[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2258 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 2258

    To provide for programs and activities to improve the health of 
             Hispanic individuals, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 22, 2003

  Mr. Rodriguez (for himself, Ms. Solis, Mr. Gonzalez, Mr. Baca, Mr. 
 Pastor, Mr. Gutierrez, Mrs. Napolitano, Ms. Roybal-Allard, Mr. Ortiz, 
Mr. Becerra, Mr. Cardoza, Mr. Reyes, Mr. Acevedo-Vila, Mr. Serrano, Ms. 
   Velazquez, Mr. Hinojosa, Ms. Linda T. Sanchez of California, Mr. 
 Menendez, Ms. DeGette, Mr. Pallone, Mrs. Christensen, and Mr. Israel) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To provide for programs and activities to improve the health of 
             Hispanic individuals, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Hispanic Health 
Improvement Act of 2003''.
    (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--HEALTH CARE COVERAGE

     Subtitle A--Coverage for Children, Parents, and Pregnant Women

Sec. 101. Coverage of parents and pregnant women under the medicaid 
                            program and title XXI.
Sec. 102. Automatic enrollment of children born to title XXI parents.
Sec. 103. Optional coverage of children through age 20 under the 
                            medicaid program and title XXI.
Sec. 104. Technical and conforming amendments to authority to pay 
                            medicaid expansion costs from title XXI 
                            appropriation.
Sec. 105. Extension of availability of SCHIP allotments for fiscal 
                            years 1998 through 2001.
 Subtitle B--State Option to Provide Coverage to All Individual Below 
                         100 Percent of Poverty

Sec. 111. State option to offer medicaid coverage based on need.
                  Subtitle C--Outreach and Enrollment

Sec. 121. Grants to promote innovative outreach and enrollment efforts 
                            under SCHIP.
           Subtitle D--Immigrant Children and Pregnant Women

Sec. 131. Optional coverage of legal immigrants under the medicaid 
                            program and SCHIP.
Sec. 132. Permitting States and localities to provide health care to 
                            all individuals.
                 Subtitle E--Eligibility Simplification

Sec. 141. State option to provide for simplified determinations of a 
                            child's financial eligibility for medical 
                            assistance under medicaid or child health 
                            assistance under SCHIP.
Sec. 142. Application of simplified title XXI procedures under the 
                            medicaid program.
                 Subtitle F--SCHIP Wrap-Around Benefits

Sec. 151. State option to provide wrap-around SCHIP coverage to 
                            children who have other health coverage.
            Subtitle G--Immunization Coverage Through SCHIP

Sec. 161. Eligibility of children enrolled in the State children's 
                            health insurance program for the pediatric 
                            vaccine distribution program.
           Subtitle H--Limited English Proficient Communities

Sec. 171. Increased Federal reimbursement for language services under 
                            the medicaid program and the State 
                            children's health insurance program.
    Subtitle I--Binational Public Health Infrastructure and Health 
                               Insurance

Sec. 181. Binational public health infrastructure and health insurance.
           Subtitle J--Migrant Workers and Farmworkers Health

Sec. 191. Demonstration project regarding continuity of coverage of 
                            migrant workers and farmworkers under 
                            medicaid and SCHIP.
                      TITLE II--HEALTH DISPARITIES

   Subtitle A--Report on Programs for Improving the Health Status of 
                          Hispanic Individuals

Sec. 201. Annual report regarding Hispanic health disparities for 
                            chronic and communicable diseases.
         Subtitle B--Diabetes Research, Control, and Prevention

Sec. 211. Treatment.
Sec. 212. Education.
Sec. 213. Health promotion, prevention activities, and access.
  Subtitle C--HIV Prevention Activities Regarding Hispanic Individuals

Sec. 221. Programs of Centers for Disease Control and Prevention; 
                            representation of Hispanic individuals in 
                            membership of community planning groups.
Sec. 222. AIDS education and training centers funded by Health 
                            Resources and Services Administration; 
                            establishment of center directed toward 
                            minority populations with HIV.
          Subtitle D--Prevention of Latina Adolescent Suicides

Sec. 231. Short title.
Sec. 232. Establishment of program for prevention of Latina adolescent 
                            suicides.
          Subtitle E--Cancer Research, Training, and Awareness

Sec. 241. Redes En Accion: the National Hispanic/Latino Cancer Network 
                            and other NCI special populations networks 
                            initiatives targeting cancer; increased 
                            authorization of appropriations for 
                            activities regarding Hispanic individuals.
      Subtitle F--Tuberculosis Control, Prevention, and Treatment

Sec. 251. Advisory Council for the Elimination of Tuberculosis.
Sec. 252. National program for tuberculosis elimination.
Sec. 253. Inclusion of inpatient hospital services for the treatment of 
                            TB-infected individuals.
                  TITLE III--ACCESS AND AFFORDABILITY

                   Subtitle A--Dental Health Services

Sec. 301. Grants to improve the provision of dental health services 
                            through community health centers and public 
                            health departments.
Sec. 302. School-based dental sealant program.
                       Subtitle B--Border Health

Sec. 311. Short title.
Sec. 312. Definitions.
Sec. 313. Border health services grants.
Sec. 314. Border bioterrorism preparedness grants.
Sec. 315. United States-Mexico Border Health Commission Act amendments.
Subtitle C--Patient Navigator, Outreach, and Chronic Disease Prevention

Sec. 321. Short title.
Sec. 322. HRSA grants for model community cancer and chronic disease 
                            care and prevention; HRSA grants for 
                            patient navigators.
Sec. 323. NCI grants for model community cancer and chronic disease 
                            care and prevention; NCI grants for patient 
                            navigators.
Sec. 324. IHS grants for model community cancer and chronic disease 
                            care and prevention; IHS grants for patient 
                            navigators.
           TITLE IV--STRENGTHENING OUR HEALTH CARE WORKFORCE

        Subtitle A--Hispanic-Serving Health Professions Schools

Sec. 401. Hispanic-serving health professions schools.
Subtitle B--Health Career Opportunity Program and Centers of Excellence

Sec. 411. Educational assistance regarding undergraduates.
Sec. 412. Centers of excellence.
               Subtitle C--Bilingual Health Professionals

Sec. 421. Training of bilingual health professionals with respect to 
                            minority health conditions.
                    Subtitle D--Cultural Competence

Sec. 431. Definition.
Sec. 432. Activities of Office of Minority Health; Center for 
                            Linguistic and Cultural Competence in 
                            Health Care.
Sec. 433. Cultural competence demonstration projects.
                      TITLE V--ADDITIONAL PROGRAMS

             Subtitle A--Data Regarding Race and Ethnicity

Sec. 501. Collection of data.
Sec. 502. Development of standards; study to measure patient outcomes 
                            under medicare and medicaid programs.
       Subtitle B--National Assessment of Status of Latino Health

Sec. 511. National assessment of status of Latino health.
                 Subtitle C--Office of Minority Health

Sec. 521. Revision and extension of programs of Office of Minority 
                            Health.
Sec. 522. Establishment of individual Offices of Minority Health within 
                            agencies of Public Health Service.
Sec. 523. Assistant Secretary of Health and Human Services for Civil 
                            Rights.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The uninsured rates of Hispanic adults and children is 
        almost two to three times those for non-Hispanic whites and 
        more than one-third of all Hispanics lack any form of health 
        insurance.
            (2) Hispanics disproportionately suffer from conditions 
        like diabetes, cardiovascular disease, HIV/AIDS, and other 
        illnesses.
            (3) Hispanic communities are underserved and continue to 
        have significantly less access to affordable quality medical 
        care.
            (4) The under-representation of Hispanics in the health 
        professions and the educational pipeline of the health 
        professions affects the current and future delivery of 
        culturally competent and sensitive health care for Hispanics.
            (5) Therefore there is a need for a comprehensive Federal 
        effort to address the unique health needs of the Hispanic 
        community.

                     TITLE I--HEALTH CARE COVERAGE

     Subtitle A--Coverage for Children, Parents, and Pregnant Women

SEC. 101. COVERAGE OF PARENTS AND PREGNANT WOMEN UNDER THE MEDICAID 
              PROGRAM AND TITLE XXI.

    (a) Incentives To Implement Coverage of Parents and Pregnant 
Women.--
            (1) Under medicaid.--
                    (A) Establishment of new optional eligibility 
                category.--Section 1902(a)(10)(A)(ii) of the Social 
                Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 
                amended--
                            (i) by striking ``or'' at the end of 
                        subclause (XVII);
                            (ii) by adding ``or'' at the end of 
                        subclause (XVIII); and
                            (iii) by adding at the end the following:
                                    ``(XIX) who are individuals 
                                described in subsection (k)(1) 
                                (relating to parents of categorically 
                                eligible children);''.
                    (B) Parents described.--Section 1902 of the Social 
                Security Act is further amended by inserting after 
                subsection (j) the following:
    ``(k)(1)(A) Individuals described in this paragraph are 
individuals--
            ``(i) who are the parents of an individual who is under 19 
        years of age (or such higher age as the State may have elected 
        under section 1902(l)(1)(D)) and who is eligible for medical 
        assistance under subsection (a)(10)(A);
            ``(ii) who are not otherwise eligible for medical 
        assistance under such subsection or under a waiver approved 
        under section 1115 or otherwise (except under section 1931 or 
        under subsection (a)(10)(A)(ii)(XIX)); and
            ``(iii) whose family income exceeds the effective income 
        level or resource level applicable under the State plan under 
        part A of title IV as in effect as of July 16, 1996, but does 
        not exceed the highest effective income level applicable to a 
        child in the family under this title.
    ``(B) In establishing an income eligibility level for individuals 
described in this paragraph, a State may vary such level consistent 
with the various income levels established under subsection (l)(2) 
based on the ages of children described in subsection (l)(1) in order 
to ensure, to the maximum extent possible, that such individuals shall 
be enrolled in the same program as their children.
    ``(C) An individual may not be treated as being described in this 
paragraph unless, at the time of the individual's enrollment under this 
title, the child referred to in subparagraph (A)(i) of the individual 
is also enrolled under this title.
    ``(D) In this subsection, the term `parent' has the meaning given 
the term `caretaker relative' for purposes of carrying out section 
1931.
    ``(2) In the case of a parent described in paragraph (1) who is 
also the parent of a child who is eligible for child health assistance 
under title XXI, the State may elect (on a uniform basis) to cover all 
such parents under section 2111 or under this title.''.
                    (C) Enhanced matching funds available if certain 
                conditions met.--Section 1905 of the Social Security 
                Act (42 U.S.C. 1396d) is amended--
                            (i) in the fourth sentence of subsection 
                        (b), by striking ``or subsection (u)(3)'' and 
                        inserting ``, (u)(3), or (u)(4)''; and
                            (ii) in subsection (u)--
                                    (I) by redesignating paragraph (4) 
                                as paragraph (6), and
                                    (II) by inserting after paragraph 
                                (3) the following:
    ``(4) For purposes of subsection (b) and section 2105(a)(1):
            ``(A) Parents and pregnant women.--The expenditures 
        described in this subparagraph are the expenditures described 
        in the following clauses (i) and (ii):
                    ``(i) Parents.--If the conditions described in 
                clause (iii) are met, expenditures for medical 
                assistance for parents described in section 1902(k)(1) 
                and for parents who would be described in such section 
                but for the fact that they are eligible for medical 
                assistance under section 1931 or under a waiver 
                approved under section 1115.
                    ``(ii) Certain pregnant women.--If the conditions 
                described in clause (iv) are met, expenditures for 
                medical assistance for pregnant women described in 
                subsection (n) or under section 1902(l)(1)(A) in a 
                family the income of which exceeds the effective income 
                level applicable under subsection (a)(10)(A)(i)(III) or 
                (l)(2)(A) of section 1902 to a family of the size 
                involved as of January 1, 2003.
                    ``(iii) Conditions for expenditures for parents.--
                The conditions described in this clause are the 
                following:
                            ``(I) The State has a State child health 
                        plan under title XXI which (whether implemented 
                        under such title or under this title) has an 
                        effective income level for children that is at 
                        least 200 percent of the poverty line.
                            ``(II) State child health plan does not 
                        limit the acceptance of applications, does not 
                        use a waiting list for children who meet 
                        eligibility standards to qualify for 
                        assistance, and provides benefits to all 
                        children in the State who apply for and meet 
                        eligibility standards.
                            ``(III) The State plans under this title 
                        and title XXI do not provide coverage for 
                        parents with higher family income without 
                        covering parents with a lower family income.
                            ``(IV) The State does not apply an income 
                        level for parents that is lower than the 
                        effective income level (expressed as a percent 
                        of the poverty line) that has been specified 
                        under the State plan under title XIX (including 
                        under a waiver authorized by the Secretary or 
                        under section 1902(r)(2)), as of January 1, 
                        2003, to be eligible for medical assistance as 
                        a parent under this title.
                    ``(iv) Conditions for expenditures for certain 
                pregnant women.--The conditions described in this 
                clause are the following:
                            ``(I) The State plans under this title and 
                        title XXI do not provide coverage for pregnant 
                        women described in subparagraph (A)(ii) with 
                        higher family income without covering such 
                        pregnant women with a lower family income.
                            ``(II) The State does not apply an income 
                        level for pregnant women that is lower than the 
                        effective income level (expressed as a percent 
                        of the poverty line and considering applicable 
                        income disregards) that has been specified 
                        under the State plan under subsection 
                        (a)(10)(A)(i)(III) or (l)(2)(A) of section 
                        1902, as of January 1, 2003, to be eligible for 
                        medical assistance as a pregnant woman.
                            ``(III) The State satisfies the conditions 
                        described in subclauses (I) and (II) of clause 
                        (iii).
                    ``(v) Definitions.--For purposes of this 
                subsection:
                            ``(I) The term `parent' has the meaning 
                        given such term for purposes of section 
                        1902(k)(1).
                            ``(II) The term `poverty line' has the 
                        meaning given such term in section 
                        2110(c)(5).''.
                    (D) Appropriation from title xxi allotment for 
                medicaid expansion costs for parents; elimination of 
                counting medicaid child presumptive eligibility costs 
                against title xxi allotment.--Subparagraph (B) of 
                section 2105(a)(1) of the Social Security Act, as 
                amended by section 104(a), is amended to read as 
                follows:
                    ``(B) Parents and pregnant women.--Expenditures for 
                medical assistance that are attributable to 
                expenditures described in section 1905(u)(4)(A).''.
                    (E) Only counting enhanced portion for coverage of 
                additional pregnant women.--Section 1905 of the Social 
                Security Act (42 U.S.C. 1396d) is amended--
                            (i) in the fourth sentence of subsection 
                        (b), by inserting ``(except in the case of 
                        expenditures described in subsection (u)(5))'' 
                        after ``do not exceed'';
                            (ii) in subsection (u), by inserting after 
                        paragraph (4) (as inserted by subparagraph 
                        (C)), the following:
    ``(5) For purposes of the fourth sentence of subsection (b) and 
section 2105(a), the following payments under this title do not count 
against a State's allotment under section 2104:
            ``(A) Regular fmap for expenditures for pregnant women with 
        income above january 1, 2003 income level.--The portion of the 
        payments made for expenditures described in paragraph 
        (4)(A)(ii) that represents the amount that would have been paid 
        if the enhanced FMAP had not been substituted for the Federal 
        medical assistance percentage.''.
            (2) Under title xxi.--
                    (A) Parents and pregnant women coverage.--Title XXI 
                of the Social Security Act (42 U.S.C. 1397aa et seq.) 
                is amended by adding at the end the following:

``SEC. 2111. OPTIONAL COVERAGE OF PARENTS OF TARGETED LOW-INCOME 
              CHILDREN OR TARGETED LOW-INCOME PREGNANT WOMEN.

