[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3250 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 3250

    To amend the Public Health Service Act to improve the health of 
                         minority individuals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 8, 1999

  Mr. Thompson of Mississippi (for himself, Mr. Lewis of Georgia, Mr. 
  Norwood, Mr. Jackson of Illinois, Mr. Brown of Ohio, Mr. Towns, Ms. 
     Roybal-Allard, Mr. Rodriguez, Mr. Underwood, Mr. Filner, Mrs. 
  Christensen, Mr. Conyers, Mr. Wynn, Mr. Gonzalez, Mr. Hilliard, Ms. 
Carson, Ms. Eddie Bernice Johnson of Texas, Mr. Scott, Ms. Kilpatrick, 
 Mr. Clyburn, Mr. Rush, Mr. Cummings, Mr. Payne, Mr. Dixon, Mr. Ford, 
Ms. Millender-McDonald, Ms. Waters, Mr. Meeks of New York, Mr. Bishop, 
 Mrs. Meek of Florida, Mrs. Jones of Ohio, Mr. Davis of Illinois, Ms. 
  Lee, Ms. McKinney, Mrs. Napolitano, Ms. Jackson-Lee of Texas, Mrs. 
   Clayton, Mr. Watt of North Carolina, Mr. Fattah, Ms. Pelosi, Mr. 
   Abercrombie, and Mr. George Miller of California) introduced the 
    following bill; which was referred to the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend the Public Health Service Act to improve the health of 
                         minority individuals.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Care 
Fairness Act of 1999''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
 TITLE I--IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF 
                HEALTH; ESTABLISHMENT OF NATIONAL CENTER

Sec. 101. Establishment of National Center for Research on Minority 
                            Health and Health Disparities.
Sec. 102. Centers of excellence for research education on health 
                            disparities and training.
Sec. 103. Extramural loan repayment program for biomedical research.
Sec. 104. General provisions regarding the Center.
Sec. 105. Report regarding methodology for determining resources of 
                            National Institutes of Health dedicated to 
                            research on minority health.
Sec. 106. Report by Director of Center regarding resources of National 
                            Institutes of Health dedicated to research 
                            on minority health.
TITLE II--MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE POLICY 
                              AND RESEARCH

Sec. 201. Minority health research by the Agency for Health Care Policy 
                            and Research.
        TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 301. Study and report by National Academy of Sciences.
                      TITLE IV--MEDICAL EDUCATION

Sec. 401. Grants for health care education curriculum development.
Sec. 402. National conference on continuing health professional 
                            education and disparity in health outcomes.
Sec. 403. Continuing medical education incentive program.
Sec. 404. Advisory committee.
Sec. 405. Cultural competency clearinghouse.
                   TITLE V--MISCELLANEOUS PROVISIONS

