            ``(iv) providing standards and best 
                        practices for programming and grant recipient 
                        compliance with Federal data collection 
                        standards, including section 4302 of the 
                        Patient Protection and Affordable Care Act; and
                            ``(v) establishing leadership and 
                        stakeholder councils with experts and leaders 
                        in racism and public health disparities.
                    ``(G) Coordinate with the Indian Health Service and 
                with the Centers for Disease Control and Prevention's 
                Tribal Advisory Committee to ensure meaningful Tribal 
                consultation, the gathering of information from Tribal 
                authorities, and respect for Tribal data sovereignty.
                    ``(H) Engage in government to government 
                consultation with Indian Tribes and Tribal 
                organizations.
                    ``(I) At least every 2 years, produce and publicly 
                post on the Centers for Disease Control and 
                Prevention's website a report on antiracist activities 
                completed by the Center, which may include newly 
                identified antiracist public health practices.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this 
section.''.
    (d) Public Health Research and Investment in Police Violence.--
            (1) In general.--The Secretary of Health and Human Services 
        shall establish within the National Center for Injury 
        Prevention and Control of the Centers for Disease Control and 
        Prevention (referred to in this subsection as the ``Center'') a 
        law enforcement violence prevention program.
            (2) General duties.--In implementing the program under 
        paragraph (1), the Center shall conduct research into, and 
        provide leadership and coordination for--
                    (A) the understanding and promotion of knowledge 
                about the public health impacts of uses of force by law 
                enforcement, including police brutality and violence;
                    (B) developing public health interventions and 
                perspectives for eliminating deaths, injury, trauma, 
                and negative mental health effects from police presence 
                and interactions, including police brutality and 
                violence; and
                    (C) ensuring comprehensive data collection, 
                analysis, and reporting regarding police violence and 
                misconduct in consultation with the Department of 
                Justice and independent researchers.
            (3) Functions.--Under the program under paragraph (1), the 
        Center shall--
                    (A) summarize and enhance the knowledge of the 
                distribution, status, and characteristics of law 
                enforcement-related death, trauma, and injury;
                    (B) conduct research and prepare, with the 
                assistance of State public health departments--
                            (i) statistics on law enforcement-related 
                        death, injury, and brutality;
                            (ii) studies of the factors, including 
                        legal, socioeconomic, discrimination, and other 
                        factors that correlate with or influence police 
                        brutality;
                            (iii) public information about uses of 
                        force by law enforcement, including police 
                        brutality and violence, for the practical use 
                        of the public health community, including 
                        publications that synthesize information 
                        relevant to the national goal of understanding 
                        police violence and methods for its control;
                            (iv) information to identify socioeconomic 
                        groups, communities, and geographic areas in 
                        need of study, and a strategic plan for 
                        research necessary to comprehend the extent and 
                        nature of police uses of force by law 
                        enforcement, including police brutality and 
                        violence, and determine what options exist to 
                        reduce or eradicate death and injury that 
                        result; and
                            (v) best practices in police violence 
                        prevention in other countries;
                    (C) award grants, contracts, and cooperative 
                agreements to provide for the conduct of epidemiologic 
                research on uses of force by law enforcement, including 
                police brutality and violence, by Federal, State, 
                local, and private agencies, institutions, 
                organizations, and individuals;
                    (D) award grants, contracts, and cooperative 
                agreements to community groups, independent research 
                organizations, academic institutions, and other 
                entities to support, execute, or conduct research on 
                interventions to reduce or eliminate uses of force by 
                law enforcement, including police brutality and 
                violence;
                    (E) coordinate with the Department of Justice, and 
                other Federal, State, and local agencies on the 
                standardization of data collection, storage, and 
                retrieval necessary to collect, evaluate, analyze, and 
                disseminate information about the extent and nature of 
                uses of force by law enforcement, including police 
                brutality and violence, as well as options for the 
                eradication of such practices;
                    (F) submit an annual report to Congress on research 
                findings with recommendations to improve data 
                collection and standardization and to disrupt processes 
                in policing that preserve and reinforce racism and 
                racial disparities in public health;
                    (G) conduct primary research and explore uses of 
                force by law enforcement, including police brutality 
                and violence, and options for its control; and
                    (H) study alternatives to law enforcement response 
                as a method of reducing police violence.
            (4) Authorization of appropriations.--There is authorized 
        to be appropriated, such sums as may be necessary to carry out 
        this subsection.