    ``(a) Optional Coverage.--Notwithstanding any other provision of 
this title, a State may provide for coverage, through an amendment to 
its State child health plan under section 2102, of parent health 
assistance for targeted low-income parents, pregnancy-related 
assistance for targeted low-income pregnant women, or both, in 
accordance with this section, but only if--
            ``(1) with respect to the provision of parent health 
        assistance, the State meets the conditions described in clause 
        (iii) of section 1905(u)(4)(A);
            ``(2) with respect to the provision of pregnancy-related 
        assistance, the State meets the conditions described in clause 
        (iv) of section 1905(u)(4)(A); and
            ``(3) in the case of parent health assistance for targeted 
        low-income parents, the State elects to provide medical 
        assistance under section 1902(a)(10)(A)(ii)(XIX), under section 
        1931, or under a waiver under section 1115 to individuals 
described in section 1902(k)(1)(A)(i) and elects an effective income 
level that, consistent with paragraphs (1)(B) and (2) of section 
1902(k), ensures to the maximum extent possible, that such individuals 
shall be enrolled in the same program as their children if their 
children are eligible for coverage under title XIX (including under a 
waiver authorized by the Secretary or under section 1902(r)(2)).''.
    ``(b) Definitions.--For purposes of this title:
            ``(1) Parent health assistance.--The term `parent health 
        assistance' has the meaning given the term child health 
        assistance in section 2110(a) as if any reference to targeted 
        low-income children were a reference to targeted low-income 
        parents.
            ``(2) Parent.--The term `parent' has the meaning given the 
        term `caretaker relative' for purposes of carrying out section 
        1931.
            ``(3) Pregnancy-related assistance.--The term `pregnancy-
        related assistance' has the meaning given the term child health 
        assistance in section 2110(a) as if any reference to targeted 
        low-income children were a reference to targeted low-income 
        pregnant women, except that the assistance shall be limited to 
        services related to pregnancy (which include prenatal, 
        delivery, and postpartum services and services described in 
        section 1905(a)(4)(C)) and to other conditions that may 
        complicate pregnancy.
            ``(4) Targeted low-income parent.--The term `targeted low-
        income parent' has the meaning given the term targeted low-
        income child in section 2110(b) as if the reference to a child 
        were deemed a reference to a parent (as defined in paragraph 
        (3)) of the child; except that in applying such section--
                    ``(A) there shall be substituted for the income 
                level described in paragraph (1)(B)(ii)(I) the 
                applicable income level in effect for a targeted low-
                income child;
                    ``(B) in paragraph (3), January 1, 2003, shall be 
                substituted for July 1, 1997; and
                    ``(C) in paragraph (4), January 1, 2003, shall be 
                substituted for March 31, 1997.
            ``(5) Targeted low-income pregnant woman.--The term 
        `targeted low-income pregnant woman' has the meaning given the 
        term targeted low-income child in section 2110(b) as if any 
        reference to a child were a reference to a woman during 
        pregnancy and through the end of the month in which the 60-day 
        period beginning on the last day of her pregnancy ends; except 
        that in applying such section--
                    ``(A) there shall be substituted for the income 
                level described in paragraph (1)(B)(ii)(I) the 
                applicable income level in effect for a targeted low-
                income child;
                    ``(B) in paragraph (3), January 1, 2003, shall be 
                substituted for July 1, 1997; and
                    ``(C) in paragraph (4), January 1, 2003, shall be 
                substituted for March 31, 1997.
            ``(6) Parent.--The term `parent' has the meaning given the 
        term `caretaker relative' for purposes of carrying out section 
        1931.
    ``(c) References to Terms and Special Rules.--In the case of, and 
with respect to, a State providing for coverage of parent health 
assistance to targeted low-income parents or pregnancy-related 
assistance to targeted low-income pregnant women under subsection (a), 
the following special rules apply:
            ``(1) Any reference in this title (other than in subsection 
        (b)) to a targeted low-income child is deemed to include a 
        reference to a targeted low-income parent or a targeted low-
        income pregnant woman (as applicable).
            ``(2) Any such reference to child health assistance--
                    ``(A) with respect to such parents is deemed a 
                reference to parent health assistance; and
                    ``(B) with respect to such pregnant women, is 
                deemed a reference to pregnancy-related assistance.
            ``(3) In applying section 2103(e)(3)(B) in the case of a 
        family or pregnant woman provided coverage under this section, 
        the limitation on total annual aggregate cost-sharing shall be 
        applied to the entire family or such pregnant woman.
            ``(4) In applying section 2110(b)(4), any reference to 
        `section 1902(l)(2) or 1905(n)(2) (as selected by a State)' is 
        deemed a reference to the effective income level applicable to 
        parents under section 1931 or under a waiver approved under 
        section 1115, or, in the case of a pregnant woman, the income 
        level established under section 1902(l)(2)(A).
            ``(5) In applying section 2102(b)(3)(B), any reference to 
        children found through screening to be eligible for medical 
        assistance under the State medicaid plan under title XIX is 
        deemed a reference to parents and pregnant women.''.
                    (B) Additional allotment for states providing 
                coverage of parents or pregnant women.--
                            (i) In general.--Section 2104 of the Social 
                        Security Act (42 U.S.C. 1397dd) is amended by 
                        inserting after subsection (c) the following:
    ``(d) Additional Allotments for State Coverage of Parents or 
Pregnant Women.--
            ``(1) Appropriation; total allotment.--For the purpose of 
        providing additional allotments to States under this title, 
        there is appropriated, out of any money in the Treasury not 
        otherwise appropriated--
                    ``(A) for fiscal year 2004, $3,000,000,000;
                    ``(B) for fiscal year 2005, $3,000,000,000; and
                    ``(C) for fiscal year 2006, $4,000,000,000;
                    ``(D) for fiscal year 2007, $5,000,000,000.
            ``(2) State and territorial allotments.--
                    ``(A) In general.--In addition to the allotments 
                provided under subsections (b) and (c), subject to 
                paragraphs (3) and (4), of the amount available for the 
                additional allotments under paragraph (1) for a fiscal 
                year, the Secretary shall allot to each State with a 
                State child health plan approved under this title--
                            ``(i) in the case of such a State other 
                        than a commonwealth or territory described in 
                        subparagraph (B), the same proportion as the 
                        proportion of the State's allotment under 
                        subsection (b) (determined without regard to 
                        subsection (f)) to the total amount of the 
                        allotments under subsection (b) for such States 
                        eligible for an allotment under this paragraph 
                        for such fiscal year; and
                            ``(ii) in the case of a commonwealth or 
                        territory described in subsection (c)(3), the 
                        same proportion as the proportion of the 
                        commonwealth's or territory's allotment under 
                        subsection (c) (determined without regard to 
                        subsection (f)) to the total amount of the 
                        allotments under subsection (c) for 
                        commonwealths and territories eligible for an 
                        allotment under this paragraph for such fiscal 
                        year.
                    ``(B) Availability and redistribution of unused 
                allotments.--In applying subsections (e) and (f) with 
                respect to additional allotments made available under 
                this subsection, the procedures established under such 
                subsections shall ensure such additional allotments are 
                only made available to States which have elected to 
                provide coverage under section 2111.
            ``(3) Use of additional allotment.--Additional allotments 
        provided under this subsection are not available for amounts 
        expended before October 1, 2003. Such amounts are available for 
        amounts expended on or after such date for child health 
        assistance for targeted low-income children, as well as for 
        parent health assistance for targeted low-income parents, and 
        pregnancy-related assistance for targeted low-income pregnant 
        women.
            ``(4) Requiring election to provide coverage.--No payments 
        may be made to a State under this title from an allotment 
        provided under this subsection unless the State has made an 
        election to provide parent health assistance for targeted low-
        income parents, or pregnancy-related assistance for targeted 
        low-income pregnant women.''.
                            (ii) Conforming amendments.--Section 2104 
                        of the Social Security Act (42 U.S.C. 1397dd) 
                        is amended--
                                    (I) in subsection (a), by inserting 
                                ``subject to subsection (d),'' after 
                                ``under this section,'';
                                    (II) in subsection (b)(1), by 
                                inserting ``and subsection (d)'' after 
                                ``Subject to paragraph (4)''; and
                                    (III) in subsection (c)(1), by 
                                inserting ``subject to subsection 
                                (d),'' after ``for a fiscal year,''.
                    (C) No cost-sharing for pregnancy-related 
                benefits.--Section 2103(e)(2) of the Social Security 
                Act (42 U.S.C. 1397cc(e)(2)) is amended--
                            (i) in the heading, by inserting ``and 
                        pregnancy-related services'' after ``preventive 
                        services''; and
                            (ii) by inserting before the period at the 
                        end the following: ``and for pregnancy-related 
                        services''.
    (b) Optional Application of Presumptive Eligibility Provisions to 
Parents.--Section 1920A of the Social Security Act (42 U.S.C. 1396r-1a) 
is amended by adding at the end the following:
    ``(e) A State may elect to apply the previous provisions of this 
section to provide for a period of presumptive eligibility for medical 
assistance for a parent (as defined for purposes of section 1902(k)(1)) 
of a child with respect to whom such a period is provided under this 
section.''.
    (c) Conforming Amendments.--
            (1) Eligibility categories.--Section 1905(a) of the Social 
        Security Act (42 U.S.C. 1396d(a)) is amended, in the matter 
        before paragraph (1)--
                    (A) by striking ``or'' at the end of clause (xii);
                    (B) by inserting ``or'' at the end of clause 
                (xiii); and
                    (C) by inserting after clause (xiii) the following:
            ``(xiv) who are parents described (or treated as if 
        described) in section 1902(k)(1),''.
            (2) Income limitations.--Section 1903(f)(4) of the Social 
        Security Act (42 U.S.C. 1396b(f)(4)) is amended by inserting 
        ``1902(a)(10)(A)(ii)(XIX),'' after 
        ``1902(a)(10)(A)(ii)(XVIII),''.
            (3) Conforming amendment relating to no waiting period for 
        pregnant women.--Section 2102(b)(1)(B) of the Social Security 
        Act (42 U.S.C. 1397bb(b)(1)(B)) is amended--
                    (A) by striking ``, and'' at the end of clause (i) 
                and inserting a semicolon;
                    (B) by striking the period at the end of clause 
                (ii) and inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(iii) may not apply a waiting period 
                        (including a waiting period to carry out 
                        paragraph (3)(C)) in the case of a targeted 
                        low-income parent who is pregnant.''.
    (d) Exemption for Puerto Rico.--Section 1108(g) of the Social 
Security Act (42 U.S.C. 1308(g)) is amended by adding at the end the 
following:
            ``(3) Certain payments disregarded.--Paragraph (2) shall be 
        applied without regard to any payments made under sections 
        1902(a)(10)(A)(ii)(XIX) and 1903(v).''.
    (e) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, without regard to whether regulations 
implementing such amendments have been issued.

SEC. 102. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.

    (a) Title XXI.--Section 2102(b)(1) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)) is amended by adding at the end the following:
                    ``(C) Automatic eligibility of children born to 
                pregnant women.--Such eligibility standards shall 
                provide for automatic coverage of a child born to an 
                individual who is provided assistance under this title 
                in the same manner as medical assistance would be 
                provided under section 1902(e)(4) to a child described 
                in such section.''.
    (b) Conforming Amendment to Medicaid.--Section 1902(e)(4) of the 
Social Security Act (42 U.S.C. 1396a(e)(4)) is amended in the first 
sentence by striking ``so long as the child is a member of the woman's 
household and the woman remains (or would remain if pregnant) eligible 
for such assistance''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, without regard to whether regulations 
implementing such amendments have been issued.

SEC. 103. OPTIONAL COVERAGE OF CHILDREN THROUGH AGE 20 UNDER THE 
              MEDICAID PROGRAM AND TITLE XXI.

    (a) Medicaid.--
            (1) In general.--Section 1902(l)(1)(D) of the Social 
        Security Act (42 U.S.C. 1396a(l)(1)(D)) is amended by inserting 
        ``(or, at the election of a State, 20 or 21 years of age)'' 
        after ``19 years of age''.
            (2) Conforming amendments.--
                    (A) Section 1902(e)(3)(A) of the Social Security 
                Act (42 U.S.C. 1396a(e)(3)(A)) is amended by inserting 
                ``(or 1 year less than the age the State has elected 
                under subsection (l)(1)(D))'' after ``18 years of 
                age''.
                    (B) Section 1902(e)(12) of the Social Security Act 
                (42 U.S.C. 1396a(e)(12)) is amended by inserting ``or 
                such higher age as the State has elected under 
                subsection (l)(1)(D)'' after ``19 years of age''.
                    (C) Section 1920A(b)(1) of the Social Security Act 
                (42 U.S.C. 1396r-1a(b)(1)) is amended by inserting ``or 
                such higher age as the State has elected under section 
                1902(l)(1)(D)'' after ``19 years of age''.
                    (D) Section 1928(h)(1) of the Social Security Act 
                (42 U.S.C. 1396s(h)(1)) is amended by inserting ``or 1 
                year less than the age the State has elected under 
                section 1902(l)(1)(D)'' before the period at the end.
                    (E) Section 1932(a)(2)(A) of the Social Security 
                Act (42 U.S.C. 1396u-2(a)(2)(A)) is amended by 
inserting ``(or such higher age as the State has elected under section 
1902(l)(1)(D))'' after ``19 years of age''.
    (b) Title XXI.--Section 2110(c)(1) of the Social Security Act (42 
U.S.C. 1397jj(c)(1)) is amended by inserting ``(or such higher age as 
the State has elected under section 1902(l)(1)(D))''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, without regard to whether regulations 
implementing such amendments have been issued.

