113 HR 5294 IH: Health Equity and Accountability Act of 2014 U.S. House of Representatives 2014-07-30 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 113th CONGRESS 2d Session H. R. 5294 IN THE HOUSE OF REPRESENTATIVES July 30, 2014 Ms. Roybal-Allard (for herself, Ms. Lee of California, Mrs. Christensen, Ms. Bordallo, Ms. Brown of Florida, Mr. Butterfield, Ms. Chu, Ms. Clarke of New York, Mr. Cárdenas, Mr. Carson of Indiana, Ms. Castor of Florida, Mr. Conyers, Mr. Crowley, Mr. Cummings, Mr. Danny K. Davis of Illinois, Ms. DeGette, Ms. DeLauro, Ms. Edwards, Mr. Ellison, Mr. Faleomavaega, Mr. Farr, Mr. Fattah, Ms. Fudge, Mr. Garcia, Mr. Grijalva, Ms. Michelle Lujan Grisham of New Mexico, Mr. Gutiérrez, Ms. Hahn, Mr. Hinojosa, Mr. Honda, Ms. Jackson Lee, Ms. Eddie Bernice Johnson of Texas, Mr. Johnson of Georgia, Mr. Lewis, Ms. Lofgren, Mrs. Lowey, Mr. Ben Ray Luján of New Mexico, Ms. Matsui, Ms. McCollum, Mr. McGovern, Mrs. Negrete McLeod, Mr. Meeks, Ms. Meng, Mrs. Napolitano, Ms. Norton, Mr. Pastor of Arizona, Mr. Pierluisi, Mr. Rangel, Mr. Richmond, Mr. Rush, Mr. Sablan, Ms. Linda T. Sánchez of California, Ms. Loretta Sanchez of California, Ms. Schakowsky, Mr. Schiff, Mr. David Scott of Georgia, Mr. Scott of Virginia, Mr. Serrano, Mr. Sires, Ms. Slaughter, Mr. Takano, Mr. Tonko, Mr. Vargas, Mr. Vela, Ms. Velázquez, and Ms. Waters) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Agriculture, Education and the Workforce, the Budget, Veterans’ Affairs, Armed Services, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To improve the health of minority individuals, and for other purposes.

1.

Short title

This Act may be cited as the Health Equity and Accountability Act of 2014.