SEC. 10014. LGBTQ ESSENTIAL DATA.

    (a) Improving Data Collection on the Sexual Orientation and Gender 
Identity of Deceased Individuals Through the National Violent Death 
Reporting System.--
            (1) Collection of sexual orientation and gender identity 
        data.--
                    (A) In general.--Not later than 120 days after the 
                date of enactment of this Act, the Director of the 
                Centers for Disease Control and Prevention shall take 
                measures to improve the incidence of the collection of 
                information on the sexual orientation and gender 
                identity of deceased individuals through the National 
                Violent Death Reporting System or any successor 
                programs.
                    (B) Confidentiality.--Any information collected 
                relating to the sexual orientation or gender identity 
                of a decedent shall be maintained in accordance with 
                the confidentiality and privacy standards and policies 
                for the protection of individuals applicable to all 
                other data collected for purposes of the National 
                Violent Death Reporting System.
            (2) Definitions.--In this subsection:
                    (A) Gender identity.--The term ``gender identity'' 
                means an individual's sense of being male, female, 
                transgender, or another gender, as distinct from the 
                individual's sex assigned at birth.
                    (B) Sexual orientation.--The term ``sexual 
                orientation'' means how a person identifies in terms of 
                their emotional, romantic, or sexual attractions, and 
                includes identification as straight, heterosexual, gay, 
                lesbian, or bisexual, among other terms.
            (3) Authorization.--There is authorized to be appropriated 
        $25,000,000 for fiscal year 2023 to carry out this subsection.
    (b) Sense of Congress.--It is the sense of the Congress that--
            (1) the Centers for Disease Control and Prevention has made 
        significant efforts to encourage States and other jurisdictions 
        to collect data on sexual orientation and gender identity 
        through the National Violent Death Reporting System; and
            (2) jurisdictions that participate in the collection of 
        such data through the National Violent Death Reporting System 
        should be commended for their participation.

SEC. 10015. SOCIAL DETERMINANTS ACCELERATOR.