SEC. 104. TECHNICAL AND CONFORMING AMENDMENTS TO AUTHORITY TO PAY 
              MEDICAID EXPANSION COSTS FROM TITLE XXI APPROPRIATION.

    (a) Authority To Pay Medicaid Expansion Costs From Title XXI 
Appropriation.--Section 2105(a) of the Social Security Act (42 U.S.C. 
1397ee(a)) is amended to read as follows:
    ``(a) Allowable Expenditures.--
            ``(1) In general.--Subject to the succeeding provisions of 
        this section, the Secretary shall pay to each State with a plan 
        approved under this title, from its allotment under section 
        2104, an amount for each quarter equal to the enhanced FMAP of 
        the following expenditures in the quarter:
                    ``(A) Child health assistance under medicaid.--
                Expenditures for child health assistance under the plan 
                for targeted low-income children in the form of 
                providing medical assistance for expenditures described 
                in the fourth sentence of section 1905(b).
                    ``(B) Reserved.--[reserved].
                    ``(C) Child health assistance under this title.--
                Expenditures for child health assistance under the plan 
                for targeted low-income children in the form of 
                providing health benefits coverage that meets the 
                requirements of section 2103.
                    ``(D) Assistance and administrative expenditures 
                subject to limit.--Expenditures only to the extent 
                permitted consistent with subsection (c)--
                            ``(i) for other child health assistance for 
                        targeted low-income children;
                            ``(ii) for expenditures for health services 
                        initiatives under the plan for improving the 
                        health of children (including targeted low-
                        income children and other low-income children);
                            ``(iii) for expenditures for outreach 
                        activities as provided in section 2102(c)(1) 
                        under the plan; and
                            ``(iv) for other reasonable costs incurred 
                        by the State to administer the plan.
            ``(2) Order of payments.--Payments under a subparagraph of 
        paragraph (1) from a State's allotment for expenditures 
        described in each such subparagraph shall be made on a 
        quarterly basis in the order of such subparagraph in such 
        paragraph.
            ``(3) No duplicative payment.--In the case of expenditures 
        for which payment is made under paragraph (1), no payment shall 
        be made under title XIX.''.
    (b) Conforming Amendments.--
            (1) Section 1905(u).--Section 1905(u)(1)(B) of the Social 
        Security Act (42 U.S.C. 1396d(u)(1)(B)) is amended by inserting 
        ``and section 2105(a)(1)'' after ``subsection (b)''.
            (2) Section 2105(c).--Section 2105(c)(2)(A) of the Social 
        Security Act (42 U.S.C. 1397ee(c)(2)(A)) is amended by striking 
        ``subparagraphs (A), (C), and (D) of''.
    (c) Effective Date.--The amendments made by this section shall be 
effective as if included in the enactment of the Balanced Budget Act of 
1997 (Public Law 105-33; 111 Stat. 251), whether or not regulations 
implementing such amendments have been issued.

SEC. 105. EXTENSION OF AVAILABILITY OF SCHIP ALLOTMENTS FOR FISCAL 
              YEARS 1998 THROUGH 2001.

    (a) Extending Availability of SCHIP Allotments for Fiscal Years 
1998 Through 2001.--
            (1) Retained and redistributed allotments for fiscal years 
        1998 and 1999.--Paragraphs (2)(A)(i) and (2)(A)(ii) of section 
        2104(g) of the Social Security Act (42 U.S.C. 1397dd(g)) are 
        each amended by striking ``fiscal year 2002'' and inserting 
        ``fiscal year 2004''.
            (2) Extension and revision of retained and redistributed 
        allotments for fiscal year 2000.--
                    (A) Permitting and extending retention of portion 
                of fiscal year 2000 allotment.--Paragraph (2) of such 
                section 2104(g) is amended--
                            (i) in the heading, by striking ``and 
                        1999'' and inserting ``through 2000''; and
                            (ii) by adding at the end of subparagraph 
                        (A) the following:
                            ``(iii) Fiscal year 2000 allotment.--Of the 
                        amounts allotted to a State pursuant to this 
                        section for fiscal year 2000 that were not 
                        expended by the State by the end of fiscal year 
                        2002, 50 percent of that amount shall remain 
                        available for expenditure by the State through 
                        the end of fiscal year 2004.''.
                    (B) Redistributed allotments.--Paragraph (1) of 
                such section 2104(g) is amended--
                            (i) in subparagraph (A), by inserting ``or 
                        for fiscal year 2000 by the end of fiscal year 
                        2002,'' after ``fiscal year 2001,'';
                            (ii) in subparagraph (A), by striking 
                        ``1998 or 1999'' and inserting ``1998, 1999, or 
                        2000'';
                            (iii) in subparagraph (A)(i)--
                                    (I) by striking ``or'' at the end 
                                of subclause (I),
                                    (II) by striking the period at the 
                                end of subclause (II) and inserting ``; 
                                or''; and
                                    (III) by adding at the end the 
                                following new subclause:
                                    ``(III) the fiscal year 2000 
                                allotment, the amount specified in 
                                subparagraph (C)(i) (less the total of 
                                the amounts under clause (ii) for such 
                                fiscal year), multiplied by the ratio 
                                of the amount specified in subparagraph 
                                (C)(ii) for the State to the amount 
                                specified in subparagraph (C)(iii).'';
                            (iv) in subparagraph (A)(ii), by striking 
                        ``or 1999'' and inserting ``, 1999, or 2000'';
                            (v) in subparagraph (B), by striking ``with 
                        respect to fiscal year 1998 or 1999'';
                            (vi) in subparagraph (B)(ii)--
                                    (I) by inserting ``with respect to 
                                fiscal year 1998, 1999, or 2000,'' 
                                after ``subsection (e),''; and
                                    (II) by striking ``2002'' and 
                                inserting ``2004''; and
                            (vii) by adding at the end the following 
                        new subparagraph:
                    ``(C) Amounts used in computing redistributions for 
                fiscal year 2000.--For purposes of subparagraph 
                (A)(i)(III)--
                            ``(i) the amount specified in this clause 
                        is the amount specified in paragraph 
                        (2)(B)(i)(I) for fiscal year 2000, less the 
                        total amount remaining available pursuant to 
                        paragraph (2)(A)(iii);
                            ``(ii) the amount specified in this clause 
                        for a State is the amount by which the State's 
                        expenditures under this title in fiscal years 
                        2000, 2001, and 2002 exceed the State's 
                        allotment for fiscal year 2000 under subsection 
                        (b); and
                            ``(iii) the amount specified in this clause 
                        is the sum, for all States entitled to a 
                        redistribution under subparagraph (A) from the 
                        allotments for fiscal year 2000, of the amounts 
                        specified in clause (ii).''.
                    (C) Conforming amendments.--Such section 2104(g) is 
                further amended--
                            (i) in its heading, by striking ``and 
                        1999'' and inserting ``, 1999, and 2000''; and
                            (ii) in paragraph (3)--
                                    (I) by striking ``or fiscal year 
                                1999'' and inserting ``, fiscal year 
                                1999, or fiscal year 2000''; and
                                    (II) by striking ``or November 30, 
                                2001'' and inserting ``November 30, 
                                2001, or November 30, 2002'', 
                                respectively.
            (3) Extension and revision of retained and redistributed 
        allotments for fiscal year 2001.--
                    (A) Permitting and extending retention of portion 
                of fiscal year 2001 allotment.--Paragraph (2) of such 
                section 2104(g), as amended in paragraph (2)(A)(ii), is 
                further amended--
                            (i) in the heading, by striking ``2000'' 
                        and inserting ``2001''; and
                            (ii) by adding at the end of subparagraph 
                        (A) the following:
                            ``(iv) Fiscal year 2001 allotment.--Of the 
                        amounts allotted to a State pursuant to this 
                        section for fiscal year 2001 that were not 
                        expended by the State by the end of fiscal year 
                        2003, 50 percent of that amount shall remain 
                        available for expenditure by the State through 
                        the end of fiscal year 2005.''.
                    (B) Redistributed allotments.--Paragraph (1) of 
                such section 2104(g), as amended in paragraph (2)(B), 
                is further amended--
                            (i) in subparagraph (A), by inserting ``or 
                        for fiscal year 2001 by the end of fiscal year 
                        2003,'' after ``fiscal year 2002,'';
                            (ii) in subparagraph (A), by striking 
                        ``1999, or 2000'' and inserting ``1999, 2000, 
                        or 2001'';
                            (iii) in subparagraph (A)(i)--
                                    (I) by striking ``or'' at the end 
                                of subclause (II),
                                    (II) by striking the period at the 
                                end of subclause (III) and inserting 
                                ``; or''; and
                                    (III) by adding at the end the 
                                following new subclause:
                                    ``(IV) the fiscal year 2001 
                                allotment, the amount specified in 
                                subparagraph (D)(i) (less the total of 
                                the amounts under clause (ii) for such 
                                fiscal year), multiplied by the ratio 
                                of the amount specified in subparagraph 
                                (D)(ii) for the State to the amount 
                                specified in subparagraph (D)(iii).'';
                            (iv) in subparagraph (A)(ii), by striking 
                        ``or 2000'' and inserting ``2000, or 2001'';
                            (v) in subparagraph (B)--
                                    (I) by striking ``and'' at the end 
                                of clause (ii);
                                    (II) by redesignating clause (iii) 
                                as clause (iv); and
                                    (III) by inserting after clause 
                                (ii) the following new clause:
                            ``(iii) notwithstanding subsection (e), 
                        with respect to fiscal year 2001, shall remain 
                        available for expenditure by the State through 
                        the end of fiscal year 2005; and''; and
                            (vi) by adding at the end the following new 
                        subparagraph:
                    ``(D) Amounts used in computing redistributions for 
                fiscal year 2001.--For purposes of subparagraph 
                (A)(i)(IV)--
                            ``(i) the amount specified in this clause 
                        is the amount specified in paragraph 
                        (2)(B)(i)(I) for fiscal year 2001, less the 
                        total amount remaining available pursuant to 
                        paragraph (2)(A)(iv);
                            ``(ii) the amount specified in this clause 
                        for a State is the amount by which the State's 
                        expenditures under this title in fiscal years 
                        2001, 2002, and 2003 exceed the State's 
                        allotment for fiscal year 2001 under subsection 
                        (b); and
                            ``(iii) the amount specified in this clause 
                        is the sum, for all States entitled to a 
                        redistribution under subparagraph (A) from the 
                        allotments for fiscal year 2001, of the amounts 
                        specified in clause (ii).''.
                    (C) Conforming amendments.--Such section 2104(g) is 
                further amended--
                            (i) in its heading, by striking ``and 
                        2000'' and inserting ``2000, and 2001''; and
                            (ii) in paragraph (3)--
                                    (I) by striking ``or fiscal year 
                                2000'' and inserting ``fiscal year 
                                2000, or fiscal year 2001''; and
                                    (II) by striking ``or November 30, 
                                2002,'' and inserting ``November 30, 
                                2002, or November 30, 2003,'', 
                                respectively.
            (4) Effective date.--This subsection, and the amendments 
        made by this subsection, shall be effective as if this 
        subsection had been enacted on September 30, 2002, and amounts 
        under title XXI of the Social Security Act (42 U.S.C. 1397aa et 
        seq.) from allotments for fiscal years 1998 through 2000 are 
        available for expenditure on and after October 1, 2002, under 
        the amendments made by this subsection as if this subsection 
        had been enacted on September 30, 2002.
    (b) Authority for Qualifying States To Use Portion of SCHIP Funds 
for Medicaid Expenditures.--Section 2105 of the Social Security Act (42 
U.S.C. 1397ee) is amended by adding at the end the following:
    ``(g) Authority for Qualifying States To Use Certain Funds for 
Medicaid Expenditures.--
            ``(1) State option.--
                    ``(A) In general.--Notwithstanding any other 
                provision of law, with respect to allotments for fiscal 
                years 1998, 1999, 2000, 2001, for fiscal years in which 
                such allotments are available under subsections (e) and 
                (g) of section 2104, a qualifying State (as defined in 
                paragraph (2)) may elect to use not more than 20 
percent of such allotments (instead of for expenditures under this 
title) for payments for such fiscal year under title XIX in accordance 
with subparagraph (B).
                    ``(B) Payments to states.--
                            ``(i) In general.--In the case of a 
                        qualifying State that has elected the option 
                        described in subparagraph (A), subject to the 
                        total amount of funds described with respect to 
                        the State in subparagraph (A), the Secretary 
                        shall pay the State an amount each quarter 
                        equal to the additional amount that would have 
                        been paid to the State under title XIX for 
                        expenditures of the State for the fiscal year 
                        described in clause (ii) if the enhanced FMAP 
                        (as determined under subsection (b)) had been 
                        substituted for the Federal medical assistance 
                        percentage (as defined in section 1905(b)) of 
                        such expenditures.
                            ``(ii) Expenditures described.--For 
                        purposes of clause (i), the expenditures 
                        described in this clause are expenditures for 
                        such fiscal years for providing medical 
                        assistance under title XIX to individuals who 
                        have not attained age 19 and whose family 
                        income exceeds 150 percent of the poverty line.
                            ``(iii) No impact on determination of 
                        budget neutrality for waivers.--In the case of 
                        a qualifying State that uses amounts paid under 
                        this subsection for expenditures described in 
                        clause (ii) that are incurred under a waiver 
                        approved for the State, any budget neutrality 
                        determinations with respect to such waiver 
                        shall be determined without regard to such 
                        amounts paid.
            ``(2) Qualifying state.--In this subsection, the term 
        `qualifying State' means a State that--
                    ``(A) as of April 15, 1997, has an income 
                eligibility standard with respect to any 1 or more 
                categories of children (other than infants) who are 
                eligible for medical assistance under section 
                1902(a)(10)(A) or under a waiver under section 1115 
                implemented on January 1, 1994, that is up to 185 
                percent of the poverty line or above; and
                    ``(B) satisfies the requirements described in 
                paragraph (3).
            ``(3) Requirements.--The requirements described in this 
        paragraph are the following:
                    ``(A) SCHIP income eligibility.--The State has a 
                State child health plan that (whether implemented under 
                title XIX or this title)--
                            ``(i) as of January 1, 2001, has an income 
                        eligibility standard that is at least 200 
                        percent of the poverty line or has an income 
                        eligibility standard that exceeds 200 percent 
                        of the poverty line under a waiver under 
                        section 1115 that is based on a child's lack of 
                        health insurance;
                            ``(ii) subject to subparagraph (B), does 
                        not limit the acceptance of applications for 
                        children; and
                            ``(iii) provides benefits to all children 
                        in the State who apply for and meet eligibility 
                        standards on a statewide basis.
                    ``(B) No waiting list imposed.--With respect to 
                children whose family income is at or below 200 percent 
                of the poverty line, the State does not impose any 
                numerical limitation, waiting list, or similar 
                limitation on the eligibility of such children for 
                child health assistance under such State plan.
                    ``(C) Additional requirements.--The State has 
                implemented at least 3 of the following policies and 
                procedures (relating to coverage of children under 
                title XIX and this title):
                            ``(i) Uniform, simplified application 
                        form.--With respect to children who are 
                        eligible for medical assistance under section 
                        1902(a)(10)(A), the State uses the same 
                        uniform, simplified application form 
                        (including, if applicable, permitting 
                        application other than in person) for purposes 
                        of establishing eligibility for benefits under 
                        title XIX and this title.
                            ``(ii) Elimination of asset test.--The 
                        State does not apply any asset test for 
                        eligibility under section 1902(l) or this title 
                        with respect to children.
                            ``(iii) Adoption of 12-month continuous 
                        enrollment.--The State provides that 
                        eligibility shall not be regularly redetermined 
                        more often than once every year under this 
                        title or for children described in section 
                        1902(a)(10)(A).
                            ``(iv) Same verification and 
                        redetermination policies; automatic 
                        reassessment of eligibility.--With respect to 
                        children who are eligible for medical 
                        assistance under section 1902(a)(10)(A), the 
                        State provides for initial eligibility 
                        determinations and redeterminations of 
                        eligibility using the same verification 
                        policies (including with respect to face-to-
                        face interviews), forms, and frequency as the 
                        State uses for such purposes under this title, 
                        and, as part of such redeterminations, provides 
                        for the automatic reassessment of the 
                        eligibility of such children for assistance 
                        under title XIX and this title.
                            ``(v) Outstationing enrollment staff.--The 
                        State provides for the receipt and initial 
                        processing of applications for benefits under 
                        this title and for children under title XIX at 
                        facilities defined as disproportionate share 
                        hospitals under section 1923(a)(1)(A) and 
                        Federally-qualified health centers described in 
                        section 1905(l)(2)(B) consistent with section 
                        1902(a)(55).''.