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. 101. Amendment to the Public Health Service Act. Sec. 102. Elimination of prerequisite of direct appropriations for data collection and analysis. Sec. 103. Collection of race and ethnicity data by the Social Security Administration. Sec. 104. Revision of HIPAA claims standards. Sec. 105. National Center for Health Statistics. Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific Islanders and other underrepresented groups in Federal health surveys. Sec. 107. Geo-access study. Sec. 108. Racial, ethnic, and primary language data collected by the Federal Government. Sec. 109. Data collection and analysis grants to minority-serving institutions. Sec. 110. Standards for measuring sexual orientation and gender identity in collection of health data. Sec. 111. Standards for measuring socioeconomic status in collection of health data. Sec. 112. Safety and effectiveness of drugs with respect to racial and ethnic background. Sec. 113. Improving health data regarding Native Hawaiians and other Pacific Islanders. Sec. 114. Clarification of simplified administrative reporting requirement. Title II—Culturally and linguistically appropriate health care Sec. 201. Definitions. Sec. 202. Amendment to the Public Health Service Act. Sec. 203. Pilot program for improvement and development of State medical interpreting services. Sec. 204. Training tomorrow’s doctors for culturally and linguistically appropriate care: graduate medical education. Sec. 205. Federal reimbursement for culturally and linguistically appropriate services under the Medicare, Medicaid, and State Children’s Health Insurance Programs. Sec. 206. Increasing understanding of and improving health literacy. Sec. 207. Assurances for receiving Federal funds. Sec. 208. Report on Federal efforts to provide culturally and linguistically appropriate health care services. Sec. 209. English for speakers of other languages. Sec. 210. Implementation. Sec. 211. Language access services. Title III—Health workforce Diversity Sec. 301. Amendment to the Public Health Service Act. Sec. 302. Hispanic-serving health professions schools. Sec. 303. Loan repayment program of Centers for Disease Control and Prevention. Sec. 304. Cooperative agreements for online degree programs at schools of public health and schools of allied health. Sec. 305. Sense of Congress on the mission of the National Health Care Workforce Commission. Sec. 306. Scholarship and fellowship programs. Sec. 307. McNair Postbaccalaureate Achievement Program. Sec. 308. Rules for determination of full-time equivalent residents for cost-reporting periods. Sec. 309. Developing and implementing strategies for local health equity. Sec. 310. Loan forgiveness for mental and behavioral health social workers. Sec. 311. Health Professions Workforce Fund. Sec. 312. Findings; sense of Congress relating to graduate medical education. Sec. 313. Career support for skilled internationally educated health professionals. Title IV—Improvement of Health Care Services Subtitle A—Health Empowerment Zones Sec. 401. Short title. Sec. 402. Findings. Sec. 403. Designation of health empowerment zones. Sec. 404. Assistance to those seeking designation. Sec. 405. Benefits of designation. Sec. 406. Definition. Sec. 407. Authorization of appropriations. Subtitle B—Other Improvements of Health Care Services Chapter 1—Expansion of Coverage Sec. 411. Amendment to the Public Health Service Act. Sec. 412. Removing citizenship and immigration barriers to access to affordable health care under the ACA. Sec. 413. Study on the uninsured. Sec. 414. Medicaid payment parity for the territories. Sec. 415. Extension of Medicare secondary payer. Sec. 416. Border health grants. Sec. 417. Removing Medicare barrier to health care. Sec. 418. 100 percent FMAP for medical assistance provided by urban Indian health centers. Sec. 419. 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. Chapter 2—Expansion of Access Sec. 421. Grants for racial and ethnic approaches to community health. Sec. 422. Critical access hospital improvements. Sec. 423. Establishment of Rural Community Hospital (RCH) Program. Sec. 424. Medicare remote monitoring pilot projects. Sec. 425. Rural health quality advisory commission and demonstration projects. Sec. 426. Rural health care services. Sec. 427. Community health center collaborative access expansion. Sec. 428. Facilitating the provision of telehealth services across State lines. Sec. 429. Scoring of preventive health savings. Sec. 430. Sense of Congress. Sec. 431. Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program. Sec. 432. Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs. Sec. 433. Indian defined in PPACA. Sec. 434. Study of DSH payments to ensure hospital access for low-income patients. Sec. 435. Assistant Secretary of the Indian Health Service. Sec. 436. Reauthorization of the Native Hawaiian Health Care Improvement Act. Title V—IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES Sec. 501. Grants to promote positive health behaviors in women and children. Sec. 502. Removing barriers to health care and nutrition assistance for children, pregnant women, and lawfully present individuals. Sec. 503. Repeal of denial of benefits. Sec. 504. Birth defects prevention, risk reduction, and awareness. Sec. 505. Uniform State maternal mortality review committees on pregnancy-related deaths. Sec. 506. Eliminating disparities in maternity health outcomes. Sec. 507. Decreasing the risk factors for sudden unexpected infant death and sudden unexplained death in childhood. Sec. 508. Reducing unintended teenage pregnancies. Sec. 509. Gestational diabetes. Sec. 510. Emergency contraception education and information programs. Sec. 511. Supporting healthy adolescent development. Sec. 512. Compassionate assistance for rape emergencies. Sec. 513. Access to birth control duties of pharmacies to ensure provision of FDA-approved contraception. Sec. 514. Additional focus area for the Office on Women’s Health. Sec. 515. Interagency coordinating committee on the promotion of optimal maternity outcomes. Sec. 516. Consumer education campaign. Sec. 517. Bibliographic database of systematic reviews for care of childbearing women and newborns. Sec. 518. Maternity care health professional shortage areas. Sec. 519. Expansion of CDC prevention research centers program to include centers on optimal maternity outcomes. Sec. 520. Expanding models allowed to be tested by Center for Medicare and Medicaid Innovation to include maternity care models. Sec. 521. Development of interprofessional maternity care educational models and tools. Sec. 522. Including within inpatient hospital services under Medicare services furnished by certain students, interns, and residents supervised by certified nurse midwives. Sec. 523. Grants to professional organizations to increase diversity in maternity care professionals. Title VI—MENTAL HEALTH Sec. 601. Coverage of marriage and family therapist services, mental health counselor services, and substance abuse counselor services under part B of the Medicare program. Sec. 602. Minority Fellowship Program. Sec. 603. Integrated Health Care Demonstration Program. Sec. 604. Addressing racial and ethnic minority mental health disparities research gaps. Sec. 605. Health professions competencies to address racial and ethnic minority mental health disparities. Title VII—ADDRESSING HIGH IMPACT MINORITY DISEASES Subtitle A—Cancer Sec. 701. Lung cancer mortality reduction. Sec. 702. Expanding prostate cancer research, outreach, screening, testing, access, and treatment effectiveness. Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer patients in the territories. Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial minorities. Sec. 705. Reducing cancer disparities within Medicare. Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention Sec. 711. Viral hepatitis and liver cancer control and prevention. Subtitle C—Acquired Bone Marrow Failure Diseases Sec. 721. Acquired bone marrow failure diseases. Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease Issues Sec. 731. Guidelines for disease screening for minority patients. Sec. 732. CDC Wisewoman Screening Program. Sec. 733. Report on cardiovascular care for women and minorities. Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid. Sec. 735. Clinical research funding for oral health. Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. Subtitle E—HIV/AIDS Sec. 741. Statement of policy. Sec. 742. Findings. Sec. 743. Additional funding for AIDS drug assistance program treatments. Sec. 744. Enhancing the national HIV surveillance system. Sec. 745. Evidence-based strategies for improving linkage to and retention in appropriate care. Sec. 746. Improving entry into and retention in care and antiretroviral adherence for persons with HIV. Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority communities. Sec. 748. Minority AIDS initiative. Sec. 749. Health care professionals treating individuals with HIV/AIDS. Sec. 750. HIV/AIDS provider loan repayment program. Sec. 751. Dental education loan repayment program. Sec. 752. Reducing new HIV infections among injecting drug users. Sec. 753. Support for expansion of comprehensive sexual health and education programs. Sec. 754. Elimination of abstinence-only education program. Sec. 755. Report on impact of HIV/AIDS in vulnerable populations. Sec. 756. National HIV/AIDS observance days. Sec. 757. Review of all Federal and State laws, policies, and regulations regarding the criminal prosecution of individuals for HIV-related offenses. Sec. 758. Repeal of limitation against use of funds for education or information designed to promote or encourage, directly, homosexual or heterosexual activity or intravenous substance abuse. Sec. 759. Expanding support for condoms in prisons. Sec. 760. Automatic reinstatement or enrollment in Medicaid for people who test positive for HIV before reentering communities. Sec. 761. Stop AIDS in prison. Sec. 762. Support data system review and indicators for monitoring HIV care. Sec. 763. Transfer of funds for implementation of national HIV/AIDS strategy. Sec. 764. HIV integrated services delivery model demonstration. Sec. 765. Report on the implementation of goal 4 (improved coordination) of the national HIV/AIDS strategy. Subtitle F—Diabetes Sec. 771. Research, treatment, and education. Sec. 772. Research, education, and other activities. Sec. 773. Research, education, and other activities. Sec. 774. Research, education, and other activities. Sec. 775. Updated report on health disparities. Subtitle G—Lung Disease Sec. 776. Expansion of the National Asthma Education and Prevention Program. Sec. 777. Asthma-related activities of the Centers for Disease Control and Prevention. Sec. 778. Influenza and pneumonia vaccination campaign. Sec. 779. Chronic obstructive pulmonary disease action plan. Subtitle H—Osteoarthritis and Musculoskeletal Diseases Sec. 781. Findings. Sec. 782. Osteoarthritis and other musculoskeletal health-related activities of the Centers for Disease Control and Prevention. Subtitle I—Sleep and Circadian Rhythm Disorders Sec. 791. Short title; findings. Sec. 792. Sleep and circadian rhythm disorders research activities of the National Institutes of Health. Sec. 793. Sleep and circadian rhythm health disparities-related activities of the Centers for Disease Control and Prevention. Title VIII—Health Information Technology Sec. 800. Definitions. Subtitle A—Reducing Health Disparities Through Health IT Sec. 801. HRSA assistance to health centers for promotion of Health IT. Sec. 802. Assessment of impact of Health IT on racial and ethnic minority communities; outreach and adoption of Health IT in such communities. Subtitle B—Modifications To Achieve Parity in Existing Programs Sec. 811. Extending funding to strengthen the Health IT infrastructure in racial and ethnic minority communities. Sec. 812. Prioritizing regional extension center assistance to racial and ethnic minority groups. Sec. 813. 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. 814. Authorization of appropriations. Subtitle C—Additional Research and Studies Sec. 831. Data collection and assessments conducted in coordination with minority-serving institutions. Sec. 832. Study of health information technology in medically underserved communities. Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs Sec. 841. Application of Medicare HITECH payments to hospitals in Puerto Rico. Sec. 842. Extending Medicaid EHR incentive payments to rehabilitation facilities, long-term care facilities, and home health agencies. Sec. 843. Extending physician assistant eligibility for Medicaid electronic health record incentive payments. Title IX—Accountability and Evaluation Sec. 901. Prohibition on discrimination in Federal assisted health care services and research programs on the basis of sex, race, color, national origin, marital status, familial status, sexual orientation, gender identity, or disability status. Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights Act of 1964. Sec. 903. Accountability and transparency within the Department of Health and Human Services. Sec. 904. United States Commission on Civil Rights. Sec. 905. Sense of Congress concerning full funding of activities to eliminate racial and ethnic health disparities. Sec. 906. GAO and NIH reports. Title X—Addressing Social Determinants and Improving Environmental Justice Sec. 1001. Definitions. Sec. 1002. Findings. Sec. 1003. Health impact assessments. Sec. 1004. Implementation of recommendations by Environmental Protection Agency. Sec. 1005. Grant program to conduct environmental health improvement activities and to improve social determinants of health. Sec. 1006. Additional research on the relationship between the built environment and the health of community residents. Sec. 1007. Environment and public health restoration. Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion in the Gulf Coast.