    (a) Findings; Purposes.--
            (1) Findings.--Congress finds the following:
                    (A) There is a significant body of evidence showing 
                that economic and social conditions have a powerful 
                impact on individual and population health outcomes and 
                well-being, as well as medical costs.
                    (B) State, local, and Tribal governments and the 
                service delivery partners of such governments face 
                significant challenges in coordinating benefits and 
                services delivered through the Medicaid program and 
                other social services programs because of the 
                fragmented and complex nature of Federal and State 
                funding and administrative requirements.
                    (C) The Federal Government should prioritize and 
                proactively assist State and local governments to 
                strengthen the capacity of State and local governments 
                to improve health and social outcomes for individuals, 
                thereby improving cost-effectiveness and return on 
                investment.
            (2) Purposes.--The purposes of this section are as follows:
                    (A) To establish effective, coordinated Federal 
                technical assistance to help State and local 
                governments to improve outcomes and cost-effectiveness 
                of, and return on investment from, health and social 
                services programs.
                    (B) To build a pipeline of State and locally 
                designed, cross-sector interventions and strategies 
                that generate rigorous evidence about how to improve 
                health and social outcomes, and increase the cost-
                effectiveness of, and return on investment from, 
                Federal, State, local, and Tribal health and social 
                services programs.
                    (C) To enlist State and local governments and the 
                service providers of such governments as partners in 
                identifying Federal statutory, regulatory, and 
                administrative challenges in improving the health and 
                social outcomes of, cost-effectiveness of, and return 
                on investment from, Federal spending on individuals 
                enrolled in Medicaid.
                    (D) To develop strategies to improve health and 
                social outcomes without denying services to, or 
                restricting the eligibility of, vulnerable populations.
    (b) Social Determinants Accelerator Council.--
            (1) Establishment.--The Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary''), in 
        coordination with the Administrator of the Centers for Medicare 
        & Medicaid Services (referred to in this section as the 
        ``Administrator''), shall establish an interagency council, to 
        be known as the Social Determinants Accelerator Interagency 
        Council (referred to in this section as the ``Council'') to 
        achieve the purposes listed in subsection (a)(2).
            (2) Membership.--
                    (A) Federal composition.--The Council shall be 
                composed of at least one designee from each of the 
                following Federal agencies:
                            (i) The Office of Management and Budget.
                            (ii) The Department of Agriculture.
                            (iii) The Department of Education.
                            (iv) The Indian Health Service.
                            (v) The Department of Housing and Urban 
                        Development.
                            (vi) The Department of Labor.
                            (vii) The Department of Transportation.
                            (viii) Any other Federal agency the Chair 
                        of the Council determines necessary.
                    (B) Designation.--
                            (i) In general.--The head of each agency 
                        specified in subparagraph (A) shall designate 
                        at least one employee described in clause (ii) 
                        to serve as a member of the Council.
                            (ii) Responsibilities.--An employee 
                        described in this subparagraph shall be a 
                        senior employee of the agency--
                                    (I) whose responsibilities relate 
                                to authorities, policies, and 
                                procedures with respect to the health 
                                and well-being of individuals receiving 
                                medical assistance under a State plan 
                                (or a waiver of such plan) under title 
                                XIX of the Social Security Act (42 
                                U.S.C. 1396 et seq.); or
                                    (II) who has authority to implement 
                                and evaluate transformative initiatives 
                                that harness data or conducts rigorous 
                                evaluation to improve the impact and 
                                cost-effectiveness of federally funded 
                                services and benefits.
                    (C) HHS representation.--In addition to the 
                designees under subparagraph (A), the Council shall 
                include designees from at least three agencies within 
                the Department of Health and Human Services, including 
                the Centers for Medicare & Medicaid Services, at least 
                one of whom shall meet the criteria under subparagraph 
                (B)(ii).
                    (D) OMB role.--The Director of the Office of 
                Management and Budget shall facilitate the timely 
                resolution of Governmentwide and multiagency issues to 
                help the Council achieve consensus recommendations 
                described under paragraph (3)(A).
                    (E) Non-federal composition.--The Comptroller 
                General of the United States may designate up to 6 
                Council designees--
                            (i) who have relevant subject matter 
                        expertise, including expertise implementing and 
                        evaluating transformative initiatives that 
                        harness data and conduct evaluations to improve 
                        the impact and cost-effectiveness of Federal 
                        Government services; and
                            (ii) that each represent--
                                    (I) State, local, and Tribal health 
                                and human services agencies;
                                    (II) public housing authorities or 
                                State housing finance agencies;
                                    (III) State and local government 
                                budget offices;
                                    (IV) State Medicaid agencies; or
                                    (V) national consumer advocacy 
                                organizations.
                    (F) Chair.--
                            (i) In general.--The Secretary shall select 
                        the Chair of the Council from among the members 
                        of the Council.
                            (ii) Initiating guidance.--The Chair, on 
                        behalf of the Council, shall identify and 
                        invite individuals from diverse entities to 
                        provide the Council with advice and information 
                        pertaining to addressing social determinants of 
                        health, including--
                                    (I) individuals from State and 
                                local government health and human 