 Subtitle B--State Option To Provide Coverage to All Individuals Below 
                         100 Percent of Poverty

SEC. 111. STATE OPTION TO OFFER MEDICAID COVERAGE BASED ON NEED.

    (a) State Option To Provide Coverage.--Section 1902(a)(10)(A)(ii) 
of the Social Security Act (42 U.S.C. 1396a), as amended by section 
531(a)(1)(A), is amended--
            (1) by striking ``or'' at the end of subclause (XIX);
            (2) by adding ``or'' at the end of subclause (XX); and
            (3) by adding at the end the following:
                                    ``(XXI) whose income does not 
                                exceed 100 percent of the income 
                                official poverty line (as defined by 
                                the Office of Management and Budget, 
                                and revised annually in accordance with 
                                section 673(2) of the Omnibus Budget 
                                Reconciliation Act of 1981) applicable 
                                to a family of the size involved;''.
    (b) Conforming Amendments.--Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)), as amended by section 501(d)(1), is amended 
in the matter preceding paragraph (1)--
            (1) by striking ``or'' at the end of clause (xiii);
            (2) by adding ``or'' at the end of clause (xiv); and
            (3) by inserting after clause (xiv) the following:
            ``(xv) individuals who are eligible for medical assistance 
        on the basis of section 1902(a)(10)(A)(ii)(XXI);''.
    (c) Effective Date.--The amendments made by this section apply to 
medical assistance provided on and after October 1, 2003.

                  Subtitle C--Outreach and Enrollment

SEC. 121. GRANTS TO PROMOTE INNOVATIVE OUTREACH AND ENROLLMENT EFFORTS 
              UNDER SCHIP.

    (a) In General.--Section 2104(f) of the Social Security Act (42 
U.S.C. 1397dd(f)) is amended--
            (1) by striking ``The Secretary'' and inserting the 
        following:
            ``(1) In general.--Subject to paragraph (2), the 
        Secretary''; and
            (2) by adding at the end the following:
            ``(2) Grants to promote innovative outreach and enrollment 
        efforts.--
                    ``(A) In general.--Prior to any redistribution 
                under paragraph (1) of unexpended allotments made to 
                States under subsection (b) or (c) for fiscal year 2001 
                and any fiscal year thereafter, the Secretary shall--
                            ``(i) reserve from such unexpended 
                        allotments the lesser of $50,000,000 or the 
                        total amount of such unexpended allotments for 
                        grants under this paragraph for the fiscal year 
                        in which the redistribution occurs; and
                            ``(ii) subject to subparagraph (B), use 
                        such reserved funds to make grants to national 
                        local and community-based public or nonprofit 
                        organizations (including organizations involved 
                        in women's health, pediatric advocacy, local 
                        and county governments, public health 
                        departments, Federally-qualified health 
                        centers, children's hospitals, and hospitals 
                        defined as disproportionate share hospitals 
                        under the State plan under title XIX) to 
                        conduct innovative outreach and enrollment 
                        efforts that are consistent with section 
                        2102(c) and to promote understanding of the 
                        importance of health insurance coverage for 
                        prenatal care and children.
                    ``(B) Priority for grants in certain areas.--In 
                making grants under subparagraph (A)(ii), the Secretary 
                shall give priority to grant applicants that propose to 
                target the outreach and enrollment efforts funded under 
                the grant to geographic areas--
                            ``(i) with high rates of eligible but 
                        unenrolled children, including such children 
                        who reside in rural areas; or
                            ``(ii) with high rates of families for whom 
                        English is not their primary language.
                    ``(C) Applications.--An organization that desires 
                to receive a grant under this paragraph shall submit an 
                application to the Secretary in such form and manner, 
                and containing such information, as the Secretary may 
                decide.''.
    (b) Extending Use of Outstationed Workers To Accept Title XXI 
Applications.--Section 1902(a)(55) of such Act (42 U.S.C. 1396a(a)(55)) 
is amended by inserting ``, and applications for child health 
assistance under title XXI'' after ``(a)(10)(A)(ii)(IX)''.

           Subtitle D--Immigrant Children and Pregnant Women

SEC. 131. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID 
              PROGRAM AND SCHIP.

    (a) Medicaid Program.--Section 1903(v) of the Social Security Act 
(42 U.S.C. 1396b(v)) is amended--
            (1) in paragraph (1), by striking ``paragraph (2)'' and 
        inserting ``paragraphs (2) and (4)''; and
            (2) by adding at the end the following:
    ``(4)(A) A State may elect (in a plan amendment under this title) 
to provide medical assistance under this title for aliens who are 
lawfully residing in the United States (including battered aliens 
described in section 431(c) of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996) and who are otherwise eligible 
for such assistance, within any of the following eligibility 
categories:
            ``(i) Pregnant women.--Women during pregnancy (and during 
        the 60-day period beginning on the last day of the pregnancy).
            ``(ii) Children.--Children (as defined under such plan), 
        including optional targeted low-income children described in 
        section 1905(u)(2)(B).
    ``(B)(i) In the case of a State that has elected to provide medical 
assistance to a category of aliens under subparagraph (A), no debt 
shall accrue under an affidavit of support against any sponsor of such 
an alien on the basis of provision of assistance to such category and 
the cost of such assistance shall not be considered as an unreimbursed 
cost.
    ``(ii) The provisions of sections 401(a), 402(b), 403, and 421 of 
the Personal Responsibility and Work Opportunity Reconciliation Act of 
1996 shall not apply to a State that makes an election under 
subparagraph (A).''.
    (b) Title XXI.--Section 2107(e)(1) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
                    ``(E) Section 1903(v)(4) (relating to optional 
                coverage of permanent resident alien children), but 
                only if the State has elected to apply such section to 
                that category of children under title XIX.''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003, and apply to medical assistance and child 
health assistance furnished on or after such date.

SEC. 132. PERMITTING STATES AND LOCALITIES TO PROVIDE HEALTH CARE TO 
              ALL INDIVIDUALS.

    (a) In General.--Section 411 of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1621) is 
amended--
            (1) in subsection (b)--
                    (A) by striking paragraphs (1) and (3); and
                    (B) by redesignating paragraphs (2) and (4) as 
                paragraphs (1) and (2), respectively; and
            (2) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``(2) and (3)'' and inserting 
                        ``(2), (3), and (4)''; and
                            (ii) in subparagraph (B), by striking 
                        ``health,''; and
                    (B) by adding at the end the following new 
                paragraph
            ``(4) Such term does not include any health benefit for 
        which payments or assistance are provided to an individual, 
        household, or family eligibility unit by an agency of a State 
        or local government or by appropriated funds of a State or 
        local government.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to health care furnished before, on, or after the date of the 
enactment of this Act.

                 Subtitle E--Eligibility Simplification

SEC. 141. STATE OPTION TO PROVIDE FOR SIMPLIFIED DETERMINATIONS OF A 
              CHILD'S FINANCIAL ELIGIBILITY FOR MEDICAL ASSISTANCE 
              UNDER MEDICAID OR CHILD HEALTH ASSISTANCE UNDER SCHIP.

    (a) Medicaid.--Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended by adding at the end the following:
            ``(13)(A) At the option of the State, the plan may provide 
        that financial eligibility requirements for medical assistance 
        are met for an individual who is under an age specified by the 
        State (not to exceed 21 years of age) by using a determination 
        (made within a reasonable period, as found by the State, before 
        its use for this purpose) of the individual's family or 
        household income or resources, notwithstanding any differences 
        in budget unit, disregard, deeming, or other methodology, by a 
        Federal or State agency (or a public or private entity making 
        such determination on behalf of such agency) specified by the 
        plan, including but not limited to the agencies administering 
        the Food Stamp Act of 1977, the Richard B. Russell National 
        School Lunch Act, and the Child Nutrition Act of 1966, provided 
        that such agency has fiscal liabilities or responsibilities 
        affected or potentially affected by such determinations and 
        provided that all information furnished by such agency pursuant 
        to this subparagraph is used solely for purposes of determining 
        eligibility for medical assistance under the State plan 
        approved under this title or for child health assistance under 
        a State plan approved under title XXI.
            ``(B) Nothing in subparagraph (A) shall be construed--
                    ``(i) to authorize the denial of medical assistance 
                under a State plan approved under this title or of 
                child health assistance under a State plan approved 
                under title XXI to an individual who, without the 
                application of this paragraph or an option exercised 
                thereunder, would qualify for such assistance;
                    ``(ii) to relieve a State of the obligation under 
                subsection (a)(8) to furnish assistance with reasonable 
                promptness after the submission of an initial 
                application that is evaluated or for which evaluation 
                is requested pursuant to this paragraph; or
                    ``(iii) to relieve a State of the obligation to 
                determine eligibility on other grounds for an 
                individual found to be ineligible under this paragraph.
            ``(C) At the option of a State, the financial eligibility 
        process described in subparagraph (A) may apply to an 
        individual who is older than age 21 if such individual's 
        eligibility for medical assistance is based on pregnancy or if 
        such individual is a parent, guardian, or other caretaker 
        relative of an individual found eligible under subparagraph 
        (A).''.
    (b) SCHIP.--Section 2107(e)(1) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)) is amended by adding at the end the following:
                    ``(E) Section 1902(e)(13) (relating to the State 
                option to base a child's eligibility for assistance on 
                financial determinations made by a program providing 
                nutrition or other public assistance).''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2003.

SEC. 142. APPLICATION OF SIMPLIFIED TITLE XXI PROCEDURES UNDER THE 
              MEDICAID PROGRAM.