Sec. 501. Office for Civil Rights.
Sec. 502. Development of standards; study to measure patient outcomes 
                            under the medicare and medicaid programs by 
                            race and ethnicity.
Sec. 503. Departmental definition regarding minority individuals.
Sec. 504. Conforming provision regarding definitions.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) The United States ranks below most industrialized 
        nations in health status as measured by longevity, sickness, 
        and mortality.
            (2) The United States ranks 24th among industrialized 
        nations in infant mortality.
            (3) This poor rank in health status is attributed in large 
        measure to the lower health status of America's minority 
        populations.
            (4) Many minority groups suffer disproportionately from 
        cancer. Disparities exist in both mortality and incidence 
        rates. For men and women combined, African Americans have a 
        cancer death rate about 35 percent higher than that for whites. 
        Paralleling the death rate, the incidence rate for lung cancer 
        in African American men is about 50 percent higher than white 
        men. Native Hawaiian men also have elevated rates of lung 
        cancer compared with white men. Alaskan Native men and women 
        suffer from higher rates of cancers of the colon and rectum 
        than do whites. Vietnamese women in the United States have a 
        cervical cancer incidence rate more than 5 times greater than 
        white women. Hispanic women also suffer elevated rates of 
        cervical cancer.
            (5) Infant death rates among African Americans, Native 
        Americans, and Alaska Natives, and Hispanics were well above 
        the national average. The greatest disparity exists for African 
        Americans. The overall Native American rate does not reflect 
        the diversity among Indian communities, some of which have 
        infant mortality rates approaching twice the national rate.
            (6) Sudden infant death syndrome (referred to in this 
        section as ``SIDS'') accounts for approximately 10 percent of 
        all infant deaths in the first year of life. Minority 
        populations are at greater risk for SIDS. In addition to the 
        greater risks among African Americans, the rates are 3 to 4 
        times as high for some Native American and Alaskan Native 
        populations.
            (7) Cardiovascular disease is the leading cause of death 
        for all racial and ethnic groups. Major disparities exist among 
        population groups, with a disproportionate burden of death and 
        disability from cardiovascular disease in minority and low-
        income populations. Stroke is the only leading cause of death 
        for which mortality is higher for Asian-American males than for 
        white males.
            (8) Racial and ethnic minorities have higher rates of 
        hypertension, tend to develop hypertension at an earlier age, 
        and are less likely to undergo treatment to control their high 
        blood pressure.
            (9) Diabetes, the 7th leading cause of death in the United 
        States, is a serious public health problem affecting racial and 
        ethnic communities. The prevalence of diabetes in African 
        Americans is approximately 70 percent higher than whites and 
        the prevalence in Hispanics is nearly double that of whites. 
        The prevalence rate of diabetes among Native Americans and 
        Alaska Natives is more than twice that for the total population 
        and at least 1 tribe, the Pimas of Arizona, have the highest 
        known prevalence of diabetes of any population in the world.
            (10) The human immunodeficiency virus (referred to in this 
        section as ``HIV''), which causes acquired immune deficiency 
        syndrome (referred to in this section as ``AIDS''), results in 
        disproportionate suffering in minority populations. Minority 
        persons represent 25 percent of the total United States 
        population, but 54 percent of all cases of AIDS.
            (11) More than 75 percent of AIDS cases reported among 
        women and children occur in minority women and children.
            (12) Nearly 2 of 5 (38 percent) Hispanic adults, 1 of 4 (24 
        percent) African American adults, and 1 of 4 (24 percent) 
        Asian-American adults are uninsured, compared with 1 of 7 (14 
        percent) white adults.
            (13) Elderly minorities experience disparities in access to 
        care and health status, in part because medicare covers only 
        half the health care expenses of older Americans.
            (14) Two of 5 Hispanics and 2 of 5 African Americans age 65 
        and older rate their health status as fair or poor, compared 
        with less than 1 of 4 (23 percent) white Americans 65 and over.
            (15) Nearly 2 of 5 (39 percent) African American adults and 
        almost half (46 percent) of Hispanic adults report that they do 
        not have a regular doctor, compared with 1 of 4 (26 percent) of 
        white adults.
            (16) Minority Americans 65 and older are less likely to 
        have a regular doctor or to see a specialist.
            (17) Ninety percent of minority physicians produced by 
        Historically Black Medical Colleges live and serve in minority 
        communities.
            (18) Almost half (45 percent) of Hispanic adults, 2 of 5 
        (41 percent) Asian-American adults, and more than 1 of 3 (35 
        percent) African American adults report difficulty paying for 
        medical care, compared with 1 of 4 (26 percent) white adults.
            (19) Despite suffering disproportionate rates of illness, 
        death, and disability, minorities have not been proportionately 
        represented in many clinical research trials, except in studies 
        of behavioral risk factors associated with negative 
        stereotypes.
            (20) Culturally sensitive approaches to research are needed 
        to encourage minority participation in research studies.
            (21) There is a national need for minority scientists in 
        the fields of biomedical, clinical, and health services 
        research.
            (22) In 1990, only 3.3 percent of all United States medical 
        school facilities were underrepresented by minority persons.
            (23) Only 1 percent of full professors were 
        underrepresented by minority persons in 1990.
            (24) The proportion of underrepresented minorities in high 
        academic ranks, such a professors and associate professors, 
        decreased from 1980 to 1990.
            (25) African Americans with identical complaints of chest 
        pain are less likely than white Americans to be referred by 
        physicians for sophisticated cardiac tests.
            (26) Cultural competency training in medical schools and 
        residency training programs has the potential to reduce 
        disparities in health care and health outcomes.
            (27) More detailed data on health disparities is needed 
        to--
                    (A) evaluate the impact that race and ethnicity 
                have on health status, access to care, and quality of 
                care; and
                    (B) enforce existing protections for equal access 
                to care.

 TITLE I--IMPROVING MINORITY HEALTH THROUGH THE NATIONAL INSTITUTES OF 
                HEALTH; ESTABLISHMENT OF NATIONAL CENTER

SEC. 101. ESTABLISHMENT OF NATIONAL CENTER FOR RESEARCH ON MINORITY 
              HEALTH AND HEALTH DISPARITIES.

    (a) In General.--Part E of title IV of the Public Health Service 
Act (42 U.S.C. 287 et seq.), as amended by section 601 of the 
Departments of Labor, Health and Human Services, and Education, and 
Related Agencies Appropriations Act, 1999 (as contained in section 
101(f) of Public Law 105-277) (112 Stat. 2681-387), is amended by 
adding at the end the following subpart:

``Subpart 6--National Center for Research on Minority Health and Health 
                              Disparities

``SEC. 485E. PURPOSE OF CENTER.

