[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1880 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1880

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            November 8, 1999

Mr. Kennedy (for himself, Mr. Akaka, Mr. Inouye, Mrs. Lincoln, and Mr. 
  Wellstone) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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

Sec. 101. Research on minority health.
                 ``Part J--Research on Minority Health

        ``Sec. 499A. Establishment of Center.
        ``Sec. 499B. Advisory Council.
        ``Sec. 499C. Comprehensive plan and budget.
        ``Sec. 499D. Center funding.
        ``Sec. 499E. Centers of excellence for research on health 
                            disparities and training.
        ``Sec. 499F. Loan repayment program for biomedical research.
        ``Sec. 499G. Additional authorities.
        ``Sec. 499H. General provisions regarding the Center.
                      TITLE II--MEDICAL EDUCATION

Sec. 201. Grants for health care education curricula development.
Sec. 202. National Conference on Continuing Health Professional 
                            Education and Disparity in Health Outcomes.
Sec. 203. Advisory Committee.
Sec. 204. Cultural competency clearinghouse.
   TITLE III--MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE 
                          POLICY AND RESEARCH

Sec. 301. Minority health research by the Agency for Health Care Policy 
                            and Research.
        TITLE IV--DATA COLLECTION RELATING TO RACE OR ETHNICITY

Sec. 401. Study and report by National Academy of Sciences.
                       TITLE V--PUBLIC AWARENESS

Sec. 501. Public awareness.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (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 American, Native 
        Americans and Alaskan 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 seventh 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 Alaskan 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 Hispanic 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 field of biomedical, clinical, and health services 
        research.
            (22) In 1990, only 3.3 percent of all United States medical 
        school faculties were underrepresented minority persons.
            (23) Only 1 percent of full professors were 
        underrepresented minority persons in 1990.
            (24) The proportion of underrepresented minorities in high 
        academic ranks, such as professors and associated 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

SEC. 101. RESEARCH ON MINORITY HEALTH.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended by adding at the end the following:

                 ``PART J--RESEARCH ON MINORITY HEALTH

``SEC. 499A. ESTABLISHMENT OF CENTER.

    ``(a) In General.--There is established within the National 
Institutes of Health an organization to be known as the Center for 
Research on Minority Health and Health Disparities (referred to in this 
part as the `Center'). The Center shall be headed by a director, who 
shall be appointed by the Secretary and shall report to the Director of 
the National Institutes of Health.
    ``(b) Task Force.--The Director of the Center shall chair a trans-
NIH task force that is composed of Institute Directors, NIH senior 
staff, and representatives of other public health agencies, that will 
establish a comprehensive plan and budget estimates under section 499C 
for minority health that should be conducted or supported by the 
national research institutes, and shall recommend an agenda for 
conducting and supporting such research.
    ``(c) Duties.--
            ``(1) Interagency coordination of minority health 
        research.--With respect to minority health, the Director of the 
        Center shall facilitate the establishment of, and provide 
        administrative support to, the task force referred to in 
        subsection (b) to plan, coordinate, and evaluate all research 
        conducted at or funded by NIH.
            ``(2) Minority health research information system.--The 
        Director of the Center shall establish a minority health 
        research information system in order to track minority-related 
        research, training, and construction. The system shall capture, 
        for each minority-related research, training, or construction 
        project year-end data.
            ``(3) Consultations.--The Director of the Center shall 
        carry out this part (including developing and revising the plan 
        required in section 499C) in consultation with the Advisory 
        Council established under section 499B, the heads of the 
        agencies of the National Institutes of Health, and the advisory 
councils of such agencies.
            ``(4) Coordination.--The Director of the Center shall act 
        as the primary Federal official with responsibility for 
        monitoring all minority health research conducted or supported 
        by the National Institutes of Health, and--
                    ``(A) 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
                    ``(B) 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.
    ``(d) Innovative Grants.--
            ``(1) In general.--The Director of the Center, in 
        consultation with the Advisory Council, shall identify areas of 
        insufficient minority health research at the Institutes and 
        Centers, and shall provide funds to the Institutes and Centers 
        for the awarding of peer-reviewed grants for innovative 
        projects that address high priority areas of minority health 
        research that are not adequately addressed by other Institutes 
        or Centers.
            ``(2) Exceptional circumstances.--
                    ``(A) In general.--If the Director of the Center 
                determines that the Institutes or Centers are unwilling 
                or unable to award a grant under paragraph (1) for the 
                conduct of a research project identified under such 
                paragraph, the Director, in consultation with the 
                Advisory Council, shall award 1 or more peer reviewed 
                grants to support such research project.
                    ``(B) Limitation.--The total amount of grants 
                awarded under subparagraph (A) for a fiscal year shall 
                not exceed an amount equal to 10 percent of the total 
                final budget for the minority health disparities 
                comprehensive plan for the National Institutes of 
                Health for the fiscal year, or $130,000,000, whichever 
                is greater.
            ``(3) Administration of research proposals.--
                    ``(A) Requests.--The Director of the Center may 
                issue requests for research proposals in areas 
                identified under paragraph (2)(A).
                    ``(B) Delegation.--The Director of the Center may 
                delegate responsibility for the review and management 
                of research proposals under this subsection to another 
                Institute or Center, or to the Center for Scientific 
                Review.
                    ``(C) Final approval.--The Director of the Center 
                may issue a final approval of research awards under 
                paragraph (1) so long as such approval is provided 
                within 30 days of the date on which the award is 
                approved by an Institute or Center.
    ``(e) Definitions.--In this part:
            ``(1) Minority health conditions.--The term `minority 
        health conditions', with respect to individuals who are members 
        of racial, ethnic, and indigenous (including Native Americans, 
        Alaskan Natives, and Native Hawaiians) minority groups, means 
        all diseases, disorders, and conditions (including with respect 
        to mental health)--
                    ``(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
                    ``(C) which have been found to result in health 
                disparities but for which insufficient research has 
                been conducted.
            ``(2) Minority health research.--The term `minority health 
        research' means basic and clinical research on minority health 
        conditions, including research on preventing such conditions.