    (a) Presumptive Eligibility.--
            (1) In general.--Section 1920A(b)(3)(A)(i) of the Social 
        Security Act (42 U.S.C. 1396r-1a(b)(3)(A)(i)) is amended by 
        inserting ``a child care resource and referral agency,'' after 
        ``a State or tribal child support enforcement agency,''.
            (2) Application to presumptive eligibility for pregnant 
        women under medicaid.--Section 1920(b) of the Social Security 
        Act (42 U.S.C. 1396r-1(b)) is amended by adding at the end 
        after and below paragraph (2) the following flush sentence:
``The term `qualified provider' includes a qualified entity as defined 
in section 1920A(b)(3).''.
            (3) Application under title xxi.--Section 2107(e)(1)(D) of 
        the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to 
        read as follows:
                    ``(D) Sections 1920 and 1920A (relating to 
                presumptive eligibility).''.
    (b) Automatic Reassessment of Eligibility for Title XXI and 
Medicaid Benefits for Children Losing Medicaid or Title XXI 
Eligibility.--
            (1) Loss of medicaid eligibility.--Section 1902(a) of the 
        Social Security Act (42 U.S.C. 1396a(a)) is amended--
                    (A) by striking the period at the end of paragraph 
                (65) and inserting ``; and'', and
                    (B) by inserting after paragraph (65) the 
                following:
            ``(66) provide, in the case of a State with a State child 
        health plan under title XXI, that before medical assistance to 
        a child (or a parent of a child) is discontinued under this 
        title, a determination of whether the child (or parent) is 
        eligible for benefits under title XXI shall be made and, if 
        determined to be so eligible, the child (or parent) shall be 
        automatically enrolled in the program under such title without 
        the need for a new application.''.
            (2) Loss of title xxi eligibility and coordination with 
        medicaid.--Section 2102(b) of the Social Security Act (42 
        U.S.C. 1397bb(b)) is amended--
                    (A) in paragraph (3), by redesignating 
                subparagraphs (D) and (E) as subparagraphs (E) and (F), 
                respectively, and by inserting after subparagraph (C) 
                the following:
                    ``(D) that before health assistance to a child (or 
                a parent of a child) is discontinued under this title, 
                a determination of whether the child (or parent) is 
                eligible for benefits under title XIX is made and, if 
                determined to be so eligible, the child (or parent) is 
                automatically enrolled in the program under such title 
                without the need for a new application;'';
                    (B) by redesignating paragraph (4) as paragraph 
                (5); and
                    (C) by inserting after paragraph (3) the following 
                new paragraph:
            ``(4) Coordination with medicaid.--The State shall 
        coordinate the screening and enrollment of individuals under 
        this title and under title XIX consistent with the following:
                    ``(A) Information that is collected under this 
                title or under title XIX which is needed to make an 
                eligibility determination under the other title shall 
                be transmitted to the appropriate administering entity 
                under such other title in a timely manner so that 
                coverage is not delayed and families do not have to 
                submit the same information twice. Families shall be 
                provided the information they need to complete the 
                application process for coverage under both titles and 
                be given appropriate notice of any determinations made 
                on their applications for such coverage.
                    ``(B) If a State does not use a joint application 
                under this title and such title, the State shall--
                            ``(i) promptly inform a child's parent or 
                        caretaker in writing and, if appropriate, 
                        orally, that a child has been found likely to 
                        be eligible under title XIX;
                            ``(ii) provide the family with an 
                        application for medical assistance under such 
                        title and offer information about what (if any) 
                        further information, documentation, or other 
                        steps are needed to complete such application 
                        process;
                            ``(iii) offer assistance in completing such 
                        application process; and
                            ``(iv) promptly transmit the separate 
                        application under this title or the information 
                        obtained through such application, and all 
                        other relevant information and documentation, 
                        including the results of the screening process, 
                        to the State agency under title XIX for a final 
                        determination on eligibility under such title.
                    ``(C) Applicants are notified in writing of--
                            ``(i) benefits (including restrictions on 
                        cost-sharing) under title XIX; and
                            ``(ii) eligibility rules that prohibit 
                        children who have been screened eligible for 
                        medical assistance under such title from being 
                        enrolled under this title, other than 
                        provisional temporary enrollment while a final 
                        eligibility determination is being made under 
                        such title.
                    ``(D) If the agency administering this title is 
                different from the agency administering a State plan 
                under title XIX, such agencies shall coordinate the 
                screening and enrollment of applicants for such 
                coverage under both titles.
                    ``(E) The coordination procedures established 
                between the program under this title and under title 
                XIX shall apply not only to the initial eligibility 
                determination of a family but also to any renewals or 
                redeterminations of such eligibility.''.
            (3) Effective date.--The amendments made by paragraphs (1) 
        and (2) apply to individuals who lose eligibility under the 
        medicaid program under title XIX, or under a State child health 
        insurance plan under title XXI, respectively, of the Social 
        Security Act on or after October 1, 2003, without regard to 
        whether regulations implementing such amendments have been 
        issued.
    (c) Provision of Medicaid and CHIP Applications and Information 
Under the School Lunch Program.--Section 9(b)(2)(B) of the Richard B. 
Russell National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 
amended--
            (1) by striking ``(B) Applications'' and inserting ``(B)(i) 
        Applications''; and
            (2) by adding at the end the following:
    ``(ii)(I) Applications for free and reduced price lunches that are 
distributed pursuant to clause (i) to parents or guardians of children 
in attendance at schools participating in the school lunch program 
under this Act shall also contain information on the availability of 
medical assistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and of child health and other assistance under 
title XXI of such Act, including information on how to obtain an 
application for assistance under such programs.
    ``(II) Information on the programs referred to in subclause (I) 
shall be provided on a form separate from the application form for free 
and reduced price lunches under clause (i).''.

                 Subtitle F--SCHIP Wrap-Around Benefits

SEC. 151. STATE OPTION TO PROVIDE WRAP-AROUND SCHIP COVERAGE TO 
              CHILDREN WHO HAVE OTHER HEALTH COVERAGE.

    (a) In General.--
            (1) SCHIP.--
                    (A) State option to provide wrap-around coverage.--
                Section 2110(b) of the Social Security Act (42 U.S.C. 
                1397jj(b)) is amended--
                            (i) in paragraph (1)(C), by inserting ``, 
                        subject to paragraph (5),'' after ``under title 
                        XIX or''; and
                            (ii) by adding at the end the following new 
                        paragraph:
            ``(5) State option to provide wrap-around coverage.--A 
        State may waive the requirement of paragraph (1)(C) that a 
        targeted low-income child may not be covered under a group 
        health plan or under health insurance coverage, if the State 
        satisfies the conditions described in subsection (c)(8). The 
        State may waive such requirement in order to provide--
                    ``(A) dental services;
                    ``(B) cost-sharing protection; or
                    ``(C) all services.
        In waiving such requirement, a State may limit the application 
        of the waiver to children whose family income does not exceed a 
        level specified by the State, so long as the level so specified 
        does not exceed the maximum income level otherwise established 
        for other children under the State child health plan.''; and
                    (B) Conditions described.--Section 2105(c) of such 
                Act (42 U.S.C. 1397ee(c)) is amended by adding at the 
                end the following new paragraph:
            ``(8) Conditions for provision of wrap around coverage.--
        For purposes of section 2110(b)(5), the conditions described in 
        this paragraph are the following:
                    ``(A) Income eligibility.--The State child health 
                plan (whether implemented under title XIX or this 
                XXI)--
                            ``(i) has an income eligibility standard 
                        not less than that described in paragraph (4) 
                        of such section;
                            ``(ii) subject to subparagraph (B), does 
                        not limit the acceptance of applications for 
                        children; and
                            ``(iii) provides benefits to all children 
                        in the State who apply for and meet eligibility 
                        standards.
                    ``(B) No waiting list imposed.--With respect to 
                children whose family income is at or below 200 percent 
                of the poverty line, the State does not impose any 
                numerical limitation, waiting list, or similar 
                limitation on the eligibility of such children for 
                child health assistance under such State plan.
                    ``(C) No more favorable treatment.--The State child 
                health plan may not provide more favorable coverage of 
                dental services to the children covered under section 
                2110(b)(5) than to children otherwise covered under 
                this title.''.
                    (C) State option to waive waiting period.--Section 
                2102(b)(1)(B) of such Act (42 U.S.C. 1397bb(b)(1)(B)), 
                as amended by section 101(c)(3), is amended--
                            (i) in clause (ii), by striking ``and'' at 
                        the end;
                            (ii) in clause (iii), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(iv) at State option, may not apply a 
                        waiting period in the case of child described 
                        in section 2110(b)(5), if the State satisfies 
                        the requirements of section 2105(c)(8).''.
            (2) Application of enhanced match under medicaid.--Section 
        1905 of such Act (42 U.S.C. 1396d), as amended by section 
        101(a)(1)(C), is amended--
                    (A) in subsection (b), in the fourth sentence, by 
                striking ``or (u)(4)'' and inserting ``(u)(4), or 
                (u)(5)''; and
                    (B) in subsection (u), by inserting after paragraph 
                (4) the following new paragraph:
    ``(5) For purposes of subsection (b), the expenditures described in 
this paragraph are expenditures for items and services for children 
described in section 2110(b)(5), but only in the case of a State that 
satisfies the requirements of section 2105(c)(8).''.
            (3) Application of secondary payor provisions.--Section 
        2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as amended by 
        section 121(b), is amended--
                    (A) by redesignating subparagraphs (B) through (E) 
                as subparagraphs (C) through (F), respectively; and
                    (B) by inserting after subparagraph (A) the 
                following new subparagraph:
                    ``(B) Section 1902(a)(25) (relating to coordination 
                of benefits and secondary payor provisions) with 
                respect to children covered under a waiver described in 
                section 2110(b)(5).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on January 1, 2004, and shall apply to child health 
assistance and medical assistance provided on or after that date.

            Subtitle G--Immunization Coverage Through SCHIP

SEC. 161. ELIGIBILITY OF CHILDREN ENROLLED IN THE STATE CHILDREN'S 
              HEALTH INSURANCE PROGRAM FOR THE PEDIATRIC VACCINE 
              DISTRIBUTION PROGRAM.

    (a) In General.--Section 1928(b)(2)(B)(ii)(I) of the Social 
Security Act (42 U.S.C. 1396s(b)(2)(B)(ii)(I)) is amended by inserting 
``(other than a State child health plan under title XXI)'' after 
``policy or plan''.
    (b) Effective Date.--The amendment made by subsection (a) applies 
with respect to vaccines administered on or after the date of the 
enactment of this Act.

           Subtitle H--Limited English Proficient Communities

SEC. 171. INCREASED FEDERAL REIMBURSEMENT FOR LANGUAGE SERVICES UNDER 
              THE MEDICAID PROGRAM AND THE STATE CHILDREN'S HEALTH 
              INSURANCE PROGRAM.

    (a) Medicaid.--Section 1903(a)(3) of the Social Security Act (42 
U.S.C. 1396b(a)(3)) is amended--
            (1) in subparagraph (D), by striking ``plus'' at the end 
        and inserting ``and''; and
            (2) by adding at the end the following:
                    ``(E) 90 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to the provision of language services, 
                including oral interpretation, translations of written 
                materials, and other language services, for individuals 
                with limited English proficiency who apply for, or 
                receive, medical assistance under the State plan; 
                plus''.
    (b) SCHIP.--Section 2105(a)(1) of the Social Security Act (42 
U.S.C. 1397ee(a)(1)), as amended by section 104(a), is amended--
            (1) in the matter preceding subparagraph (A), by inserting 
        ``or, in the case of expenditures described in subparagraph 
        (D)(iv), 90 percent'' after ``enhanced FMAP''; and
            (2) in subparagraph (D)--
                    (A) in clause (iii), by striking ``and'' at the 
                end;
                    (B) be redesignating clause (iv) as clause (v); and
                    (C) by inserting after clause (iii) the following:
                            ``(iv) for expenditures attributable to the 
                        provision of language services, including oral 
                        interpretation, translations of written 
materials, and other language services, for individuals with limited 
English proficiency who apply for, or receive, child health assistance 
under the plan; and''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 2004.

    Subtitle I--Binational Public Health Infrastructure and Health 
                               Insurance

SEC. 181. BINATIONAL PUBLIC HEALTH INFRASTRUCTURE AND HEALTH INSURANCE.

    (a) In General.--The Secretary of Health and Human Services shall 
enter into a contract with the Institute of Medicine for the conduct of 
a study concerning binational public health infrastructure and health 
insurance efforts. In conducting such study, the Institute shall 
solicit input from border health experts and health insurance 
companies.
    (b) Report.--Not later than 1 year after the date on which the 
Secretary of Health and Human Services enters into the contract under 
subsection (a), the Institute of Medicine shall submit to the Secretary 
and the appropriate committees of Congress a report concerning the 
study conducted under subsection (a). Such report shall include the 
recommendations of the Institute on ways to expand or improve 
binational public health infrastructure and health insurance efforts.

           Subtitle J--Migrant Workers and Farmworkers Health

SEC. 191. DEMONSTRATION PROJECT REGARDING CONTINUITY OF COVERAGE OF 
              MIGRANT WORKERS AND FARMWORKERS UNDER MEDICAID AND SCHIP.

    (a) Authority To Conduct Demonstration Project.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a demonstration project for the purpose of 
        evaluating methods for strengthening the health coverage of, 
        and continuity of coverage of, migrant workers and farmworkers 
        under the medicaid and State children's health insurance 
        programs (42 U.S.C. 1396 et seq., 1397aa et seq.).
            (2) Waiver authority.--The Secretary of Health and Human 
        Services shall waive compliance with the requirements of titles 
        XI, XIX, and XXI of the Social Security Act (42 U.S.C. 1301 et 
        seq, 1396 et seq., 1397aa et seq.) to such extent and for such 
        period as the Secretary determines is necessary to conduct the 
        demonstration project under this section.
    (b) Requirements.--The demonstration project conducted under this 
section shall provide for--
            (1) uniform eligibility criteria under the medicaid and 
        State children's health insurance programs with respect to 
        migrant workers and farmworkers; and
            (2) the portability of coverage of such workers under those 
        programs between participating States.
    (c) Report.--Not later than March 31, 2005, the Secretary of Health 
and Human Services shall submit a report to Congress on the 
demonstration project conducted under this section that contains such 
recommendations for legislative action as the Secretary determines is 
appropriate.

                      TITLE II--HEALTH DISPARITIES

   Subtitle A--Report on Programs for Improving the Health Status of 
                          Hispanic Individuals

SEC. 201. ANNUAL REPORT REGARDING HISPANIC HEALTH DISPARITIES FOR 
              CHRONIC AND COMMUNICABLE DISEASES.

    (a) In General.--The Secretary of Health and Human Services (in 
this Act referred to as the ``Secretary'') shall annually submit to 
Congress a report on programs carried out through the Public Health 
Service with respect to improving the health status of Hispanic 
individuals regarding diabetes, cancer, asthma, HIV infection, AIDS, 
tuberculosis, injuries (unintentional and intentional), obesity, 
immunization rates, oral health, substance abuse, and mental health, 
including--
            (1) prevention programs carried out through the Centers for 
        Disease Control and Prevention and the Substance Abuse and 
        Mental Health Services Administration;
            (2) treatment programs carried out through the Health 
        Resources and Services Administration and the Substance Abuse 
        and Mental Health Services Administration;
            (3) research programs carried out through the National 
        Institutes of Health, the National Center on Minority Health 
        and Health Disparities, the Agency for Healthcare Quality and 
        Research, the Maternal Child Health Bureau, and the Centers for 
        Medicare & Medicaid Services; and
            (4) activities of the Office of Public Health and Science, 
        including activities of the Office of Minority Health.
    (b) Data Collection.--Each report under subsection (a) shall 
include information on programs carried out through the Public Health 
Service to collect data that relates to the health status of Hispanic 
individuals regarding diabetes, cancer, asthma, HIV infection, AIDS, 
tuberculosis, injuries (unintentional and intentional), obesity, 
immunization rates, oral health, substance abuse, and mental health.

         Subtitle B--Diabetes Research, Control, and Prevention

SEC. 211. TREATMENT.

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

``SEC. 399P. DIABETES; TREATMENT FOR MINORITY POPULATIONS.