    ``(a) In General.--The general purpose of the National Center for 
Research on Minority Health and Health Disparities (in this subpart 
referred to as the `Center') is the conduct and support of basic and 
clinical research, training, the dissemination of health information, 
and other programs with respect to minority health.
    ``(b) Coordination of Activities.--The Director of the Center shall 
act as the primary Federal official with responsibility for overseeing 
all minority health research conducted or supported by the National 
Institutes of Health, and--
            ``(1) shall serve to represent the National Institutes of 
        Health minority health research program at all relevant 
        Executive branch task forces, committees and planning 
        activities; and
            ``(2) shall maintain communications with all relevant 
        Public Health Service agencies and with various other 
        departments of the Federal Government, to ensure the timely 
        transmission of information concerning advances in minority 
        health research between these various agencies for 
        dissemination to affected communities and health care 
        providers.
    ``(c) Collaborative Comprehensive Plan and Budget.--
            ``(1) In general.--Subject to the provisions of this 
        section and other applicable law, the Director of NIH, the 
        Director of the Center, and the directors of the national 
        research institutes in collaboration (and in consultation with 
        the advisory council for the Center) shall--
                    ``(A) establish a comprehensive plan and budget for 
                the conduct and support of all minority health research 
                activities of the agencies of the National Institutes 
                of Health (which plan and budget shall be first 
                established under this subsection not later than 12 
                months after the date of the enactment of this 
                subpart);
                    ``(B) ensure that the plan and budget demonstrate 
                how minority research activities address the health 
                needs of specific minority populations;
                    ``(C) ensure that the plan and budget establish 
                priorities among the minority health research 
                activities that such agencies are authorized to carry 
                out;
                    ``(D) ensure that the plan and budget establish 
                objectives regarding such activities, describes the 
                means for achieving the objectives, and designates the 
                date by which the objectives are expected to be 
                achieved;
                    ``(E) ensure that all amounts appropriated for such 
                activities are expended in accordance with the plan and 
                budget;
                    ``(F) review the plan and budget not less than 
                annually, and revise the plan and budget as 
                appropriate; and
                    ``(G) ensure that the plan and budget serve as a 
                broad, binding statement of policies regarding minority 
                health research activities of the agencies, but do not 
                remove the responsibility of the heads of the agencies 
                for the approval of specific programs or projects, or 
                for other details of the daily administration of such 
                activities, in accordance with the plan and budget.
            ``(2) Certain components of plan and budget.--With respect 
        to minority health research activities of the agencies of the 
        National Institutes of Health, the Director of the Center shall 
ensure that the plan and budget provide for--
                    ``(A) basic research and applied research, 
                including research and development with respect to 
                products;
                    ``(B) research that is conducted by the agencies;
                    ``(C) research that is supported by the agencies;
                    ``(D) proposals developed pursuant to solicitations 
                by the agencies and for proposals developed 
                independently of such solicitations; and
                    ``(E) behavioral research and social sciences 
                research, which may include cultural and linguistic 
                research in each of the agencies.
    ``(d) Clinical Research Equity.--The Director of the Center shall 
assist in the administration of section 492B with respect to the 
inclusion of members of minority groups as subjects in clinical 
research.
    ``(e) Research Endowments.--The Director of the Center may carry 
out a program to facilitate research on minority health by providing 
for research endowments at centers of excellence under section 736.
    ``(f) Certain Activities.--In carrying out subsection (a), the 
Director of the Center--
            ``(1) shall assist the Director of the National Center for 
        Research Resources in carrying out section 481(c)(3) and in 
        committing resources for construction at Institutions of 
        Emerging Excellence;
            ``(2) shall establish projects to promote cooperation among 
        Federal agencies, State, local, and regional public health 
        agencies, and private entities, in minority health research; 
        and
            ``(3) may utilize information from previous health 
        initiatives concerning minorities.
    ``(g) Advisory Council.--The Secretary shall, in accordance with 
section 406, establish an advisory council to advise, assist, consult 
with, and make recommendations to the Director of the Center on matters 
relating to the activities described in subsection (a), and with 
respect to such activities to carry out any other functions described 
in section 406 for advisory councils under such section. Minority 
groups shall be equally represented among such members of the advisory 
council representing a diversity of health professionals.
    ``(h) Special Authorities.--
            ``(1) Annual budget estimate.--With respect to a fiscal 
        year, the Director of the Center shall prepare and submit 
        directly to the President, for review and transmittal to the 
        Congress, a budget estimate for the Center for the fiscal year, 
        after reasonable opportunity for comment (but without change) 
        by the Secretary, the Director of NIH, and the advisory council 
        under section subsection (e). The budget estimate shall include 
        an estimate of the number and type of personnel needs for the 
        Center.
            ``(2) Receipt of appropriations.--The Director of the 
        Center shall receive directly from the President and the 
        Director of the Office of Management and Budget all funds 
        available for the Center.
    ``(i) Annual Report.--The Director of the Center shall prepare an 
annual report on the activities carried out or to be carried out by the 
Center, and shall submit each such report to the Congress, the 
Secretary, and the Director of NIH. With respect to the fiscal year 
involved, the report shall--
            ``(1) describe and evaluate the progress made in minority 
        health research conducted or supported by the national research 
        institutes;
            ``(2) summarize and analyze expenditures made for 
        activities with respect to minority health research conducted 
        or supported by the National Institutes of Health; and
            ``(3) contain such recommendations as the Director 
        considers appropriate.
    ``(j) Definitions.--For purposes of this subpart:
            ``(1) The term `minority health conditions', with respect 
        to individuals who are members of racial and ethnic minority 
        groups, means all diseases, disorders, and conditions 
        (including with respect to mental health and substance abuse)--
                    ``(A) unique to, more serious, or more prevalent in 
                such individuals;
                    ``(B) for which the factors of medical risk or 
                types of medical intervention are different for such 
                individuals, or for which it is unknown whether such 
                factors or types are different for such individuals; or
                    ``(C) with respect to which there has been 
                insufficient research involving such individuals as 
                subjects or insufficient data on such individuals.
            ``(2) The term `minority health research' means research on 
        minority health conditions, including research on preventing 
        such conditions, and including research on access, outreach, 
        treatment, and research on cultural and linguistic services for 
        decreasing those conditions.
            ``(3) The term `racial and ethnic minority group' has the 
        meaning given such term in section 1707.
    ``(k) Authorization of Appropriations.--For the purpose of carrying 
out this subpart, there are authorized to be appropriated $100,000,000 
for fiscal year 2000, and such sums as may be necessary for each of the 
fiscal years 2001 through 2004. Such authorization of appropriations is 
in addition to other authorizations of appropriations that are 
available for the conduct and support of research on minority health by 
the national research institutes and other agencies of the National 
Institutes of Health.''.
    (b) Conforming Amendment.--Part A of title IV of the Public Health 
Service Act (42 U.S.C. 281 et seq.) is amended by striking section 404.

SEC. 102. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION ON HEALTH 
              DISPARITIES AND TRAINING.

    Subpart 6 of part E of title IV of the Public Health Service Act, 
as added by section 101 of this Act, is amended by adding at the end 
the following section:

``SEC. 485F. CENTERS OF EXCELLENCE FOR RESEARCH EDUCATION ON HEALTH 
              DISPARITIES AND TRAINING.