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 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)By 2020, the Nation will face a shortage of health care providers and allied health workers and this shortage disproportionately affects health professional shortage areas where many racial and ethnic minority populations reside. (4)All efforts to reduce health disparities and barriers to quality health services require better and more consistent 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, two strategic plans that represent the country’s first coordinated roadmap to reducing health disparities. Along with the National Prevention Strategy, Healthy People 2020, and the National Health Care Quality Strategy, as well as critical resources such as the 2012 National Healthcare Quality and Disparities Reports, these comprehensive plans will work to increase the number of Americans who are healthy at every stage of life. (9)The Department of Health and Human Services also developed other strategic planning documents to combat disease disparities with a high impact on minority populations including the National HIV/AIDS Strategy, and the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. (10)The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, represents the biggest advancement for minority health in the last 40 years.

.

203.

Pilot program for improvement and development of State medical interpreting services

(a)

Grants authorized

The Secretary shall award one grant in accordance with this section to each of three States to assist each such State in designing, implementing, and evaluating a statewide program to provide onsite interpreter services under Medicaid. (b)

Grant period

A grant awarded under this section is authorized for a period of three fiscal years beginning on October 1, 2014. (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 LEP individuals, 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 plan under Medicaid 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 plan under Medicaid; 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 LEP individuals seeking to enroll in the State plan under Medicaid; (iii)ensuring that interpreters receive payment for interpreter services rendered under the system; and (iv)consulting regularly with organizations representing 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 plan under Medicaid. (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 plan under Medicaid. (3)A description of how the program will be evaluated, including a proposal for collaboration with organizations representing interpreters, consumers, and LEP individuals. (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 plan under Medicaid. (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. (3)

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. (g)

Funding

(1)

Authorization of appropriations

There is authorized to be appropriated $5,000,000 to carry out this section. (2)

Availability of funds

The funds authorized by paragraph (1) shall be 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)), as amended by section 205(d)(1) of this Act, is further amended by inserting (or, in the case of a State receiving a grant under section 203 of the Health Equity and Accountability Act of 2014, 100 percent for each quarter occurring during the grant period) after 90 percent. (h)

Limitation

No Federal funds under this section may be used to provide interpreter services from a location outside the United States.

204.

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 competency 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 cultural competency and linguistically appropriate service delivery shall be counted toward the determination of full-time equivalency.. (b)

Indirect medical education

Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following new clause: (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.

205.

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, shall establish a demonstration program under which the Secretary shall award grants to eligible Medicare service providers to improve communication between such providers and limited-English-proficient Medicare beneficiaries, 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; (ii)a provider of services under part B of such title; (iii)a Medicare Advantage organization offering a Medicare Advantage plan under part C of such title; or (iv)a PDP sponsor offering a prescription drug plan under part D of such title. (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 limited-English-proficient individuals, 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 6 grants to providers of services described in paragraph (2)(A)(i); (B)at least 6 grants to service providers described in paragraph (2)(A)(ii); (C)at least 6 grants to organizations described in paragraph (2)(A)(iii); and (D)at least 6 grants to sponsors described in paragraph (2)(A)(iv). (4)

Considerations in awarding grants

(A)

Variation in 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 serve Medicare beneficiaries in at least two geographic regions, as defined by the Secretary. (v)The grantees serve Medicare beneficiaries in at least two large metropolitan statistical areas with racial, ethnic, 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 limited-English-proficient. (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 (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.Subparagraph (C)(ii) shall not be construed to exempt emergency rooms or similar entities that regularly provide health care services in medical emergencies to limited-English-proficient patients 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

If a grantee is a Medicare Advantage organization offering a Medicare Advantage plan under part C of title XVIII of the Social Security Act or a PDP sponsor offering a prescription drug plan under part D of such title, such entity must provide at least 50 percent of the grant funds that the entity 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 limited-English-proficient. (E)

Administrative and reporting costs

A grantee may use up to 10 percent of the grant funds to pay for administrative costs 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 limited-English-proficient Medicare beneficiaries in a grantee’s service area utilizing— (i)data on the numbers of limited-English-proficient individuals 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 limited-English-proficient individuals 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 with limited-English proficiency 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; (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 202 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 are collected on the parent or legal guardian of such recipient. (8)

No Cost-Sharing

Limited-English-proficient Medicare beneficiaries 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. (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 limited-English-proficient Medicare beneficiaries participating in the project as compared to such outcomes and costs for limited-English-proficient 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; (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 subsection (c) of section 1907 of this Act. (D)Recommendations, if any, regarding the extension of such project to the entire Medicare program, subject to the provisions of section 1115A(c) of the Social Security Act. (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. (b)

Language 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 the and at the end; (ii)in subparagraph (C), by inserting and after the comma at the end; and (iii)by inserting after subparagraph (C) the following: (D)language services as defined in subsection (iii)(1),; and (B)by adding at the end the following new subsection: (iii)