``SEC. 499B. ADVISORY COUNCIL.

    ``(a) In General.--The Secretary shall establish an advisory 
council (referred to in this part as the `Advisory Council'), pursuant 
to the Federal Advisory Committee Act, for the purpose of providing 
advice to the Director of the Center on carrying out this part.
    ``(b) Composition.--The Advisory Council shall be composed of not 
less than 18, and not more than 24 individuals, who are not officers or 
employees of the Federal Government, to be appointed by the Secretary. 
A majority of the members of the Advisory Council shall be individuals 
with demonstrated expertise regarding minority health issues. The 
Advisory Council shall include representatives of communities impacted 
by racial and ethnic health disparities. The Director of the Center 
shall serve as the chairperson of the Advisory Council.

``SEC. 499C. COMPREHENSIVE PLAN AND BUDGET.

    ``(a) In General.--Subject to this section and other applicable 
law, the Director of the Center (in consultation with the Advisory 
Council) and the members of the Task Force established under section 
499A, in carrying out section 499A, shall--
            ``(1) 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 shall be first established under this subsection not later 
        than 12 months after the date of the enactment of this part), 
        which budget shall be submitted to the Secretary, the Director 
        of the Office of Management and Budget and Congress and 
        included in the annual budget justification for the National 
        Institutes of Health;
            ``(2) ensure that the plan and budget establishes 
        priorities, consistent with sound medical and scientific 
        judgment, among the minority health research activities that 
        such agencies are authorized to carry out;
            ``(3) ensure that the plan and budget establishes 
        objectives regarding such activities, describes the means for 
        achieving the objectives, and designates the date by which the 
        objectives are expected to be achieved;
            ``(4) ensure that all amounts appropriated for such 
        activities are expended in accordance with the plan and budget;
            ``(5) review the plan and budget not less than annually, 
        and coordinate revisions to the plan as appropriate; and
            ``(6) ensure that the plan and budget serve as a broad, 
        binding statement of policies regarding minority health 
        research activities of the agencies, but does not remove the 
        responsibility of the heads of the agencies for the approval of 
        specific programs or projects, grant management, or for other 
        details of the daily administration of such activities, in 
        accordance with the plan and budget.
    ``(b) Certain Components.--With respect to minority health research 
activities of the agencies of the National Institutes of Health, the 
plan and budget shall--
            ``(1) provide for basic research;
            ``(2) provide for clinical research;
            ``(3) provide for research that is conducted by the 
        agencies;
            ``(4) provide for research that is supported by the 
        agencies;
            ``(5) provide for proposals developed pursuant to 
        solicitations by the agencies and for proposals developed 
        independently of such solicitations; and
            ``(6) provide for prevention research, behavioral research 
        and social sciences research.
    ``(c) Approval.--The plan and budget established under this section 
are subject to the approval of the Director of the Center and the 
Director of the National Institutes of Health.
    ``(d) Budget Items for Minority Health.--In the Budget of the 
United States that is submitted to Congress by the President, the 
President shall, with respect to each Institute or agency of the 
National Institutes of Health, include a separate line item account for 
the amount that each such Institute or agency requests for minority 
health activities.