    ``(a) In General.--The Director of the Center shall make grants to, 
and enter into contracts with, designated biomedical research 
institutions described in subsection (c), and other public and 
nonprofit health or educational entities, for the purpose of assisting 
the institutions in supporting programs of excellence in biomedical 
research education for underrepresented minority individuals.
    ``(b) Required Use of Funds.--The Director of the Center may not 
make a grant under subsection (a) unless the designated biomedical 
research institution involved agrees, subject to subsection (c)(1)(B), 
to expend the grant--
            ``(1) to conduct research into the nature of health 
        disparities and the causes of such disparities, and conduct 
        basic and applied biomedical research, into remedies for 
        disparities and specific diseases affecting minorities and 
        other disadvantaged socioeconomic groups;
            ``(2) to train minorities and other disadvantaged 
        socioeconomic groups as professionals in the area of biomedical 
        research; or
            ``(3) to expand, remodel, renovate, or alter existing 
        research facilities or construct new research facilities for 
        the purpose of conducting biomedical research related to health 
        disparities.
    ``(c) Centers of Excellence.--
            ``(1) Designated institutions.--
                    ``(A) General conditions.--The conditions specified 
                in this subparagraph are that a designated biomedical 
                research institution--
                            ``(i) has a significant number of 
                        underrepresented minority individuals enrolled 
                        in the institution, including individuals 
                        accepted for enrollment in the institution;
                            ``(ii) has been effective in assisting 
                        underrepresented minority students of the 
                        institution to complete the program of 
                        education and receive the degree involved;
                            ``(iii) has been effective in recruiting 
                        underrepresented minority individuals to enroll 
                        in and graduate from the institution, including 
                        providing scholarships and other financial 
                        assistance to such individuals and encouraging 
                        underrepresented minority students from all 
                        levels of the educational pipeline to pursue 
                        biomedical research careers; and
                            ``(iv) has made significant recruitment 
                        efforts to increase the number of 
                        underrepresented minority individuals serving 
                        in faculty or administrative positions at the 
                        institution.
                    ``(B) Consortium.--Any designated biomedical 
                research institution involved may, with other 
                biomedical institutions (designated or otherwise) form 
                a consortium to carry out the purposes described in 
                subsection (b) at the institutions of the consortium.
                    ``(C) Application of criteria to other programs.--
                In the case of any criteria established by the Director 
                of the Center for purposes of determining whether 
                institutions meet the conditions described in 
                subparagraph (A), this section may not, with respect to 
                racial and ethnic minorities, be construed to 
                authorize, require, or prohibit the use of such 
                criteria in any program other than the program 
                established in this section.
    ``(d) Duration of Grant.--The period during which payments are made 
under a grant under subsection (a) may not exceed 5 years. Such 
payments shall be subject to annual approval by the Director of the 
Center and to the availability of appropriations for the fiscal year 
involved to make the payments.
    ``(e) Definitions.--For purposes of this section:
            ``(1) The term `disadvantaged socioeconomic groups' means 
        any group, defined by race, ethnicity, gender, sexual 
        orientation, or economic status that is underrepresented in 
        health research.
            ``(2) The term `minority' means an individual from a racial 
        or ethnic group (as defined in section 1707) that is 
        underrepresented in health research.
            ``(3) The term `program of excellence' means any program 
        carried out by a designated biomedical research institution 
        with a grant made under subsection (a), if the program is for 
        purposes for which the institution involved is authorized in 
        subsection (b) or (c) to expend the grant.
    ``(f) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        making grants under subsection (a), there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2000 through 2004.
            ``(2) No limitation.--Nothing in this subsection shall be 
        construed as limiting the centers of excellence referred to in 
        this section to the designated amount, or to preclude such 
        entities from competing for other grants under this section.
            ``(3) Maintenance of effort.--
                    ``(A) In general.--With respect to activities for 
                which a grant made under this part are authorized to be 
                expended, the Director of the Center may not make such 
                a grant to a center of excellence for any fiscal year 
                unless the center agrees to maintain expenditures of 
                non-Federal amounts for such activities at a level that 
                is not less than the level of such expenditures 
                maintained by the center for the fiscal year preceding 
                the fiscal year for which the institution receives such 
                a grant.
                    ``(B) Use of federal funds.--With respect to any 
                Federal amounts received by a center of excellence and 
                available for carrying out activities for which a grant 
                under this part is authorized to be expended, the 
                Director of the Center may not make such a grant to the 
                center for any fiscal year unless the center agrees 
                that the center will, before expending the grant, 
                expend the Federal amounts obtained from sources other 
                than the grant.''.

SEC. 103. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR BIOMEDICAL RESEARCH.

    Subpart 6 of part E of title IV of the Public Health Service Act, 
as amended by section 102 of this Act, is amended by adding at the end 
the following section:

``SEC. 485G. EXTRAMURAL LOAN REPAYMENT PROGRAM FOR BIOMEDICAL RESEARCH.

    ``(a) In General.--The Director of the Center shall establish a 
program of entering into contracts with qualified health professionals 
under which such health professionals agree to engage in biomedical 
research, in consideration of the Federal Government agreeing to repay, 
for each year of such service, not more than $35,000 of the principal 
and interest of the educational loans of such health professionals.
    ``(b) Service Provisions.--The provisions of sections 338B, 338C, 
and 338E shall, except as inconsistent with subsection (a), apply to 
the program established in such subsection (a) to the same extent and 
in the same manner as such provisions apply to the National Health 
Service Corps Loan Repayment Program established in subpart III of part 
D of title III.
    ``(c) Availability of Appropriations.--Amounts available for 
carrying out this section shall remain available until the expiration 
of the second fiscal year beginning after the fiscal year for which the 
amounts were made available.
    ``(d) Health Disparities.--In carrying out this section, the 
Director of the Center shall ensure that not less than 50 percent of 
the contracts entered into under this section involve appropriately 
qualified health professionals who are from disadvantaged backgrounds. 
Any remaining contracts entered into under this section may involve 
appropriately qualified health professionals who are pursuing 
biomedical research in the fields of minority health research and 
health disparities.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2000 through 2002.''.