Language services and related terms

(1)

Language services defined

The term language services has the same meaning given language or language access services in section 3400 of the Public Health Service Act. (2)

Interpreter services defined

For the purposes of this subsection, the term interpreter services has the meaning given competent interpreter services under section 3400(3) of the Public Health Service Act. (3)

Interpreter defined

The term interpreter— (A)means an individual— (i)who faithfully, accurately, and objectively transmits a spoken message from one language into another language; and (ii)who knows health and health-related terminology in both languages; and (B)includes individuals who provide in-person, telephonic, and video interpretation. (4)

Translation defined

The term translation means the transmission of a written message in one language into a written message in another language that retains the intended meaning of the original message. (5)

Limited-English-Proficient and LEP defined

The terms limited-English-proficient and LEP have the meaning given the term limited english proficient under section 9101(25) of the Elementary and Secondary Education Act of 1965, except that subparagraphs (A), (B), and (D) of such section not apply.. (2)

Coverage

Section 1832(a)(2) of such 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 of subparagraph (J) the following: (K)language services (as defined in paragraph (1) of section 1861(iii)) furnished by an interpreter (as defined in paragraph (3) of such section) or translator.. (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 (8); (B)by redesignating paragraph (9) as paragraph (10); and (C)by inserting after paragraph (8) the following new paragraph: (9)in the case of language services described in section 1861(iii)(1), 100 percent of the reasonable charges for such services, as determined in consultation with the Medicare Payment Advisory Commission; and. (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 services (as such term is defined in section 1861(iii)(1) of such Act). (c)

Medicare parts C and D

(1)

In general

Medicare Advantage plans under part C of the Social Security Act and prescription drug plans under part D of such Act shall comply with title VI of the Civil Rights Act of 1964 and section 1557 of the Patient Protection and Affordable Care Act 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: (5)

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 plan’s internal policies and procedures 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 2014, 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 health plan’s language services programs and services with respect to the plan’s 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 plan’s enrollee population. (E)The periodic provision of educational information to plan enrollees on the plan’s language services and programs.. (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)) is amended by— (A)striking 75 and inserting 90; (B)striking translation or interpretation services and inserting language 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 (28) and inserting (28), and (29). (3)

Definition of medical assistance

Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by— (A)in paragraph (28), by striking and at the end; (B)by redesignating paragraph (29) as paragraph (30); and (C)by inserting after paragraph (28) the following new paragraph: (29)language services, as such term is defined in section 1861(iii)(1), provided in a timely manner to limited-English-proficient individuals who need such services; and. (4)

Use of deductions and cost sharing

Section 1916(a)(2) of the Social Security Act (42 U.S.C. 1396o(2)) is amended by— (A)by striking or at the end of subparagraph (D); (B)by striking ; and at the end of subparagraph (E) and inserting , or; and (C)by adding at the end the following new subparagraph: (F)language services described in section 1905(a)(29); and. (5)

CHIP coverage requirements

Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended— (A)in subsection (a), in the matter before paragraph (1), by striking and (7) and inserting (7), and (9); and (B)in subsection (c), by adding at the end the following new paragraph: (9)

Language services

The child health assistance provided to a targeted low-income child shall include coverage of language services, as such term is defined in section 1861(iii)(1), provided in a timely manner to limited-English-proficient individuals who need such services.; and (C)in subsection (e)(2)— (i)in the heading, by striking Preventive and inserting Certain; and (ii)by inserting , subsection (c)(9), after subsection (c)(1)(C). (6)

Definition of child health assistance

Section 2110(a)(27) of the Social Security Act (42 U.S.C. 1397jj) is amended by striking translation and inserting language services as described in section 2103(c)(9). (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; 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(c)) is amended— (A)in subsection (a)(1) by striking 75 and inserting 90; and (B)in subsection (c)(2)(A), by inserting before the period , except that expenditures pursuant to clause (iv) of subparagraph (D) of such paragraph shall not count towards this total. (e)