``SEC. 499D. CENTER FUNDING.

    ``For the purpose of carrying out administrative functions related 
to minority health research activities under the plan under sections 
499A, 499B, and 499C, there are authorized to be appropriated 
$100,000,000 for fiscal year 2000, and such sums as may be necessary 
for each of fiscal years 2001 through 2004.

``SEC. 499E. CENTERS OF EXCELLENCE FOR RESEARCH ON HEALTH DISPARITIES 
              AND TRAINING.

    ``(a) In General.--The Secretary, acting through the Director of 
the National Institutes of Health, 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 under-
represented minority individuals.
    ``(b) Required Use of Funds.--
            ``(1) In general.--The Secretary 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--
                    ``(A) to conduct minority health research and 
                research into the nature of health disparities that 
                affect racial, ethnic, and indigenous minorities, the 
                causes of such disparities, and remedies for such 
                disparities;
                    ``(B) to train minorities as professionals in the 
                area of biomedical research;
                    ``(C) 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; or
                    ``(D) to establish or increase an endowment fund in 
                accordance with paragraph (2).
            ``(2) Endowment funds.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), an institution that meets the 
                requirements of subparagraph (B) may utilize not to 
                exceed 35 percent of the amounts received under a grant 
                under subsection (a) to establish or increase an 
                endowment fund at the institution. Amounts used under 
                this subparagraph shall be dedicated exclusively to the 
                support of biomedical research and the associated costs 
                of such research.
                    ``(B) Requirements.--To be eligible to use funds as 
                provided for under subparagraph (A), an institution 
                shall not have a endowment fund that is worth in excess 
                of an amount equal to 50 percent of the national 
                average of all endowment funds at all institutions that 
                are of the same biomedical research discipline.
    ``(c) Centers of Excellence.--
            ``(1) General conditions.--The conditions specified in this 
        paragraph are that a designated biomedical research 
        institution--
                    ``(A) has a significant number of under-represented 
                minority individuals enrolled in the institution, 
                including individuals accepted for enrollment in the 
                institution;
                    ``(B) has been effective in assisting under-
                represented minority students of the institution to 
                complete the program of education and receive the 
                degree involved;
                    ``(C) has been effective in recruiting under-
                represented minority individuals to enroll in and 
                graduate from the institution, including providing 
                scholarships and other financial assistance to such 
                individuals and encouraging under-represented minority 
                students from all levels of the educational pipeline to 
                pursue biomedical research careers; and
                    ``(D) has made significant recruitment efforts to 
                increase the number of under-represented minority 
                individuals serving in faculty or administrative 
                positions at the institution.
            ``(2) 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.
            ``(3) Application of criteria to other programs.--In the 
        case of any criteria established by the Secretary for purposes 
        of determining whether institutions meet the conditions 
        described in paragraph (1), this section may not, with respect 
        to racial, ethnic, and indigenous 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 Secretary and to 
the availability of appropriations for the fiscal year involved to make 
the payments.
    ``(e) Definitions.--In this section:
            ``(1) Minority.--The term `minority' means an individual 
        from a racial or ethnic group that is under-represented in 
        health research.
            ``(2) Program of excellence.--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 Secretary 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 
                Secretary 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. 499F. LOAN REPAYMENT PROGRAM FOR BIOMEDICAL RESEARCH.

    ``(a) In General.--The Secretary, acting through the Director of 
the National Institutes of Health, shall establish a program of 
entering into contracts with qualified health professionals under which 
such health professionals agree to engage in minority health research 
or research into the nature of health disparities that affect racial, 
ethnic, and indigenous populations, 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 
Secretary shall take steps sufficient to ensure the active 
participation of appropriately qualified minority heath professionals, 
including extensive outreach and recruitment efforts. In complying with 
this subsection, the Secretary shall waive the requirement that the 
recipients of loan repayment assistance agree to engage in minority 
health research or research into the nature of health disparities that 
affect racial, ethnic and indigenous populations.
    ``(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 2004.

``SEC. 499G. ADDITIONAL AUTHORITIES.