                                services agencies;
                                    (II) individuals from State 
                                Medicaid agencies;
                                    (III) individuals from State and 
                                local government budget offices;
                                    (IV) individuals from public 
                                housing authorities or State housing 
                                finance agencies;
                                    (V) individuals from nonprofit 
                                organizations, small businesses, and 
                                philanthropic organizations;
                                    (VI) advocates;
                                    (VII) researchers; and
                                    (VIII) any other individuals the 
                                Chair determines to be appropriate.
            (3) Duties.--The duties of the Council are--
                    (A) to make recommendations to the Secretary and 
                the Administrator regarding the criteria for making 
                awards under subsection (c);
                    (B) to identify Federal authorities and 
                opportunities for use by States or local governments to 
                improve coordination of funding and administration of 
                Federal programs, the beneficiaries of whom include 
                individuals described in subsection (a), and which may 
                be unknown or underutilized and to make information on 
                such authorities and opportunities publicly available;
                    (C) to provide targeted technical assistance to 
                States developing a social determinants accelerator 
                plan under subsection (c), including identifying 
                potential statutory or regulatory pathways for 
                implementation of the plan and assisting in identifying 
                potential sources of funding to implement the plan;
                    (D) to report to Congress annually on the subjects 
                set forth in paragraph (4);
                    (E) to develop and disseminate evaluation 
                guidelines and standards that can be used to reliably 
                assess the impact of an intervention or approach that 
                may be implemented pursuant to this section on 
                outcomes, cost-effectiveness of, and return on 
                investment from Federal, State, local, and Tribal 
                governments, and to facilitate technical assistance, 
                where needed, to help to improve State and local 
                evaluation designs and implementation;
                    (F) to seek feedback from State, local, and Tribal 
                governments, including through an annual survey by an 
                independent third party, on how to improve the 
                technical assistance the Council provides to better 
                equip State, local, and Tribal governments to 
                coordinate health and social service programs;
                    (G) to solicit applications for grants under 
                subsection (c); and
                    (H) to coordinate with other cross-agency 
                initiatives focused on improving the health and well-
                being of low-income and at-risk populations in order to 
                prevent unnecessary duplication between agency 
                initiatives.
            (4) Schedule.--Not later than 60 days after the date of the 
        enactment of this Act, the Council shall convene to develop a 
        schedule and plan for carrying out the duties described in 
        paragraph (3), including solicitation of applications for the 
        grants under subsection (c).
            (5) Report to congress.--The Council shall submit an annual 
        report to Congress, which shall include--
                    (A) a list of the Council members;
                    (B) activities and expenditures of the Council;
                    (C) summaries of the interventions and approaches 
                that will be supported by State, local, and Tribal 
                governments that received a grant under subsection (c), 
                including--
                            (i) the best practices and evidence-based 
                        approaches such governments plan to employ to 
                        achieve the purposes listed in subsection 
                        (a)(2); and
                            (ii) a description of how the practices and 
                        approaches will impact the outcomes, cost-
                        effectiveness of, and return on investment 
                        from, Federal, State, local, and Tribal 
                        governments with respect to such purposes;
                    (D) the feedback received from State and local 
                governments on ways to improve the technical assistance 
                of the Council, including findings from a third-party 
                survey and actions the Council plans to take in 
                response to such feedback; and
                    (E) the major statutory, regulatory, and 
                administrative challenges identified by State, local, 
                and Tribal governments that received a grant under 
                subsection (c), and the actions that Federal agencies 
                are taking to address such challenges.
            (6) FACA applicability.--The Federal Advisory Committee Act 
        (5 U.S.C. App.) shall not apply to the Council.
            (7) Council procedures.--The Secretary, in consultation 
        with the Comptroller General of the United States and the 
        Director of the Office of Management and Budget, shall 
        establish procedures for the Council to--
                    (A) ensure that adequate resources are available to 
                effectively execute the responsibilities of the 
                Council;
                    (B) effectively coordinate with other relevant 
                advisory bodies and working groups to avoid unnecessary 
                duplication;
                    (C) create transparency to the public and Congress 
                with regard to Council membership, costs, and 
                activities, including through use of modern technology 
                and social media to disseminate information; and
                    (D) avoid conflicts of interest that would 
                jeopardize the ability of the Council to make decisions 
                and provide recommendations.
    (c) Social Determinants Accelerator Grants to States or Local 
Governments.--
            (1) Grants to states, local governments, and tribes.--Not 
        later than 180 days after the date of the enactment of this 
        Act, the Administrator, in consultation with the Secretary and 
        the Council, shall award on a competitive basis not more than 
        25 grants to eligible applicants described in paragraph (2), 
        for the development of social determinants accelerator plans, 
        as described in paragraph (6).
            (2) Eligible applicant.--An eligible applicant described in 
        this subsection is a State, local, or Tribal health or human 
        services agency that--
                    (A) demonstrates the support of relevant parties 
                across relevant State, local, or Tribal jurisdictions; 
                and
                    (B) in the case of an applicant that is a local 
                government agency, provides to the Secretary a letter 
                of support from the lead State health or human services 
                agency for the State in which the local government is 
                located.
            (3) Amount of grant.--The Administrator, in coordination 
        with the Council, shall determine the total amount that the 
        Administrator will make available to each grantee under this 
        subsection.
            (4) Application.--An eligible applicant seeking a grant 