SEC. 104. GENERAL PROVISIONS REGARDING THE CENTER.

    Subpart 6 of part E of title IV of the Public Health Service Act, 
as amended by section 103 of this Act, is amended by adding at the end 
the following section:

``SEC. 485H. GENERAL PROVISIONS REGARDING THE CENTER.

    ``(a) Administrative Support for Center.--The Secretary, acting 
through the Director of the National Institutes of Health, shall 
provide administrative support and support services to the Director of 
the Center and shall ensure that such support takes maximum advantage 
of existing administrative structures at the agencies of the National 
Institutes of Health.
    ``(b) Evaluation and Report.--
            ``(1) Evaluation.--Not later than 5 years after the date of 
        the enactment of this part, the Secretary shall conduct an 
        evaluation to--
                    ``(A) determine the effect of this section on the 
                planning and coordination of the minority health 
                research programs at the institutes, centers and 
                divisions of the National Institutes of Health;
                    ``(B) evaluate the extent to which this part has 
                eliminated the duplication of administrative resources 
                among such Institutes, centers and divisions; and
                    ``(C) provide recommendations concerning future 
                alterations with respect to this part.
            ``(2) Report.--Not later than 1 year after the date on 
        which the evaluation is commenced under paragraph (1), the 
        Secretary shall prepare and submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate, and the Committee 
        on Commerce of the House of Representatives, a report 
        concerning the results of such evaluation.''.

SEC. 105. REPORT REGARDING METHODOLOGY FOR DETERMINING RESOURCES OF 
              NATIONAL INSTITUTES OF HEALTH DEDICATED TO RESEARCH ON 
              MINORITY HEALTH.

    Not later than one year after the date of the enactment of this 
Act, the Director of the National Center for Research on Minority 
Health and Health Disparities (established by the amendment made by 
section 101(a)), after consultation with the advisory council for such 
Center, shall submit to the Congress, the Secretary of Health and Human 
Services, and the Director of the National Institutes of Health a 
report that makes recommendations for the methodology that should be 
used to determine the extent of the resources of the National 
Institutes of Health that are dedicated to research on minority health, 
including determining the amount of funds that are used to conduct and 
support such research. With respect to such methodology, the report 
shall address the discrepancies between the methodology used by such 
Institutes as of the date of the enactment of this Act and the 
methodology used by the Institute of Medicine as of such date.

SEC. 106. REPORT BY DIRECTOR OF CENTER REGARDING RESOURCES OF NATIONAL 
              INSTITUTES OF HEALTH DEDICATED TO RESEARCH ON MINORITY 
              HEALTH.

    Not later than December 1, 2003, the Director of the National 
Center for Research on Minority Health and Health Disparities 
(established by the amendment made by section 101(a)), after 
consultation with the advisory council for the Center, shall submit to 
the Congress a report that provides a determination by the Director of 
whether and to what extent, relative to fiscal year 1999, there has 
been an increase in the level of resources of the National Institutes 
of Health that are dedicated to research on minority health, including 
the amount of funds used to conduct and support such research. The 
report shall include provisions describing whether and to what extent 
there have been increases in the number and amount of awards to 
minority serving institutions.

TITLE II--MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE POLICY 
                              AND RESEARCH

SEC. 201. MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE POLICY 
              AND RESEARCH.

    (a) In General.--Part A of title IX of the Public Health Service 
Act (42 U.S.C. 299 et seq.) is amended by adding at the end the 
following:

``SEC. 906. RESEARCH ON MINORITY HEALTH DISPARITIES.