    ``(a) In General.--The Secretary shall conduct and support programs 
to treat diabetes in minority populations.
    ``(b) National Institutes of Health.--With respect to the National 
Institutes of Health, activities under subsection (a) regarding the 
treatment of diabetes in minority populations shall include the 
following:
            ``(1) Through the National Institute of Mental Health, 
        providing for comprehensive mental health services and 
        treatment for individuals within such populations who 
        experience mental barriers to proper diabetes care.
            ``(2) Through the National Center on Minority Health and 
        Health Disparities, recommending and disseminating the 
        guidelines of the American Diabetes Association for nutrition 
        exercise and diet for diabetes treatment and prevention.
    ``(c) Other Agencies.--Activities under subsection (a) regarding 
the treatment of diabetes in minority populations shall include the 
following:
            ``(1) Through the Substance Abuse and Mental Health 
        Services Administration and the National Institute of Mental 
        Health, providing for comprehensive mental health services and 
        treatment for minorities who experience mental barriers to 
        proper diabetes care.
            ``(2) Promoting early detection as a cost-saving mechanism, 
        including making grants to community health centers and clinics 
        to specifically treat type 2 diabetes and complications, 
        including eye disease, kidney failure, heart disease and 
        stroke, nerve damage, and limb amputations.
            ``(3) Through the Health Resources and Services 
        Administration and the Centers for Disease Control and 
        Prevention, carrying out a collaborative program to encourage 
        preventive care. Such program shall not be limited to primary 
        prevention, and shall include secondary and tertiary 
        prevention. Such program shall include the award of grants to 
        community health centers and clinics to specifically treat 
        diabetes, with an emphasis on type 2 diabetes, and diabetic 
        complications, including eye disease, kidney failure, heart 
        disease and stroke, nerve damage, and limb amputation.
    ``(d) Definition.--For purposes of this section, the term `minority 
populations' means racial and ethnic minority groups within the meaning 
of section 1707.
    ``(e) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out 
        subsections (a) and (c), there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 2003 
        and each subsequent fiscal year.
            ``(2) National institutes of health.--For the purpose of 
        carrying out subsection (b), there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 2004 
        and each subsequent fiscal year.''.

SEC. 212. EDUCATION.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 211, is further amended by adding 
at the end the following:

``SEC. 399Q. DIABETES; EDUCATION REGARDING MINORITY POPULATIONS.

    ``(a) In General.--The Secretary shall conduct and support programs 
to educate the public on the causes of effects of diabetes in minority 
populations.
    ``(b) National Institutes of Health.--With respect to the National 
Institutes of Health, activities under subsection (a) regarding 
education on diabetes in minority populations shall include the 
following:
            ``(1) Through the National Center on Minority Health and 
        Health Disparities--
                    ``(A) making grants to programs funded under 
                section 485F (relating to centers of excellence) for 
                the purpose of establishing a mentoring program for 
                health care professionals to be more involved in weight 
                counseling, obesity research, and nutrition;
                    ``(B) providing for the participation of minority 
                health professionals in diabetes-focused research 
                programs; and
                    ``(C) providing for the participation of minority 
                health professionals in diabetes-focused research 
                programs.
            ``(2) Making grants for programs to establish a pipeline 
        from high school to professional school that will increase 
        minority representation in diabetes-focused health fields by 
        expanding Minority Access to Research Careers (MARC) program 
        internships and mentoring opportunities for recruitment.
    ``(c) Centers for Disease Control and Prevention.--With respect to 
the Centers for Disease Control and Prevention, activities under 
subsection (a) regarding education on diabetes in minority populations 
shall include the following:
            ``(1) Making grants for diabetes-focused education classes 
        or training programs on cultural sensitivity and patient care 
        within such populations for health care providers.
            ``(2) Carrying out public awareness campaigns directed 
        toward such populations to aggressively emphasize the 
        importance and impact of physical activity and diet in regard 
        to diabetes and diabetes-related complications.
    ``(d) Health Resources and Services Administration.--With respect 
to the Health Resources and Services Administration, activities under 
subsection (a) regarding education on diabetes in minority populations 
shall include the following:
            ``(1) Providing additional funds for the Health Careers 
        Opportunity Program, Centers for Excellence, and the Minority 
        Faculty Fellowship Program to partner with the Office of 
Minority Health under section 1707 and the National Institutes of 
Health to strengthen programs for career opportunities within minority 
populations focused on diabetes treatment and care.
            ``(2) In partnership with the Health Resources and Services 
        Administration, develop a diabetes focus within, and provide 
        additional funds for, the National Health Service Corps 
        Scholarship program to place individuals in areas that are 
        disproportionately affected by diabetes, to provide health care 
        services.
            ``(3) Establishing a diabetes ambassador program for 
        recruitment efforts to increase the number of underrepresented 
        minorities currently serving in student, faculty, or 
        administrative positions in institutions of higher learning, 
        hospitals, and community health centers.
            ``(4) Establishing a loan repayment program that focuses on 
        diabetes care and prevention.
    ``(e) Additional Programs.--Activities under subsection (a) 
regarding education on diabetes in minority populations shall include 
the following:
            ``(1) Through collaboration between the Health Resources 
        and Services Administration and the Indian Health Service, 
        establishing a joint scholarship and loan-repayment program for 
        American Indians health profession students.
            ``(2) Providing funds for new and existing diabetes-focused 
        education grants and programs for present and future students 
        and clinicians in the medical field from minority populations, 
        including the following:
                    ``(A) Federal and State loan repayment programs for 
                health profession students within communities of color.
                    ``(B) Providing funds to the Office of Minority 
                Health under section 1707 for training health 
                profession students to focus on diabetes within such 
                populations.
                    ``(C) Providing funds to State and local entities 
                to establish diabetes awareness week or day every month 
                in schools, nursing homes, and colleges through 
                partnerships with the Office of Minority Health under 
                section 1707 and the Health Resources and Services 
                Administration.
    ``(f) Definition.--For purposes of this section, the term `minority 
populations' means racial and ethnic minority groups within the meaning 
of section 1707.
    ``(g) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out 
        subsections (a) and (e), there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 2004 
        and each subsequent fiscal year.
            ``(2) National institutes of health.--For the purpose of 
        carrying out subsection (b), there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 2004 
        and each subsequent fiscal year.
            ``(3) Centers for disease control and prevention.--For the 
        purpose of carrying out subsection (c), there are authorized to 
        be appropriated such sums as may be necessary for fiscal year 
        2004 and each subsequent fiscal year.
            ``(4) Health resources and services administration.--For 
        the purpose of carrying out subsection (c), there are 
        authorized to be appropriated such sums as may be necessary for 
        fiscal year 2004 and each subsequent fiscal year.''.

SEC. 213. HEALTH PROMOTION, PREVENTION ACTIVITIES, AND ACCESS.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 212, is amended by adding at the 
end the following:

``SEC. 399R. DIABETES; HEALTH PROMOTION, PREVENTION ACTIVITIES, AND 
              ACCESS REGARDING MINORITY POPULATIONS.

    ``(a) National Institutes of Health.
            ``(1) In general.--The Secretary, acting through the 
        Director of the National Institutes of Health, shall provide 
        access to proper care of diabetes for minority populations.
            ``(2) Certain activities.--Activities under paragraph (1) 
        regarding proper care of diabetes in minority populations shall 
        include the following:
                    ``(A) Providing funds for research to assess and 
                identify the number of individuals affected by 
                socioeconomic and environmental barriers to diabetes 
                health care access, including research regarding 
                language, transportation, daily routine, lifestyle, and 
                housing.
                    ``(B) Through the National Center on Minority 
                Health and Health Disparities, identifying the manner 
                in which health care providers, community health 
                centers, and hospitals provide proper options and 
                education on available services for diabetes care, 
                management, and prevention, including identifying the 
                effects of differences in the cultures of staff and 
                patients on clinical and other workforce encounters.
    ``(b) Centers for Disease Control and Prevention.
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall carry out culturally appropriate diabetes health 
        promotion and prevention programs for minority populations.
            ``(2) Certain activities.--Activities under paragraph (1) 
        regarding culturally appropriate diabetes health promotion and 
        prevention programs for minority populations shall include the 
        following:
                    ``(A) Expanding the Diabetes Control Program 
                (currently existing in all the States and territories).
                    ``(B) Providing funds for the Diabetes Today 
                program to adapt community planning tools within such 
                populations.
                    ``(C) Providing funds for Racial and Ethnic 
                Approaches to Community Health (REACH 2010) grants to 
                develop and evaluate diabetes prevention and control 
                community programs focused on such populations.
                    ``(D) Providing funds to community health centers 
                for a monthly diabetes week program of diabetes 
                services, including screenings.
                    ``(E) Providing funds for free diabetes self-
                management education classes in hospitals, clinics, and 
                community health centers.
                    ``(F) Providing funds for education and community 
                outreach on diabetes.
                    ``(G) Providing funds for the United States and 
                Mexico Border Diabetes project to develop culturally 
                appropriate diabetes prevention and control 
                interventions for Minority populations in the border 
                region.
                    ``(H) Providing funds for an aggressive prevention 
                campaign that focuses on physical inactivity and diet 
                and its relation to type 2 diabetes within such 
                populations.
                    ``(I) Providing funds for surveillance systems and 
                strategies for strengthening existing systems to 
                improve the quality, accuracy, and timelines of 
                morbidity and mortality diabetes data for such 
                populations.
    ``(c) Definition.--For purposes of this section, the term `minority 
populations' means racial and ethnic minority groups within the meaning 
of section 1707.
    ``(d) Authorization of Appropriations.--
            ``(1) National institutes of health.--For the purpose of 
        carrying out subsection (b), there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 2004 
        and each subsequent fiscal year.
            ``(2) Centers for disease control and prevention.--For the 
        purpose of carrying out subsection (c), there are authorized to 
        be appropriated such sums as may be necessary for fiscal year 
        2004 and each subsequent fiscal year.''.

  Subtitle C--HIV Prevention Activities Regarding Hispanic Individuals

SEC. 221. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION; 
              REPRESENTATION OF HISPANIC INDIVIDUALS IN MEMBERSHIP OF 
              COMMUNITY PLANNING GROUPS.

    (a) In General.--With respect to community planning groups that the 
Centers for Disease Control and Prevention utilizes in carrying out 
programs for the prevention of HIV infection, the Secretary, acting 
through the Director of such Centers, shall carry out the following:
            (1) The Secretary shall identify community planning groups 
        for which Hispanic individuals are underrepresented as members 
        in relation to the number of Hispanic individuals with HIV who 
        reside in the communities involved.
            (2) The Secretary shall develop a plan to increase the 
        representation of Hispanic individuals in the membership of the 
        community planning groups identified under paragraph (1). Such 
        plan may provide for facilitating the participation of Hispanic 
        individuals as members in such groups by assisting the 
        individuals with the incidental costs incurred by the 
        individuals in being such members, such as the costs of 
        transportation and child-care services.
            (3) The plan shall include a strategy and detailed timeline 
        for implementing the plan.
    (b) Definition.--In this section, the term ``community planning 
group'' has the meaning that applies for purposes of programs 
established pursuant to the Ryan White Comprehensive AIDS Resources 
Emergency Act of 1990 (including title XXVI of the Public Health 
Service Act).

SEC. 222. AIDS EDUCATION AND TRAINING CENTERS FUNDED BY HEALTH 
              RESOURCES AND SERVICES ADMINISTRATION; ESTABLISHMENT OF 
              CENTER DIRECTED TOWARD MINORITY POPULATIONS WITH HIV.

    (a) In General.--In carrying out section 2692 of the Public Health 
Service Act (42 U.S.C. 300ff-111), the Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall make grants to eligible Hispanic-serving institutions for the 
purpose of carrying out projects under such section with respect to HIV 
in racial and ethnic minority groups.
    (b) Cultural Competence.--A condition for grants under subsection 
(a) is that the applicants involved agree that the education and 
training provided through projects under such subsection will be 
provided in a culturally competent manner (as defined in section 331).
    (c) Eligible Institutions.--In this section:
            (1) Eligible hispanic-serving institution.--The term 
        ``eligible Hispanic-serving institution'' means a Hispanic-
        serving institution that has a record of carrying out HIV-
        related activities with respect to Hispanic individuals.
            (2) Hispanic-serving institution.--The term ``Hispanic-
        serving institution'' has the meaning given such term in 
        section 502 of the Higher Education Act of 1965 (20 U.S.C. 
        1101a).

          Subtitle D--Prevention of Latina Adolescent Suicides

SEC. 231. SHORT TITLE.

    This subtitle may be cited as the ``Latina Adolescent Suicide 
Prevention Act''.

SEC. 232. ESTABLISHMENT OF PROGRAM FOR PREVENTION OF LATINA ADOLESCENT 
              SUICIDES.

    Title V of the Public Health Service Act (42 U.S.C. 290aa et seq.) 
is amended by inserting after section 520A the following section:

``SEC. 520B. PREVENTION OF LATINA ADOLESCENT SUICIDES.

    ``(a) In General.--The Secretary shall carry out a program to make 
awards of grants, cooperative agreements, or contracts to public and 
nonprofit private entities for the purpose of reducing suicide attempts 
and deaths among Latina adolescents and for the purpose of dealing with 
depression and other related emotional conditions which may contribute 
to suicide.
    ``(b) Collaboration.--The Secretary shall ensure that the program 
carried out under this section is developed in collaboration with the 
relevant institutes at the National Institutes of Health, the Health 
Resources and Services Administration, the Centers for Disease Control 
and Prevention, and the Administration on Children and Families.
    ``(c) Preference.--In making awards under subsection (a), the 
Secretary shall give preference to applicants that--
            ``(1) demonstrate a strong linkage with schools and are 
        actually supported by and operated within a school facility or 
        associated setting;
            ``(2) provide direct services to Latina adolescents and 
        their family members when appropriate; and
            ``(3) serve geographic areas that already have a high 
        concentration of underserved adolescent Latinas or a rapidly 
        growing Hispanic population, based on the latest census data.
    ``(d) Requirements.--A condition for the receipt of an award under 
subsection (a) is that the applicant involved demonstrate that the 
project to be carried out with the award will--
            ``(1) provide for the timely assessment and treatment of 
        Latina adolescents at risk for suicide;
            ``(2) use evidenced-based strategies;
            ``(3) be based on exemplary practices that are adapted to 
        the unique characteristics and needs of the local community;
            ``(4) be integrated into the existing health care system in 
        the community, including primary health care, mental health 
        services, and substance abuse services as appropriate;
            ``(5) be integrated into other systems in the community to 
        address the needs of Latina adolescents including the 
        educational system, juvenile justice, and recreation;
            ``(6) provide support services to the families and friends 
        of those who plan, attempt, or actually commit suicide;
            ``(7) provide culturally, linguistically, and 
        developmentally appropriate services;
            ``(8) agree to outcomes evaluation to determine the success 
        of the program and the possibility of replication to other 
        adolescent girls at risk of suicide;
            ``(9) provide or ensure referral for mental health and 
        substance abuse services as needed; and
            ``(10) ensure that staff used in the program are trained in 
        suicide prevention and in the identification of conditions 
        which left untreated may lead to suicide, are capable of 
        providing culturally and linguistically appropriate services, 
        and that professionals involved in the system of care are given 
        training in identifying persons at risk of suicide.
    ``(e) Coordination.--A condition for the receipt of an award under 
subsection (a) is that the applicant involved demonstrate that--
            ``(1) the application has the support of the local 
        communities and the approval of the political subdivision to be 
        served by the project to be carried out under the award; and
            ``(2) the applicant has discussed the application with 
        local and State mental health officials.
    ``(f) Matching Requirement.--With respect to the costs to be 
incurred by an applicant in carrying out a project under subsection 
(a), the Secretary may require as a condition of the receipt of the 
award that the applicant make available (directly or through donations 
from public or private entities) non-Federal contributions toward such 
costs in an amount that is not less than 25 percent of such costs ($1 
for each $3 of Federal funds provided under the award).
    ``(g) Evaluation.--The Secretary shall ensure that entities 
receiving awards under subsection (a) submit an evaluation of the 
project carried out under the award that includes an evaluation of--
            ``(1) the efficacy of project strategies; and
            ``(2) short, intermediate, and long-term outcomes, 
        including the overall impact of the project on the self-esteem 
        of Latina adolescents, their emotional well-being and 
        development, ability to deal in a positive and confident manner 
        with their families, peers, and social environment, and to make 
        constructive and personally fulfilling life choices.
    ``(h) Dissemination and Education.--The Secretary shall ensure that 
the findings from the program carried out under this section are 
disseminated to State and local governmental agencies and private 
providers of mental health and substance abuse services.
    ``(i) Duration of Projects.--With respect to an award under 
subsection (a), the period during which payments under such award are 
made may not exceed 5 years.
    ``(j) Definition.--In this section, the term `adolescent' means an 
individual between the ages of 11 and 17 (inclusive).
    ``(k) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated $10,000,000 for fiscal year 2004, and such sums as 
        may be necessary for each of the fiscal years 2005 and 2006.
            ``(2) Allocation for program management.--Of the amount 
        appropriated under paragraph (1) for a fiscal year, the 
        Secretary may reserve not more than 1 percent for administering 
        the program under this section.''.