        under this subsection shall include in the application the 
        following information:
                    (A) The target population (or populations) that 
                would benefit from implementation of the social 
                determinants accelerator plan proposed to be developed 
                by the applicant.
                    (B) A description of the objective or objectives 
                and outcome goals of such proposed plan, which shall 
                include at least one health outcome and at least one 
                other important social outcome.
                    (C) The sources and scope of inefficiencies that, 
                if addressed by the plan, could result in improved 
                cost-effectiveness of or return on investment from 
                Federal, State, local, and Tribal governments.
                    (D) A description of potential interventions that 
                could be designed or enabled using such proposed plan.
                    (E) The State, local, Tribal, academic, nonprofit, 
                community-based organizations, and other private sector 
                partners that would participate in the development of 
                the proposed plan and subsequent implementation of 
                programs or initiatives included in such proposed plan.
                    (F) Such other information as the Administrator, in 
                consultation with the Secretary and the Council, 
                determines necessary to achieve the purposes of this 
                section.
            (5) Use of funds.--A recipient of a grant under this 
        subsection may use funds received through the grant for the 
        following purposes:
                    (A) To convene and coordinate with relevant 
                government entities and other stakeholders across 
                sectors to assist in the development of a social 
                determinant accelerator plan.
                    (B) To identify populations of individuals 
                receiving medical assistance under a State plan (or a 
                waiver of such plan) under title XIX of the Social 
                Security Act (42 U.S.C. 1396 et seq.) who may benefit 
                from the proposed approaches to improving the health 
                and well-being of such individuals through the 
                implementation of the proposed social determinants 
                accelerator plan.
                    (C) To engage qualified research experts to advise 
                on relevant research and to design a proposed 
                evaluation plan, in accordance with the standards and 
                guidelines issued by the Administrator.
                    (D) To collaborate with the Council to support the 
                development of social determinants accelerator plans.
                    (E) To prepare and submit a final social 
                determinants accelerator plan to the Council.
            (6) Contents of plans.--A social determinant accelerator 
        plan developed under this subsection shall include the 
        following:
                    (A) A description of the target population (or 
                populations) that would benefit from implementation of 
                the social determinants accelerator plan, including an 
                analysis describing the projected impact on the well-
                being of individuals described in paragraph (5)(B).
                    (B) A description of the interventions or 
                approaches designed under the social determinants 
                accelerator plan and the evidence for selecting such 
                interventions or approaches.
                    (C) The objectives and outcome goals of such 
                interventions or approaches, including at least one 
                health outcome and at least one other important social 
                outcome.
                    (D) A plan for accessing and linking relevant data 
                to enable coordinated benefits and services for the 
                jurisdictions described in paragraph (2)(A) and an 
                evaluation of the proposed interventions and 
                approaches.
                    (E) A description of the State, local, Tribal, 
                academic, nonprofit, or community-based organizations, 
                or any other private sector organizations that would 
                participate in implementing the proposed interventions 
                or approaches, and the role each would play to 
                contribute to the success of the proposed interventions 
                or approaches.
                    (F) The identification of the funding sources that 
                would be used to finance the proposed interventions or 
                approaches.
                    (G) A description of any financial incentives that 
                may be provided, including outcome-focused contracting 
                approaches to encourage service providers and other 
                partners to improve outcomes of, cost-effectiveness of, 
                and return on investment from, Federal, State, local, 
                or Tribal government spending.
                    (H) The identification of the applicable Federal, 
                State, local, or Tribal statutory and regulatory 
                authorities, including waiver authorities, to be 
                leveraged to implement the proposed interventions or 
                approaches.
                    (I) A description of potential considerations that 
                would enhance the impact, scalability, or 
                sustainability of the proposed interventions or 
                approaches and the actions the grant awardee would take 
                to address such considerations.
                    (J) A proposed evaluation plan, to be carried out 
                by an independent evaluator, to measure the impact of 
                the proposed interventions or approaches on the 
                outcomes of, cost-effectiveness of, and return on 
                investment from, Federal, State, local, and Tribal 
                governments.
                    (K) Precautions for ensuring that vulnerable 
                populations will not be denied access to Medicaid or 
                other essential services as a result of implementing 
                the proposed plan.
    (d) Funding.--
            (1) In general.--Out of any money in the Treasury not 
        otherwise appropriated, there is appropriated to carry out this 
        section $25,000,000, of which up to $5,000,000 may be used to 
        carry out this section, to remain available for obligation 
        until the date that is 5 years after the date of enactment of 
        this Act.
            (2) Reservation of funds.--
                    (A) In general.--Of the funds made available under 
                paragraph (1), the Secretary shall reserve not less 
                than 20 percent to award grants to eligible applicants 
                for the development of social determinants accelerator 
                plans under subsection (c) intended to serve rural 
                populations.
                    (B) Exception.--In the case of a fiscal year for 
                which the Secretary determines that there are not 
                sufficient eligible applicants to award up to 25 grants 
                under subsection (c) that are intended to serve rural 
                populations and the Secretary cannot satisfy the 20-
                percent requirement, the Secretary may reserve an 
                amount that is less than 20 percent of amounts made 
                available under paragraph (1) to award grants for such 
                purpose.
            (3) Rule of construction.--Nothing in this section shall 
        prevent Federal agencies represented on the Council from 
        contributing additional funding from other sources to support 
        activities to improve the effectiveness of the Council.