    ``(a) In General.--The Administrator of the Agency for Health Care 
Policy and Research shall--
            ``(1) conduct and support research to identify how to 
        improve the quality and outcomes of health care services for 
        minority populations and the causes of health disparities for 
        minority populations, including barriers to health care access;
            ``(2) conduct and support research and support 
        demonstration projects to identify, test, and evaluate 
        strategies for eliminating the disparities described in 
        paragraph (1) and promoting effective interventions;
            ``(3) develop measures for the assessment and improvement 
        of the quality and appropriateness of health care services 
        provided to minority populations; and
            ``(4) in carrying out 902(c), provide support to increase 
        the number of minority health care researchers and the health 
        services research capacity of institutions that train minority 
        health care researchers.
    ``(b) Research and Demonstration Projects.--
            ``(1) In general.--In carrying out subsection (a), the 
        Administrator shall conduct and support research to--
                    ``(A) identify the clinical, cultural, 
                socioeconomic, and organizational factors that 
                contribute to health disparities for minority 
                populations (including examination of patterns of 
                clinical decisionmaking and of the availability of 
                support services);
                    ``(B) identify and evaluate clinical and 
                organizational strategies to improve the quality, 
                outcomes, and access to care for minority populations;
                    ``(C) support demonstrations to test such 
                strategies; and
                    ``(D) widely disseminate strategies for which there 
                is scientific evidence of effectiveness.
            ``(2) Use of certain strategies.--In carrying out this 
        section the Administrator shall implement research strategies 
        and mechanisms that will enhance the involvement of minority 
        health services researchers, institutions that train minority 
        researchers, and members of minority populations for whom the 
        Agency is attempting to improve the quality and outcomes of 
        care, including--
                    ``(A) centers of excellence that can demonstrate, 
                either individually or through consortia, a combination 
                of multi-disciplinary expertise in outcomes or quality 
                improvement research and a demonstrated capacity to 
                engage minority populations in the planning, conduct 
                and translation of research, with linkages to relevant 
                sites of care;
                    ``(B) provider-based research networks, including 
                health plans, facilities, or delivery system sites of 
                care (especially primary care), that make extensive use 
                of minority health care providers or serve minority 
                patient populations and have the capacity to evaluate 
                and promote quality improvement; and
                    ``(C) other innovative mechanisms or strategies 
                that will facilitate the translation of past research 
                investments into clinical practices that can reasonably 
                be expected to benefit these populations.
    ``(c) Quality Measurement Development.--
            ``(1) In general.--To ensure that minority populations 
        benefit from the progress made in the ability of individuals to 
        measure the quality of health care delivery, the Administrator 
        of the Agency for Health Care Policy and Research shall support 
        the development of quality of health care measures that assess 
        the experience of minority populations with health care 
        systems, such as measures that assess the access of minority 
        populations to health care, the cultural competence of the care 
        provided, the quality of the care provided, the outcomes of 
        care, or other aspects of health care practice that the 
        Administrator determines to be important.
            ``(2) Report.--Not later than 24 months after the date of 
        enactment of this section, the Secretary, acting through the 
        Administrator, shall prepare and submit to the appropriate 
        committees of Congress a report describing the state-of-the-art 
        of quality measurement for minority populations which will 
        identify critical unmet needs, the current activities of the 
        Department to address those needs, and a description of related 
        activities in the private sector.
    ``(d) Definition.--For purposes of this section, the term 
`minority', with respect to populations, refers to racial and ethnic 
minority groups as defined in section 1707.''.
    (b) Funding.--Section 926 of the Public Health Service Act (42 
U.S.C. 299c-5) is amended by adding at the end the following:
    ``(f) Minority Health Disparities Research.--For the purpose of 
carrying out the activities under section 906, there are authorized to 
be appropriated such sums as may be necessary for each of the fiscal 
years 2000 through 2004.''.

        TITLE III--DATA COLLECTION RELATING TO RACE OR ETHNICITY

SEC. 301. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

    (a) Study.--The National Academy of Sciences shall conduct a 
comprehensive study of the Department of Health and Human Services' 
data collection systems and practices, and any data collection or 
reporting systems required under any of the programs or activities of 
the Department, relating to the collection of data on race or 
ethnicity, including other Federal data collection systems (such as the 
Social Security Administration) with which the Department interacts to 
collect relevant data on race and ethnicity.
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the National Academy of Sciences shall prepare and submit to 
the Committee on Health, Education, Labor, and Pensions of the Senate 
and the Committee on Commerce of the House of Representatives, a report 
that--
            (1) identifies the data needed to support efforts to 
        evaluate the effects of race and ethnicity on access to health 
        care and other services and on disparity in health and other 
        social outcomes and the data needed to enforce existing 
        protections for equal access to health care;
            (2) examines the effectiveness of the systems and practices 
        of the Department of Health and Human Services described in 
        subsection (a), including pilot and demonstration projects of 
        the Department, and the effectiveness of selected systems and 
        practices of other Federal and State agencies and the private 
        sector, in collecting and analyzing such data;
            (3) contains recommendations for ensuring that the 
        Department of Health and Human Services, in administering its 
        entire array of programs and activities, collects, or causes to 
        be collected, reliable and complete information relating to 
        race and ethnicity; and
            (4) includes projections about the costs associated with 
        the implementation of the recommendations described in 
        paragraph (3), and the possible effects of the costs on program 
        operations.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary for fiscal year 2000 to 
carry out this section.

                      TITLE IV--MEDICAL EDUCATION

SEC. 401. GRANTS FOR HEALTH CARE EDUCATION CURRICULUM DEVELOPMENT.

    Part F of title VII of the Public Health Service Act (42 U.S.C. 
295j et seq.) is amended by inserting after section 791 the following:

``SEC. 791A. GRANTS FOR HEALTH PROFESSIONAL EDUCATION CURRICULUM 
              DEVELOPMENT.