          Subtitle E--Cancer Research, Training, and Awareness

SEC. 241. REDES EN ACCION: THE NATIONAL HISPANIC/LATINO CANCER NETWORK 
              AND OTHER NCI SPECIAL POPULATIONS NETWORKS INITIATIVES 
              TARGETING CANCER; INCREASED AUTHORIZATION OF 
              APPROPRIATIONS FOR ACTIVITIES REGARDING HISPANIC 
              INDIVIDUALS.

    (a) In General.--For the purpose of carrying out and increasing the 
activities of the Special Populations Networks of the National Cancer 
Institute's Center for Cancer Health Disparities, specifically Redes En 
Accion: The National Hispanic/Latino Cancer Network, and other programs 
in the Special Populations Network initiative promoting cancer 
research, cancer research training, and cancer awareness among the 
Hispanic/Latino population, there are authorized to be appropriated 
$2,500,000 for fiscal year 2004, and for each of the fiscal years 2005 
through 2008. Such authorization of appropriations is in addition to 
any other authorizations of appropriations that are available for such 
purposes.
    (b) Purpose.--Amounts appropriated under subsection (a) shall be 
used to continue to provide and increase support of Redes En Accion: 
The National Hispanic/Latino Cancer Network and other Special 
Populations Network initiatives targeting cancer among Hispanics to 
achieve the following:
            (1) Prioritize cancer issues impacting Hispanics.
            (2) Foster cancer pilot and other research projects based 
        on these priorities.
            (3) Establish cancer research training opportunities for 
        Hispanic undergraduate students, pre- and post-doctoral 
        individuals and junior faculty members.
            (4) Develop and support cancer awareness activities among 
        Hispanic communities.

      Subtitle F--Tuberculosis Control, Prevention, and Treatment

SEC. 251. ADVISORY COUNCIL FOR THE ELIMINATION OF TUBERCULOSIS.

    Section 317E(f) of the Public Health Service Act (42 U.S.C. 247b-
6(f)) is amended--
            (1) by redesignating paragraph (5) as paragraph (6); and
            (2) by striking paragraphs (2) through (4), and inserting 
        the following:
            ``(2) Duties.--For the purpose of making progress toward 
        the goal of eliminating tuberculosis from the United States, 
the Council shall provide to the Secretary and other appropriate 
Federal officials advice on coordinating the activities of the Public 
Health Service and other Federal agencies that relate to such disease 
and on efficiently utilizing the Federal resources involved.
            ``(3) National plan.--In carrying out paragraph (2), the 
        Council, in consultation with appropriate public and private 
        entities, shall make recommendations on the development, 
        revision, and implementation of a national plan to eliminate 
        tuberculosis in the United States. In carrying out this 
        paragraph, the Council shall--
                    ``(A) consider the recommendations of the Institute 
                of Medicine regarding the elimination of tuberculosis;
                    ``(B) address the development and application of 
                new technologies; and
                    ``(C) review the extent to which progress has been 
                made toward eliminating tuberculosis.
            ``(4) Global activities.--In carrying out paragraph (2), 
        the Council, in consultation with appropriate public and 
        private entities, shall make recommendations for the 
        development and implementation of a plan to guide the 
        involvement of the United States in global and cross border 
        tuberculosis-control activities, including recommendations 
        regarding policies, strategies, objectives, and priorities. 
        Such recommendations for the plan shall have a focus on 
        countries where a high incidence of tuberculosis directly 
        affects the United States, such as Mexico, and on access to a 
        comprehensive package of tuberculosis control measures, as 
        defined by the World Health Organization directly observed 
        treatment, short course strategy (commonly known as DOTS).
            ``(5) Composition.--The Council shall be composed of--
                    ``(A) representatives from the Centers for Disease 
                Control and Prevention, the National Institutes of 
                Health, the Agency for Healthcare Research and Quality, 
                the Health Resources and Services Administration, the 
                U.S.-Mexico Border Health Commission, and other Federal 
                departments and agencies that carry out significant 
                activities relating to tuberculosis; and
                    ``(B) members appointed from among individuals who 
                are not officers or employees of the Federal 
                Government.''.

SEC. 252. NATIONAL PROGRAM FOR TUBERCULOSIS ELIMINATION.

    Section 317E of the Public Health Service Act (42 U.S.C. 247b-6) is 
amended--
            (1) by striking the heading for the section and inserting 
        the following:

           ``national program for tuberculosis elimination'';

            (2) by amending subsection (b) to read as follows:
    ``(b) Research, Demonstration Projects, Education, and Training.--
With respect to the prevention, control, and elimination of 
tuberculosis, the Secretary may, directly or through grants to public 
or nonprofit private entities, carry out the following:
            ``(1) Research, with priority given to research 
        concerning--
                    ``(A) diagnosis and treatment of latent infection 
                of tuberculosis;
                    ``(B) strains of tuberculosis resistant to drugs;
                    ``(C) cases of tuberculosis that affect certain 
                high-risk populations; and
                    ``(D) clinical trials, including those conducted 
                through the Tuberculosis Trials Consortium.
            ``(2) Demonstration projects, including for--
                    ``(A) the development of regional capabilities for 
                the prevention, control, and elimination of 
                tuberculosis particularly in low-incidence regions; and
                    ``(B) collaboration with the Immigration and 
                Naturalization Service to identify and treat immigrants 
                with active or latent tuberculosis infection.
            ``(3) Public information and education programs.
            ``(4) Education, training and clinical skills improvement 
        activities for health professionals, including allied health 
        personnel.
            ``(5) Support of model centers to carry out activities 
        under paragraphs (2) through (4).
            ``(6) Collaboration with international organizations and 
        foreign countries, including Mexico, in coordination with the 
        United States Agency for International Development, in carrying 
        out such activities, including coordinating activities through 
        the Advisory Council for the Elimination of Tuberculosis.''; 
        and
            (3) by striking subsection (g) and inserting the following:
    ``(g) Reports.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention and in consultation with the 
Advisory Council for the Elimination of Tuberculosis, shall biennially 
prepare and submit to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on Energy and Commerce of the 
House of Representatives, a report on the activities carried out under 
this section. Each report shall include the opinion of the Council on 
the extent to which its recommendations under section 317E(f)(3) 
regarding tuberculosis have been implemented.''; and
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $235,000,000 
for fiscal year 2004, and such sums as may be necessary for each of the 
fiscal years 2005 through 2008.''.

SEC. 253. INCLUSION OF INPATIENT HOSPITAL SERVICES FOR THE TREATMENT OF 
              TB-INFECTED INDIVIDUALS.

    (a) In General.--Section 1902(z)(2) of the Social Security Act (42 
U.S.C. 1396a(z)(2)) is amended by adding at the end the following:
            ``(G) Inpatient hospital services.''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on October 1, 2003.

                  TITLE III--ACCESS AND AFFORDABILITY

                   Subtitle A--Dental Health Services

SEC. 301. GRANTS TO IMPROVE THE PROVISION OF DENTAL HEALTH SERVICES 
              THROUGH COMMUNITY HEALTH CENTERS AND PUBLIC HEALTH 
              DEPARTMENTS.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by inserting before section 330, the 
following:

``SEC. 329. GRANT PROGRAM TO EXPAND THE AVAILABILITY OF SERVICES.

    ``(a) In General.--The Secretary, acting through the Health 
Resources and Services Administration, shall establish a program under 
which the Secretary may award grants to eligible entities and eligible 
individuals to expand the availability of primary dental care services 
in dental health professional shortage areas or medically underserved 
areas.
    ``(b) Eligibility.--
            ``(1) Entities.--To be eligible to receive a grant under 
        this section an entity--
                    ``(A) shall be--
                            ``(i) a health center receiving funds under 
                        section 330 or designated as a Federally 
                        qualified health center;
                            ``(ii) a county or local public health 
                        department, if located in a federally-
                        designated dental health professional shortage 
                        area;
                            ``(iii) an Indian tribe or tribal 
                        organization (as defined in section 4 of the 
                        Indian Self-Determination and Education 
                        Assistance Act (25 U.S.C. 450b)); or
                            ``(iv) a dental education program 
                        accredited by the Commission on Dental 
                        Accreditation; and
                    ``(B) shall prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require.
            ``(2) Individuals.--To be eligible to receive a grant under 
        this section an individual shall--
                    ``(A) be a dental health professional licensed or 
                certified in accordance with the laws of State in which 
such individual provides dental services;
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require; and
                    ``(C) provide assurances that--
                            ``(i) the individual will practice in a 
                        federally-designated dental health professional 
                        shortage area; and
                            ``(ii) not less than 33 percent of the 
                        patients of such individual are--
                                    ``(I) receiving assistance under a 
                                State plan under title XIX of the 
                                Social Security Act (42 U.S.C. 1396 et 
                                seq.);
                                    ``(II) receiving assistance under a 
                                State plan under title XXI of the 
                                Social Security Act (42 U.S.C. 1397aa 
                                et seq.); or
                                    ``(III) uninsured.
    ``(c) Use of Funds.--
            ``(1) Entities.--An entity shall use amounts received under 
        a grant under this section to provide for the increased 
        availability of primary dental services in the areas described 
        in subsection (a). Such amounts may be used to supplement the 
        salaries offered for individuals accepting employment as 
        dentists in such areas.
            ``(2) Individuals.--A grant to an individual under 
        subsection (a) shall be in the form of a $1,000 bonus payment 
        for each month in which such individual is in compliance with 
        the eligibility requirements of subsection (b)(2)(C).
    ``(d) Authorization of Appropriations.--
            ``(1) In general.--Notwithstanding any other amounts 
        appropriated under section 330 for health centers, there is 
        authorized to be appropriated $40,000,000 for each of fiscal 
        years 2004 through 2008 to hire and retain dental health care 
        providers under this section.
            ``(2) Use of funds.--Of the amount appropriated for a 
        fiscal year under paragraph (1), the Secretary shall use--
                    ``(A) not less than 75 percent of such amount to 
                make grants to eligible entities; and
                    ``(B) not more than 25 percent of such amount to 
                make grants to eligible individuals.''.

SEC. 302. SCHOOL-BASED DENTAL SEALANT PROGRAM.

    Section 317M(c) of the Public Health Service Act (42 U.S.C. 247b-
14) is amended--
            (1) in paragraph (1), by inserting ``and school-linked'' 
        after ``school-based'';
            (2) in the first sentence of paragraph (2)--
                    (A) by inserting ``and school-linked'' after 
                ``school-based''; and
                    (B) by inserting ``or Indian tribe'' after 
                ``State''; and
            (3) by striking paragraph (3) and inserting the following:
            ``(3) Eligibility.--To be eligible to receive funds under 
        paragraph (1), an entity shall--
                    ``(A) prepare and submit to the State or Indian 
                tribe an application at such time, in such manner and 
                containing such information as the State or Indian 
                tribe may require; and
                    ``(B) be a--
                            ``(i) public elementary or secondary 
                        school--
                                    ``(I) that is located in an urban 
                                area in which and more than 50 percent 
                                of the student population is 
                                participating in Federal or State free 
                                or reduced meal programs; or
                                    ``(II) that is located in a rural 
                                area and, with respect to the 
school district in which the school is located, the district involved 
has a median income that is at or below 235 percent of the poverty 
line, as defined in section 673(2) of the Community Services Block 
Grant Act (42 U.S.C. 9902(2)); or
                            ``(ii) public or non-profit health 
                        organization, including a grantee under section 
                        330, that is under contract with an elementary 
                        or secondary school described in subparagraph 
                        (B) to provide dental services to school-age 
                        children.''.

                       Subtitle B--Border Health

SEC. 311. SHORT TITLE.

    This subtitle may be cited as the ``Border Health Security Act of 
2003''.

SEC. 312. DEFINITIONS.

    In this subtitle:
            (1) Border area.--The term ``border area'' has the meaning 
        given the term ``United States-Mexico Border Area'' in section 
        8 of the United States-Mexico Border Health Commission Act (22 
        U.S.C. 290n-6).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 313. BORDER HEALTH SERVICES GRANTS.