SEC. 10016. IMPROVING SOCIAL DETERMINANTS OF HEALTH.

    (a) Findings.--Congress finds the following:
            (1) Healthy People 2030 defines social determinants of 
        health as conditions in the environments where people are born, 
        live, learn, work, play, worship, and age that affect a wide 
        range of health, functioning, and quality-of-life outcomes and 
        risks.
            (2) One of the overarching goals of Healthy People 2030 is 
        to ``create social, physical, and economic environments that 
        promote attaining the full potential for health and well-being 
        for all''.
            (3) Healthy People 2030 developed a ``place-based'' 
        organizing framework, reflecting five key areas of social 
        determinants of health namely--
                    (A) economic stability;
                    (B) education access and quality;
                    (C) social and community context;
                    (D) health care access and quality; and
                    (E) neighborhood and built environment.
            (4) It is estimated that medical care accounts for only 10 
        to 20 percent of the modifiable contributors to healthy 
        outcomes for a population.
            (5) The Centers for Medicare & Medicaid Services has 
        indicated the importance of the social determinants in its work 
        stating that, ``As we seek to foster innovation, rethink rural 
        health, find solutions to the opioid epidemic, and continue to 
        put patients first, we need to take into account social 
        determinants of health and recognize their importance.''.
            (6) The Department of Health and Human Services' Public 
        Health 3.0 initiative recognizes the role of public health in 
        working across sectors on social determinants of health, as 
        well as the role of public health as chief health strategist in 
        communities.
            (7) Through its Health Impact in 5 Years initiative, the 
        Centers for Disease Control and Prevention has highlighted 
        nonclinical, community-wide approaches that show positive 
        health impacts, results within five years, and cost-
        effectiveness or cost-savings over the lifetime of the 
        population or earlier.
            (8) Health departments and the Centers for Disease Control 
        and Prevention are not funded for such cross-cutting work.
    (b) Social Determinants of Health Program.--
            (1) Program.--To the extent and in the amounts made 
        available in advance in appropriations Acts, the Director of 
        the Centers for Disease Control and Prevention (in this section 
        referred to as the ``Director'') shall carry out a program, to 
        be known as the Social Determinants of Health Program (in this 
        section referred to as the ``Program''), to achieve the 
        following goals:
                    (A) Improve health outcomes and reduce health 
                inequities by coordinating social determinants of 
                health activities across the Centers for Disease 
                Control and Prevention.
                    (B) Improve the capacity of public health agencies 
                and community organizations to address social 
                determinants of health in communities.
            (2) Activities.--To achieve the goals listed in paragraph 
        (1), the Director shall carry out activities including the 
        following:
                    (A) Coordinating across the Centers for Disease 
                Control and Prevention to ensure that relevant programs 
                consider and incorporate social determinants of health 
                in grant awards and other activities.
                    (B) Awarding grants under subsection (c) to State, 
                local, territorial, and Tribal health agencies and 
                organizations, and to other eligible entities, to 
                address social determinants of health in target 
                communities.
                    (C) Awarding grants under subsection (d) to 
                nonprofit organizations and public or other nonprofit 
                institutions of higher education--
                            (i) to conduct research on best practices 
                        to improve social determinants of health;
                            (ii) to provide technical assistance, 
                        training, and evaluation assistance to grantees 
                        under subsection (c); and
                            (iii) to disseminate best practices to 
                        grantees under subsection (c).
                    (D) Coordinating, supporting, and aligning 
                activities of the Centers for Disease Control and 
                Prevention related to social determinants of health 
                with activities of other Federal agencies related to 
                social determinants of health, including such 
                activities of agencies in the Department of Health and 
                Human Services such as the Centers for Medicare & 
                Medicaid Services.
                    (E) Collecting and analyzing data related to the 
                social determinants of health.
    (c) Grants To Address Social Determinants of Health.--
            (1) In general.--The Director, as part of the Program, 
        shall award grants to eligible entities to address social 
        determinants of health in their communities.
            (2) Eligibility.--To be eligible to apply for a grant under 
        this subsection, an entity shall be--
                    (A) a State, local, territorial, or Tribal health 
                agency or organization;
                    (B) a qualified nongovernmental entity, as defined 
                by the Director; or
                    (C) a consortium of entities that includes a State, 
                local, territorial, or Tribal health agency or 
                organization.
            (3) Use of funds.--
                    (A) In general.--A grant under this subsection 
                shall be used to address social determinants of health 
                in a target community by designing and implementing 
                innovative, evidence-based, cross-sector strategies.
                    (B) Target community.--For purposes of this 