    ``(a) Grants for Graduate Education Curriculum Development.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and in collaboration with the Administrator for 
        Health Care Policy and Research and the Deputy Assistant 
        Secretary for Minority Health, may make awards of grants, 
        contracts, or cooperative agreements to public and nonprofit 
        private entities for the purpose of carrying out research 
        projects and demonstration projects to develop curricula to 
        reduce disparity in health care outcomes, including curricula 
        for cultural competency in graduate medical education.
            ``(2) Eligibility.--To be eligible to receive a grant, 
        contract or cooperative agreements under paragraph (1), an 
        entity shall--
                    ``(A) be a school of medicine, school or 
                osteopathic medicine, school or dentistry, school of 
                public health, school of nursing, or other recognized 
                health profession school; and
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require.
            ``(3) Use of funds.--An entity shall use amounts received 
        under a grant under paragraph (1) to carry out research 
        projects and demonstration projects to develop curricula to 
        reduce disparity in health care outcomes, including curricula 
        for cultural competency in graduate medical education.
            ``(4) Number of grants and grant term.--The Secretary shall 
        award 20 grants, contracts or cooperative agreements (or 
        combination thereof) under paragraph (1) in each of the first 
        and second fiscal years for which funds are available under 
        subsection (f). The term of each such grant, contract or 
        cooperative agreement shall be 3 years.
    ``(b) Grants for Continuing Health Professional Education 
Curriculum Development.--
            ``(1) In general.--The Secretary, acting through the Health 
        Resources and Services Administration and the Agency for Health 
        Care Policy and Research and in collaboration with the Office 
        of Minority Health, shall award grants to eligible entities for 
        the establishment of demonstration and pilot projects to 
        develop curricula to reduce disparity in health care and health 
        outcomes, including curricula for cultural competency, in 
        continuing medical education.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1) an entity shall--
                    ``(A) be a school of medicine, osteopathic 
                medicine, public health, dentistry, optometry, 
                pharmacy, allied health, chiropractic, podiatric 
                medicine, nursing, and public health and health 
                administration, public or nonprofit private school that 
                offers graduate programs in behavioral and mental 
                health, program for the training of physician 
                assistants, health professional association, or other 
                public or nonprofit health educational entity, or any 
                consortium of entities described in this subparagraph; 
                and
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require.
            ``(3) Use of funds.--An entity shall use amounts received 
        under a grant under paragraph (1) to develop and evaluate the 
        effect and impact of curricula for continuing medical education 
        courses or programs to provide education concerning issues 
        relating to disparity in health care and health outcomes, 
        including cultural competency of health professionals. Such 
        curricula shall focus on the need to remove bias from health 
        care at a personal level as well as at a systematic level.
            ``(4) Number of grants and grant term.--The Secretary shall 
        award 20 grants under paragraph (1) in each of the first and 
        second fiscal years for which funds are available under 
        subsection (f). The term of each such grant shall be 3 years.
    ``(c) Distribution of Projects.--The Secretary shall ensure that, 
to the extent practicable, projects under subsections (a) and (b) are 
carried out in each of the principal geographic regions of the United 
States and involve different racial and ethnic minority groups and 
health professions.
    ``(d) Monitoring.--An entity that receives a grant, contract or 
cooperative agreement under subsection (a) or (b) shall ensure that 
procedures are in place to monitor activities undertaken using grant, 
contract or cooperative agreement funds. Such entity shall annually 
prepare and submit to the Secretary a report concerning the 
effectiveness of curricula developed under the grant contract or 
cooperative agreement.
    ``(e) Report to Congress.--Not later than January 1, 2002, the 
Secretary shall prepare and submit to the appropriate committees of 
Congress, a report concerning the effectiveness of programs funded 
under this section and a plan to encourage the implementation and 
utilization of curricula to reduce disparity in health care and health 
outcomes. A final report shall be submitted by the Secretary not later 
than January 1, 2004.
    ``(f) Definition.--For purposes of this section, the term `racial 
and ethnic minority group' has the meaning given such term in section 
1707.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $3,500,000 for fiscal year 
2000, $7,000,000 for fiscal year 2001, $7,000,000 for fiscal year 2002, 
and $3,500,000 for fiscal year 2003.''.

SEC. 402. NATIONAL CONFERENCE ON CONTINUING HEALTH PROFESSIONAL 
              EDUCATION AND DISPARITY IN HEALTH OUTCOMES.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall convene a 
national conference on continuing medical education as a method for 
reducing disparity in health care and health outcomes, including 
continuing medical education on cultural competency. The conference 
shall include sessions to address measurements of outcomes to assess 
the effectiveness of curricula in reducing disparity.
    (b) Participants.--The Secretary of Health and Human Services shall 
invite minority health advocacy groups, health education entities 
described in section 741(b)(1) of the Public Health Service Act (as 
added by section 401), and other interested parties to attend the 
conference under subsection (a).
    (c) Issues.--The national conference convened under subsection (a) 
shall address issues relating to the role of continuing medical 
education in the effort to reduce disparity in health care and health 
outcomes, including the role of continuing medical education in 
improving the cultural competency of health professionals. The 
conference shall focus on methods to achieve reductions in the 
disparities in health care and health outcomes through continuing 
medical education courses or programs and on strategies for measuring 
the effectiveness of curricula to reduce disparities.
    (d) Publication of Findings.--Not later than 6 months after the 
convening of the national conference under subsection (a), the 
Secretary of Health and Human Services shall publish in the Federal 
Register a summary of the proceedings and the findings of the 
conference.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 403. CONTINUING MEDICAL EDUCATION INCENTIVE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services shall 
develop and implement a program to provide incentives to health 
maintenance organizations, community health centers, rural health 
centers, and other entities providing services under title XVIII or XIX 
of the Social Security Act (42 U.S.C. 1395 et seq. or 1396 et seq.) to 
encourage health care professionals employed by, or under contract 
with, such entities to participate in continuing medical education 
programs designed to decrease the disparity of health across racial and 
ethnic minority groups.
    (b) Effective Programs.--In developing the program under subsection 
(a), the Secretary of Health and Human Services shall ensure that 
incentives are targeted at programs that address each of the following 
issues:
            (1) Implementing new curricula or strategies for continuing 
        medical education programs designed to decrease the disparity 
        of health across racial and ethnic minority groups or of 
        continuing medical education curricula or strategies that have 
        been proven effective in decreasing the disparity of health 
        across racial and ethnic minority groups.
            (2) Encouraging health professionals to participate in such 
        curricula.
            (3) Monitoring health care and health outcomes as a way in 
        which to evaluate the effectiveness of continuing medical 
        education programs in decreasing the disparity of health across 
        racial and ethnic minority groups.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 404. ADVISORY COMMITTEE.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish an advisory committee the provide advice to the 
Secretary on matters related to the development, implementation, and 
evaluation of graduate and continuing education curricula for health 
care professionals to decrease the disparity in health care and health 
outcomes, including curricula on cultural competency as a method of 
eliminating health disparity.
    (b) Membership.--Not later than 3 months after the date on which 
amounts are appropriated to carry out this section, the Secretary of 
Health and Human Services shall appoint the members of the advisory 
committee. Such members shall be appointed from among individuals who--
            (1) are not officers or employees of the Federal 
        Government;
            (2) are experienced in issues relating to health disparity;
            (3) are minorities or representatives of racial and ethnic 
        minority groups; and
            (4) meet such other requirements as the Secretary 
        determines appropriate;
and shall include a representative of the Office of Minority Health 
under section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) 
and such other representatives of offices and agencies of the Public 
Health Service as the Secretary determines to be appropriate. Such 
representatives shall include 1 or more individuals who serve on the 
advisory committee under section 1707(c) of such Act.
    (c) Collaboration.--The advisory committee shall carry out its 
duties under this section in collaboration with the Office of Minority 
Health of the Department of Health and Human Services, and other 
offices centers and institutes of the Department of Health and Human 
Services, and other Federal agencies.
    (d) Termination.--The advisory committee shall terminate on the 
date that is 4 years after the date on which the first member of the 
committee is appointed.
    (e) Existing Committee.--The Secretary may designate an existing 
advisory committee operating under the authority of the Office of 
Minority Health of the Department of Health and Human Services to serve 
as the advisory committee under this section.