    ``(a) In General.--In overseeing and supporting minority health 
research, 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 assist in the administration of section 492B 
        with respect to the inclusion of members of minority groups as 
        subjects in clinical research; and
            ``(3) subject to section 405(b)(2) and without regard to 
        section 3324 of title 31, United States Code, and section 3709 
        of the Revised Statutes (41 U.S.C. 5), may enter into such 
        contracts and cooperative agreements with any public agency, or 
        with any person, firm, association, corporation, or educational 
        institution, as may be necessary to expedite and coordinate 
        minority health research.
    ``(b) Report to Congress and the Secretary.--The Director of the 
Center shall each fiscal year prepare and submit to the appropriate 
committees of Congress and the Secretary a report--
            ``(1) describing and evaluating the progress made in such 
        fiscal year in minority health research conducted or supported 
        by the Institutes;
            ``(2) summarizing and analyzing expenditures made in such 
        fiscal year for activities with respect to minority health 
        research conducted or supported by the National Institutes of 
        Health; and
            ``(3) containing such recommendations as the Director 
        considers appropriate.
    ``(c) Projects for Cooperation Among Public and Private Health 
Entities.--In carrying out subsection (a), the Director of the Center 
shall establish projects to promote cooperation among Federal agencies, 
State, local, and regional public health agencies, and private 
entities, in minority health research.

``SEC. 499H. 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) Required Expertise.--The Director of the Center, in 
consultation with the Advisory Council and the Center for Scientific 
Review, shall ensure that scientists with appropriate expertise in 
research on minority health are incorporated into the review, 
oversight, and management processes of all research projects in the 
National Institutes of Health minority health research program and 
other activities under such program.
    ``(c) Technical Assistance.--The Director of the Center, in 
consultation with the directors of the national research institutes and 
centers, shall ensure that appropriate technical assistance is 
available to applicants for all research projects and other activities 
supported by the National Institutes of Health minority health research 
program.
    ``(d) 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.''.

                      TITLE II--MEDICAL EDUCATION

SEC. 201. GRANTS FOR HEALTH CARE EDUCATION CURRICULA 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 PROFESSIONS EDUCATION CURRICULA 
              DEVELOPMENT.

    ``(a) Grants for Graduate Education Curricula Development.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator for 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 
        and faculty development for cultural competency in graduate and 
        undergraduate health professions 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 of 
                osteopathic medicine, school of dentistry, school of 
                public health, school of nursing, school of pharmacy, 
                school of allied health, 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. 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 not to exceed 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 Curricula 
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, contracts or 
        cooperative agreements to eligible entities for the 
        establishment of demonstration 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, 
        contract, or cooperative agreement under paragraph (1) an 
        entity shall--
                    ``(A) be a school of medicine, school of 
                osteopathic medicine, school of dentistry, school of 
                public health, school of nursing, school of pharmacy, 
                school of allied health, 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, contract, or cooperative agreement 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 systemic level.
            ``(4) Number of grants and grant term.--The Secretary shall 
        award not to exceed 20 grants, contracts, or cooperative 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 address issues associated with different 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) 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. 202. 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 health professions 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 201), 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 and health 
professions faculty. 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. 203. ADVISORY COMMITTEE.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish an advisory committee to 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) unless otherwise specified, are not officers or 
        employees of the Federal Government;
            (2) are experienced in issues relating to health disparity; 
        and
            (3) 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. The 
Secretary shall ensure that members of minority communities are well 
represented on the advisory committee. 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. 204. 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 contract provide for the establishment of, an information 
clearinghouse for curricula to reduce racial and ethnic 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 minority and ethnic 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 201), 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 III--MINORITY HEALTH RESEARCH BY THE AGENCY FOR HEALTH CARE 
                          POLICY AND RESEARCH

SEC. 301. 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.''.
    (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 IV--DATA COLLECTION RELATING TO RACE OR ETHNICITY

SEC. 401. STUDY AND REPORT BY NATIONAL ACADEMY OF SCIENCES.

    (a) Study.--The Secretary of Health and Human Services shall enter 
into a contract with the National Academy of Sciences for the conduct 
of 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 and 
        quality of health care and other services and on disparity in 
        health and other social outcomes, the data needed to define 
        appropriate quality of care measures to assess the equivalence 
        of health care outcomes in health care payer systems, 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 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, accurate and complete information relating to 
        race and ethnicity as may be necessary to monitor access to and 
        quality of health care and to ensure the capability to monitor 
        and enforce civil rights laws; 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 V--PUBLIC AWARENESS

SEC. 501. PUBLIC AWARENESS.

    (a) Public Awareness Campaign.--The Secretary of Health and Human 
Services, acting through the Surgeon General and the Director of the 
Office for Civil Rights, shall conduct a national media campaign for 
the purpose of informing the public about racial and ethnic disparities 
in health care and health outcomes.
    (b) Authorization of Appropriations.--For the purpose of carrying 
out subsection (a), there are authorized to be appropriated such sums 
as may be necessary for fiscal year 2000.
                                 <all>