Funding language 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 shall make payments (on a quarterly basis) directly to eligible entities to support the provision of language services to limited-English-proficient individuals in an amount equal to an eligible entity’s eligible costs for 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 2012 through 2016. (C)

Relation to Medicaid DSH

Payments under this subsection shall not offset or reduce payments under section 1923 of the Social Security Act, nor shall payments under such section be considered when determining uncompensated costs associated with the provision of language services. (2)

Methodology for payment of claims

(A)

In general

The Secretary shall establish a methodology to determine the average per person cost of language 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 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 are provided. (4)

Guidelines

Not later than 6 months after the date of enactment of this Act, the Secretary of Health and Human Services 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 services to limited-English-proficient individuals, the product of— (i)the average per person cost of language services, determined according to the methodology devised under paragraph (2); and (ii)the number of limited-English-proficient individuals who are provided language services by the entity and for whom no reimbursement is available for such services under the amendments made by subsections (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; or (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))); (ii)provide language services to at least 8 percent of the entity’s total number of patients, not later than 6 months after the date of the enactment of the Act; and (iii)prepare and submit 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 services

The term language services has the meaning given such term in section 1861(iii)(1) of the Social Security Act. (f)

Application of Civil Rights Act of 1964 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. 2000(d) et seq.) 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, 2013. (2)

Exception if State legislation required

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 requirement imposed by the amendments 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 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.

206.

Increasing understanding of and improving health literacy

(a)

In general

The Secretary, acting through the Director of the Agency for Healthcare Research and Quality and the Administrator of the Health Resources and Services Administration, in consultation with the Director of the National Institute on Minority Health and Health Disparities and the Office of Minority Health, shall award grants to eligible entities to improve health care for patient populations that have low functional 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 require. (c)

Use of funds

(1)

Agency for healthcare research and quality

Grants awarded under subsection (a) through the Agency for Healthcare Research and Quality shall be used— (A)to define and increase the understanding of health literacy; (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 of the Agency. (2)

Health resources and services administration

Grants awarded under subsection (a) through 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 programs for patients with low health literacy; (B)the tailoring of existing disease management programs 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; and (F)other activities determined appropriate by the Administrator of the Health Resources and Services Administration. (d)

Definitions

In this section, 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. (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 2015 through 2019.

207.

Assurances for receiving Federal funds

(a)

In general

Any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, and any program or activity that is administered by an executive agency or any entity established under title I of the Patient Protection and Affordable Care Act (or amendments made thereby), as such programs, activities, agencies, and entities are described in section 1557(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18116), in order to ensure the right of LEP individuals to receive access to quality health care, shall— (1)ensure that appropriate clinical and support staff receive ongoing education and training in linguistically appropriate service delivery; (2)offer and provide appropriate language services at no additional charge to each patient 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 competent interpreter or translation services, as defined in section 3400 of the Public Health Service Act. (b)

Exemptions

The requirements of subsection (a)(4) shall not apply as follows: (1)When a patient (who has been informed in his or her primary language of the availability of free interpreter and translation services) requests the use of family, friends, or other persons untrained in interpretation or translation if the following conditions are met: (A)The interpreter requested by the patient is over the age of 18. (B)The recipient informs the patient that he or she has the option of having the recipient provide an interpreter for him or her without charge, or of using his or her own interpreter. (C)The recipient informs the patient that the recipient may not require an LEP person to use a family member or friend as an interpreter. (D)The recipient evaluates whether the person the patient wishes to use as an interpreter is competent. If the recipient has reason to believe that the interpreter is not competent, the recipient provides the recipient’s own interpreter to protect the recipient from liability if the patient’s interpreter is later found not competent. (E)If the recipient has reason to believe that there is a conflict of interest between the interpreter and patient, the recipient may not use the patient’s interpreter. (F)The recipient 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 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. (c)

Rule of construction

Subsection (b)(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.