                subsection, a target community shall be a State, 
                county, city, or other municipality.
            (4) Priority.--In awarding grants under this subsection, 
        the Director shall prioritize applicants proposing to serve 
        target communities with significant unmet health and social 
        needs, as defined by the Director.
            (5) Application.--To seek a grant under this subsection, an 
        eligible entity shall--
                    (A) submit an application at such time, in such 
                manner, and containing such information as the Director 
                may require;
                    (B) propose a set of activities to address social 
                determinants of health through evidence-based, cross-
                sector strategies, which activities may include--
                            (i) collecting quantifiable data from 
                        health care, social services, and other 
                        entities regarding the most significant gaps in 
                        health-promoting social, economic, and 
                        environmental needs;
                            (ii) identifying evidence-based approaches 
                        to meeting the nonmedical, social needs of 
                        populations identified by data collection 
                        described in clause (i), such as unstable 
                        housing or food insecurity;
                            (iii) developing scalable methods to meet 
                        patients' social needs identified in clinical 
                        settings or other sites;
                            (iv) convening entities such as local and 
                        State governmental and nongovernmental 
                        organizations, health systems, payors, and 
                        community-based organizations to review, plan, 
                        and implement community-wide interventions and 
                        strategies to advance health-promoting social 
                        conditions;
                            (v) monitoring and evaluating the impact of 
                        activities funded through the grant on the 
                        health and well-being of the residents of the 
                        target community and on the cost of health 
                        care; and
                            (vi) such other activities as may be 
                        specified by the Director;
                    (C) demonstrate how the eligible entity will 
                collaborate with--
                            (i) health systems;
                            (ii) payors, including, as appropriate, 
                        medicaid managed care organizations (as defined 
                        in section 1903(m)(1)(A) of the Social Security 
                        Act (42 U.S.C. 1396b(m)(1)(A))), Medicare 
                        Advantage plans under part C of title XVIII of 
                        such Act (42 U.S.C. 1395w-21 et seq.), and 
                        health insurance issuers and group health plans 
                        (as such terms are defined in section 2791 of 
                        the Public Health Service Act);
                            (iii) other relevant stakeholders and 
                        initiatives in areas of need, such as the 
                        Accountable Health Communities Model of the 
                        Centers for Medicare & Medicaid Services, 
                        health homes under the Medicaid program under 
                        title XIX of the Social Security Act (42 U.S.C. 
                        1396 et seq.), community-based organizations, 
                        and human services organizations;
                            (iv) other non-health care sector 
                        organizations, including organizations focusing 
                        on transportation, housing, or food access; and
                            (v) local employers; and
                    (D) identify key health inequities in the target 
                community and demonstrate how the proposed efforts of 
                the eligible entity would address such inequities.
            (6) Monitoring and evaluation.--As a condition of receipt 
        of a grant under this subsection, a grantee shall agree to 
        submit an annual report to the Director describing the 
        activities carried out through the grant and the outcomes of 
        such activities.
            (7) Independent national evaluation.--
                    (A) In general.--Not later than 5 years after the 
                first grants are awarded under this subsection, the 
                Director shall provide for the commencement of an 
                independent national evaluation of the program under 
                this subsection.
                    (B) Report to congress.--Not later than 60 days 
                after receiving the results of such independent 
                national evaluation, the Director shall report such 
                results to the Congress.
    (d) Research and Training.--The Director, as part of the Program--
            (1) shall award grants to nonprofit organizations and 
        public or other nonprofit institutions of higher education--
                    (A) to conduct research on best practices to 
                improve social determinants of health;
                    (B) to provide technical assistance, training, and 
                evaluation assistance to grantees under subsection (c); 
                and
                    (C) to disseminate best practices to grantees under 
                subsection (c); and
            (2) may require a grantee under paragraph (1) to provide 
        technical assistance and capacity building to entities that are 
        eligible entities under subsection (c) but not receiving funds 
        through such section.
    (e) Funding.--
            (1) In general.--There is authorized to be appropriated to 
        carry out this section, $50,000,000 for each of fiscal years 
        2023 through 2028.
            (2) Allocation.--Of the amount made available to carry out 
        this section for a fiscal year, not less than 75 percent shall 
        be used for grants under subsections (c) and (d).