SEC. 405. CULTURAL COMPETENCY CLEARINGHOUSE.

    (a) Establishment.--The Director of the Office of Minority Health 
of the Department of Health and Human Services shall establish within 
the Resource Center of the Office of Minority Health, or through the 
awarding of a grant provide for the establishment of, an information 
clearinghouse for curricula to reduce disparity in health care and 
health outcomes. The clearinghouse shall facilitate and enhance, 
through the effective dissemination of information, knowledge and 
understanding of practices that lead to decreases in the disparity of 
health across racial and ethnic minority groups, including curricula 
for continuing medical education to develop cultural competency in 
health care professionals.
    (b) Availability of Information.--Information contained in the 
clearinghouse shall be made available to minority health advocacy 
groups, health education entities described in section 791A(b)(2)(A) of 
the Public Health Service Act (as added by section 401), health 
maintenance organizations, and other interested parties.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

                   TITLE V--MISCELLANEOUS PROVISIONS

SEC. 501. OFFICE FOR CIVIL RIGHTS.

    (a) Public Awareness Campaign.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a national media campaign for the purpose of 
        informing the public of the programs and activities of the 
        Office for Civil Rights, Department of Health and Human 
        Services. The campaign shall--
                    (A) have a specific focus on racial and ethnic 
                minority communities, as well as the general public; 
                and
                    (B) involve racial and ethnic media as participants 
                in the design and conduct of the campaign.
            (2) Authorization of Appropriations.--For the purpose of 
        carrying out paragraph (1), there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 
        2000.
    (b) Ombudsman Demonstration Program.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        carry out a demonstration program under which the Secretary 
        makes grants to States for the purpose of establishing and 
        operating State offices to identify, investigate, and 
        facilitate the resolution of complaints relating to civil 
        rights, and to carry out functions authorized pursuant to 
        paragraph (3) (which office is referred to in this subsection 
        as the ``State Ombudsman Office'').
            (2) Ombudsman.--The Secretary shall require that each State 
        Ombudsman Office under paragraph (1) be headed by an individual 
        with expertise and experience in the field of civil rights and 
        advocacy.
            (3) Certain requirements and authorities.--In carrying out 
        paragraph (1), the Secretary shall consider the requirements 
        and authorities that apply to the operation of State offices 
        under chapter 2 of subtitle A of title VII of the Older 
        Americans Act of 1965 (relating to State Long-Term Care 
        Ombudsman Programs). In providing for State Ombudsman Offices 
        under paragraph (1), the Secretary may establish requirements 
        and authorities with respect to civil rights that are the same 
        as or similar to the requirements and authorities that apply 
        under such chapter 2 with respect to residents of long-term 
        care facilities.
    (c) Funding.--There are authorized to be appropriated for the 
Office for Civil Rights, Department of Health and Human Services, 
$36,000,000 for fiscal year 2000 and each subsequent fiscal year.

SEC. 502. DEVELOPMENT OF STANDARDS; STUDY TO MEASURE PATIENT OUTCOMES 
              UNDER THE MEDICARE AND MEDICAID PROGRAMS BY RACE AND 
              ETHNICITY.

    (a) Development of Standards.--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 Care Financing 
Administration, shall develop outcome measures to evaluate, by race and 
ethnicity, the performance of health care programs and projects that 
provide health care to individuals under the medicare and medicaid 
programs (under titles XVIII and XIX, respectively, of the Social 
Security Act (42 U.S.C. 1395 et seq. and 1396 et seq.).
    (b) Study.--After the Secretary develops the outcome measures under 
subsection (a), the Secretary shall conduct a study that evaluates, by 
race and ethnicity, the performance of health care programs and 
projects referred to in subsection (a).
    (c) Report to Congress.--Not later that 2 years after the date of 
the enactment of this Act, the Secretary of Health and Human Services 
shall submit to Congress a report describing the outcome measures 
developed under subsection (a), and the results of the study conducted 
pursuant to subsection (b).

SEC. 503. DEPARTMENTAL DEFINITION REGARDING MINORITY INDIVIDUALS.

    Section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
300u-6) is amended--
            (1) by striking ``Asian Americans and'' and inserting 
        ``Asian Americans;''; and
            (2) by inserting ``Native Hawaiians and other'' before 
        ``Pacific Islanders;''.

SEC. 504. CONFORMING PROVISION REGARDING DEFINITIONS.

    For purposes of this Act, the term ``racial and ethnic minority 
group'' has the meaning given such term in section 1707 of the Public 
Health Service Act.
                                 <all>