208.

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 Institute 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 culturally competent to health care and health-care-related services. 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 and health-care-related services for limited-English-proficient individuals; (4)a description of the effect of providing language services on quality of health care and access to care; and (5)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 2015 through 2019.

209.

English for speakers of other languages

(a)

Grants authorized

The Secretary of Education is authorized to provide grants to eligible entities for the provision of English as a second language (hereafter referred to as ESL) instruction and shall determine, after consultation with appropriate stakeholders, the mechanism for administering and distributing such grants. (b)

Eligible entity defined

For purposes of this section, the term eligible entity means a State or community-based organization that employs, and serves, minority populations. (c)

Application

An eligible entity may apply for a grant under this section by submitting such information as the Secretary may require and in such form and manner as the Secretary may require. (d)

Use of grant

As a condition of receiving a grant under this section, an eligible entity shall— (1)develop and implement a plan for assuring the availability of ESL instruction 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 them to access and regularly negotiate the system effectively; (2)develop a plan, including, where appropriate, public-private partnerships, for making ESL instruction progressively available to all individuals seeking instruction; and (3)maintain current ESL instruction efforts by using the additional funds to supplement rather than supplant any funds expended for ESL instruction in the State as of January 1, 2015. (e)

Additional duties of the secretary

The Secretary of Education shall— (1)collect and publicize annual data on how much Federal, State, and local governments spend on ESL instruction; (2)collect data from State and local governments to identify the unmet needs of English language learners for appropriate ESL instruction, including— (A)the preferred written and spoken language of such English language learners; (B)the extent of waiting lists including how many programs maintain waiting lists and, for programs that do not have waiting lists, the reasons why not; (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 individuals in the State and each participating locality; (F)the effectiveness of the instruction in meeting the needs of individuals receiving instruction and those needing instruction; (G)as assessment of the need for programs that integrate job training and ESL instruction, to assist individuals to obtain better jobs; and (H)the availability of ESL slots by State and locality; (3)determine the cost and most appropriate methods of making ESL instruction available to all English language learners seeking instruction; and (4)within 1 year of the date of enactment of this Act, issue a report to Congress that assesses the information collected in paragraphs (1), (2), and (3) and makes recommendations on steps that should be taken to progressively realize the goal of making ESL instruction available to all English language learners seeking instruction. (f)

Authorization of Appropriations

There are authorized to be appropriated to the Secretary of Education for each of fiscal years 2015 through 2018 $250,000,000 to carry out this section.

210.

Implementation

(a)

General provisions

(1)A State shall not be immune under the Eleventh Amendment of the Constitution of the United States from suit in Federal court for failing to provide the language access funded pursuant to this title. (2)In a suit against a State for a violation of this title, remedies (including remedies at both at law and in equity) are available for such a violation to the same extent as such remedies are available for such a violation in the suit against any public or private entity other than a State. (b)

Rule of construction

Nothing in this title shall be construed to limit otherwise existing obligations of recipients of Federal financial assistance under title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et seq.) or any other statute.

211.

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

Section 36B(c)(2)(C) of the Internal Revenue Code of 1986 is amended by adding at the end the following: (v)

Coverage must include language access and services

Except as provided in clause (iii), 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.. (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 54.9815–2719T(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, 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 written translations of notices, to apply a threshold that 5 percent of the population or at least 500 individuals per service area are literate only in the same non-English language in lieu of 10 percent or more residing in a county. (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 the Patient Protection and Affordable Care Act; (2)require navigators, certified application counselors, and other enrollment assisters to collect and report requests for language assistance; and (3)require the Federal and State call centers 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, and any steps the call center and language line have taken to actively address some of the consumer complaints. (f)

Effective date

The amendments made by this section shall apply to plan years beginning after the date of the enactment of this Act.