                        Subtitle B--Gun Violence

SEC. 10101. REAFFIRMING RESEARCH AUTHORITY OF THE CENTERS FOR DISEASE 
              CONTROL AND PREVENTION.

    (a) In General.--Section 391 of the Public Health Service Act (42 
U.S.C. 280b) is amended--
            (1) in subsection (a)(1), by striking ``research relating 
        to the causes, mechanisms, prevention, diagnosis, treatment of 
        injuries, and rehabilitation from injuries;'' and inserting the 
        following: ``research, including data collection, relating to--
                    ``(A) the causes, mechanisms, prevention, 
                diagnosis, and treatment of injuries, including with 
                respect to gun violence; and
                    ``(B) rehabilitation from such injuries;''; and
            (2) by adding at the end the following new subsection:
    ``(c) No Advocacy or Promotion of Gun Control.--Nothing in this 
section shall be construed to--
            ``(1) authorize the Secretary to give assistance, make 
        grants, or enter into cooperative agreements or contracts for 
        the purpose of advocating or promoting gun control; or
            ``(2) permit a recipient of any assistance, grant, 
        cooperative agreement, or contract under this section to use 
        such assistance, grant, agreement, or contract for the purpose 
        of advocating or promoting gun control.''.

SEC. 10102. NATIONAL VIOLENT DEATH REPORTING SYSTEM.

    The Secretary of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
improve the National Violent Death Reporting System (as authorized by 
sections 301(a) and 391(a) of the Public Service Health Act (42 U.S.C. 
241(a), 280(b))), particularly through the inclusion of additional 
States and activities to increase the quality, type, and timeliness of 
reported data. Participation in the System by the States shall be 
voluntary.

SEC. 10103. REPORT ON EFFECTS OF GUN VIOLENCE ON PUBLIC HEALTH.

    Not later than one year after the date of the enactment of this 
Act, and annually thereafter, the Surgeon General shall submit to 
Congress a report on the effects on public health, including mental 
health, of gun violence in the United States during the preceding year, 
and the status of actions taken to address such effects.

SEC. 10104. REPORT ON EFFECTS OF GUN VIOLENCE ON MENTAL HEALTH IN 
              MINORITY COMMUNITIES.

    Not later than one year after the date of the enactment of this 
Act, the Deputy Assistant Secretary for Minority Health in the Office 
of the Secretary of Health and Human Services shall submit to the 
Congress a report on the effects of gun violence on public health, 
including mental health, in minority communities in the United States, 
and the status of actions taken to address such effects.
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