    (a) Eligible Entity Defined.--In this section, the term ``eligible 
entity'' means a State, public institution of higher education, local 
government, tribal government, nonprofit health organization, or 
community health center receiving assistance under section 330 of the 
Public Health Service Act (42 U.S.C. 254b), that is located in the 
border area.
    (b) Authorization.--From funds appropriated under subsection (f), 
the Secretary, acting through the United States members of the United 
States-Mexico Border Health Commission, shall award grants to eligible 
entities to address priorities and recommendations to improve the 
health of border area residents that are established by--
            (1) the United States members of the United States-Mexico 
        Border Health Commission;
            (2) the State border health offices; and
            (3) the Secretary.
    (c) Application.--An eligible entity that desires a grant under 
subsection (b) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    (d) Use of Funds.--An eligible entity that receives a grant under 
subsection (b) shall use the grant funds for--
            (1) programs relating to--
                    (A) maternal and child health;
                    (B) primary care and preventative health;
                    (C) public health and public health infrastructure;
                    (D) health promotion;
                    (E) oral health;
                    (F) behavioral and mental health;
                    (G) substance abuse;
                    (H) health conditions that have a high prevalence 
                in the border area;
                    (I) medical and health services research;
                    (J) community health workers or promotoras;
                    (K) health care infrastructure problems in the 
                border area (including planning and construction 
                grants);
                    (L) health disparities in the border area;
                    (M) environmental health;
                    (N) health education; and
                    (O) outreach and enrollment services with respect 
                to Federal programs (including programs authorized 
                under titles XIX and XXI of the Social Security Act (42 
                U.S.C. 1396 and 1397aa)); and
            (2) other programs determined appropriate by the Secretary.
    (e) Supplement, Not Supplant.--Amounts provided to an eligible 
entity awarded a grant under subsection (b) shall be used to supplement 
and not supplant other funds available to the eligible entity to carry 
out the activities described in subsection (d).
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $200,000,000 for fiscal year 
2004, and such sums as may be necessary for each succeeding fiscal 
year.

SEC. 314. BORDER BIOTERRORISM PREPAREDNESS GRANTS.

    (a) Eligible Entity Defined.--In this section, the term ``eligible 
entity'' means a State, local government, or public health entity.
    (b) Authorization.--From funds appropriated under subsection (e), 
the Secretary shall award grants to eligible entities for bioterrorism 
preparedness in the border area.
    (c) Application.--An eligible entity that desires a grant under 
this section shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the Secretary may 
require.
    (d) Uses of Funds.--An eligible entity that receives a grant under 
subsection (b) shall use the grant funds to--
            (1) develop and implement bioterror preparedness plans and 
        readiness assessments and purchase items necessary for such 
        plans;
            (2) coordinate bioterrorism and emergency preparedness 
        planning in the region;
            (3) improve infrastructure, including surveillance and 
        laboratory capacity;
            (4) create a health alert network, including risk 
        communication and information dissemination;
            (5) educate and train clinicians, epidemiologists, 
        laboratories, and emergency personnel; and
            (6) carry out such other activities identified by the 
        Secretary, State and local public health offices, and border 
        health offices.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $25,000,000 for fiscal year 2004 
and such sums as may be necessary for each succeeding fiscal year.

SEC. 315. UNITED STATES-MEXICO BORDER HEALTH COMMISSION ACT AMENDMENTS.

    The United States-Mexico Border Health Commission Act (22 U.S.C. 
290n et seq.) is amended by adding at the end the following:

``SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated to carry out this Act 
$10,000,000 for fiscal year 2004 and such sums as may be necessary for 
each succeeding fiscal year.''.

Subtitle C--Patient Navigator, Outreach, and Chronic Disease Prevention

SEC. 321. SHORT TITLE.

    This title may be cited as the ``Patient Navigator, Outreach, and 
Chronic Disease Prevention Act of 2003''.

SEC. 322. HRSA GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE 
              CARE AND PREVENTION; HRSA GRANTS FOR PATIENT NAVIGATORS.

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

``SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE AND 
              PREVENTION; PATIENT NAVIGATORS.

    ``(a) Model Community Cancer and Chronic Disease Care and 
Prevention.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may make grants to public and nonprofit private 
        health centers (including health centers under section 330, 
        Indian Health Service Centers, tribal governments, urban Indian 
        organizations, tribal organizations, clinics serving Asian 
        Americans and Pacific Islanders and Alaskan Natives, and rural 
        health clinics and qualified nonprofit entities that partner 
        with one or more centers providing health care to provide 
        navigation services, which demonstrate the ability to perform 
all of the functions outlined in this subsection and subsections (b) 
and (c)) for the development and operation of model programs that--
                    ``(A) provide to individuals of health disparity 
                populations prevention, early detection, treatment, and 
                appropriate follow-up care services for cancer and 
                chronic diseases;
                    ``(B) ensure that the health services are provided 
                to such individuals in a culturally competent manner;
                    ``(C) assign patient navigators, in accordance with 
                applicable criteria of the Secretary, for managing the 
                care of individuals of health disparity populations 
                to--
                            ``(i) accomplish, to the extent possible, 
                        the follow-up and diagnosis of an abnormal 
                        finding and the treatment and appropriate 
                        follow-up care of cancer or other chronic 
                        disease; and
                            ``(ii) facilitate access to appropriate 
                        health care services within the health care 
                        system to ensure optimal patient utilization of 
                        such services, including aid in coordinating 
                        and scheduling appointments and referrals, 
                        community outreach, assistance with 
                        transportation arrangements, and assistance 
                        with insurance issues and other barriers to 
                        care and providing information about clinical 
                        trials;
                    ``(D) require training for patient navigators 
                employed through such model programs to ensure the 
                ability of navigators to perform all of the duties 
required in this subsection and in subsection (b), including training 
to ensure that navigators are informed about health insurance systems 
and are able to aid patients in resolving access issues; and
                    ``(E) ensure that consumers have direct access to 
                patient navigators during regularly scheduled hours of 
                business operation.
            ``(2) Outreach services.--A condition for the receipt of a 
        grant under paragraph (1) is that the applicant involved agree 
        to provide ongoing outreach activities while receiving the 
        grant, in a manner that is culturally competent for the health 
        disparity population served by the program, to inform the 
        public and the specific community that the program is serving 
        of the services of the model program under the grant. Such 
        activities shall include facilitating access to appropriate 
        health care services and patient navigators within the health 
        care system to ensure optimal patient utilization of these 
        services.
            ``(3) Data collection and report.--In order to allow for 
        effective program evaluation, the grantee shall collect 
        specific patient data recording services provided to each 
        patient served by the program and shall establish and implement 
        procedures and protocols, consistent with applicable Federal 
        and State laws (including 45 C.F.R. 160 and 164) to ensure the 
        confidentiality of all information shared by a participant in 
        the program, or their personal representative and their health 
        care providers, group health plans, or health insurance 
        insurers with the program. The program may, consistent with 
        applicable Federal and State confidentiality laws, collect, use 
        or disclose aggregate information that is not individually 
        identifiable (as defined in 45 C.F.R. 160 and 164). With this 
        data, the grantee shall submit an annual report to the 
        Secretary that summarizes and analyzes these data, provides 
        information on needs for navigation services, types of access 
        difficulties resolved, sources of repeated resolution and flaws 
        in the system of access, including insurance barriers.
            ``(4) Application for grant.--A grant may be made under 
        paragraph (1) only if an application for the grant is submitted 
        to the Secretary and the application is in such form, is made 
        in such manner, and contains such agreements, assurances, and 
        information as the Secretary determines to be necessary to 
        carry out this section.
            ``(5) Evaluations.--
                    ``(A) In general.--The Secretary, acting through 
                the Administrator of the Health Resources and Services 
                Administration, shall, directly or through grants or 
                contracts, provide for evaluations to determine which 
                outreach activities under paragraph (2) were most 
                effective in informing the public and the specific 
                community that the program is serving of the model 
                program services and to determine the extent to which 
                such programs were effective in providing culturally 
                competent services to the health disparity population 
                served by the programs.
                    ``(B) Dissemination of findings.--The Secretary 
                shall as appropriate disseminate to public and private 
                entities the findings made in evaluations under 
                subparagraph (A).
            ``(6) Coordination with other programs.--The Secretary 
        shall coordinate the program under this subsection with the 
        program under subsection (b), with the program under section 
        417D, and to the extent practicable, with programs for 
        prevention centers that are carried out by the Director of the 
        Centers for Disease Control and Prevention.
    ``(b) Program for Patient Navigators.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may make grants to public and nonprofit private 
        health centers (including health centers under section 330, 
        Indian Health Service Centers, tribal governments, urban Indian 
        organizations, tribal organizations, clinics serving Asian 
        Americans and Pacific Islanders and Alaskan Natives, and rural 
        health clinics and qualified nonprofit entities that partner 
        with one or more centers providing health care to provide 
        navigation services, which demonstrate the ability to perform 
        all of the functions outlined in this subsection and 
        subsections (a) and (c)) for the development and operation of 
        programs to pay the costs of such health centers in--
                    ``(A) assigning patient navigators, in accordance 
                with applicable criteria of the Secretary, for managing 
                the care of individuals of health disparity populations 
                for the duration of receiving health services from the 
                health centers, including aid in coordinating and 
                scheduling appointments and referrals, community 
                outreach, assistance with transportation arrangements, 
                and assistance with insurance issues and other barriers 
to care and providing information about clinical trials;
                    ``(B) ensuring that the services provided by the 
                patient navigators to such individuals include case 
                management and psychosocial assessment and care or 
                information and referral to such services;
                    ``(C) ensuring that patient navigators with direct 
                knowledge of the communities they serve provide 
                services to such individuals in a culturally competent 
                manner;
                    ``(D) developing model practices for patient 
                navigators, including with respect to--
                            ``(i) coordination of health services, 
                        including psychosocial assessment and care;
                            ``(ii) appropriate follow-up care, 
                        including psychosocial assessment and care;
                            ``(iii) determining coverage under health 
                        insurance and health plans for all services;
                            ``(iv) ensuring the initiation, 
                        continuation and/or sustained access to care 
                        prescribed by the patients' health care 
                        providers; and
                            ``(v) aiding patients with health insurance 
                        coverage issues;
                    ``(E) requiring training for patient navigators to 
                ensure the ability of navigators to perform all of the 
                duties required in this subsection and in subsection 
                (a), including training to ensure that navigators are 
                informed about health insurance systems and are able to 
                aid patients in resolving access issues; and
                    ``(F) ensuring that consumers have direct access to 
                patient navigators during regularly scheduled hours of 
                business operation.
            ``(2) Outreach services.--A condition for the receipt of a 
        grant under paragraph (1) is that the applicant involved agree 
        to provide ongoing outreach activities while receiving the 
        grant, in a manner that is culturally competent for the health 
        disparity population served by the program, to inform the 
        public and the specific community that the patient navigator is 
        serving of the services of the model program under the grant.
            ``(3) Data collection and report.--In order to allow for 
        effective patient navigator program evaluation, the grantee 
        shall collect specific patient data recording navigation 
        services provided to each patient served by the program and 
        shall establish and implement procedures and protocols, 
        consistent with applicable Federal and State laws (including 45 
        C.F.R. 160 and 164) to ensure the confidentiality of all 
        information shared by a participant in the program, or their 
        personal representative and their health care providers, group 
        health plans, or health insurance insurers with the program. 
        The patient navigator program may, consistent with applicable 
        Federal and State confidentiality laws, collect, use or 
        disclose aggregate information that is not individually 
        identifiable (as defined in 45 C.F.R. 160 and 164). With this 
        data, the grantee shall submit an annual report to the 
        Secretary that summarizes and analyzes these data, provides 
        information on needs for navigation services, types of access 
        difficulties resolved, sources of repeated resolution and flaws 
        in the system of access, including insurance barriers.
            ``(4) Application for grant.--A grant may be made under 
        paragraph (1) only if an application for the grant is submitted 
        to the Secretary and the application is in such form, is made 
        in such manner, and contains such agreements, assurances, and 
        information as the Secretary determines to be necessary to 
        carry out this section.
            ``(5) Evaluations.--
                    ``(A) In general.--The Secretary, acting through 
                the Administrator of the Health Resources and Services 
                Administration, shall, directly or through grants or 
                contracts, provide for evaluations to determine the 
                effects of the services of patient navigators on the 
                individuals of health disparity populations for whom 
                the services were provided, taking into account the 
                matters referred to in paragraph (1)(C).
                    ``(B) Dissemination of findings.--The Secretary 
                shall as appropriate disseminate to public and private 
                entities the findings made in evaluations under 
                subparagraph (A).
            ``(6) Coordination with other programs.--The Secretary 
        shall coordinate the program under this subsection with the 
        program under subsection (a) and with the program under section 
        417D.
    ``(c) Requirements Regarding Fees.--
            ``(1) In general.--A condition for the receipt of a grant 
        under subsection (a)(1) or (b)(1) is that the program for which 
the grant is made have in effect--
                    ``(A) a schedule of fees or payments for the 
                provision of its health care services related to the 
                prevention and treatment of disease that is consistent 
                with locally prevailing rates or charges and is 
                designed to cover its reasonable costs of operation; 
                and
                    ``(B) a corresponding schedule of discounts to be 
                applied to the payment of such fees or payments, which 
                discounts are adjusted on the basis of the ability of 
                the patient to pay.
            ``(2) Rule of construction.--Nothing in this section shall 
        be construed to require payment for navigation services or to 
        require payment for health care services in cases where care is 
        provided free of charge, including the case of services 
        provided through programs of the Indian Health Service.
    ``(d) Model.--Not later than five years after the date of the 
enactment of this section, the Secretary shall develop a peer-reviewed 
model of systems for the services provided by this section. The 
Secretary shall update such model as may be necessary to ensure that 
the best practices are being utilized.
    ``(e) Duration of Grant.--The period during which payments are made 
to an entity from a grant under subsection (a)(1) or (b)(1) may not 
exceed five years. The provision of such payments are subject to annual 
approval by the Secretary of the payments and subject to the 
availability of appropriations for the fiscal year involved to make the 
payments. This subsection may not be construed as establishing a 
limitation on the number of grants under such subsection that may be 
made to an entity.
    ``(f) Definitions.--For purposes of this section:
            ``(1) The term `culturally competent', with respect to 
        providing health-related services, means services that, in 
        accordance with standards and measures of the Secretary, are 
        designed to effectively and efficiently respond to the cultural 
        and linguistic needs of patients.
            ``(2) The term `appropriate follow-up care' includes 
        palliative and end-of-life care.
            ``(3) The term `health disparity population' means a 
        population where there exists a significant disparity in the 
        overall rate of disease incidence, morbidity, mortality, or 
        survival rates in the population as compared to the health 
        status of the general population. Such term includes--
                    ``(A) racial and ethnic minority groups as defined 
                in section 1707; and
                    ``(B) medically underserved groups, such as rural 
                and low-income individuals and individuals with low 
                levels of literacy.
            ``(4)(A) The term `patient navigator' means an individual 
        whose functions include--
                    ``(i) assisting and guiding patients with a symptom 
                or an abnormal finding or diagnosis of cancer or other 
                chronic disease within the health care system to 
                accomplish the follow-up and diagnosis of an abnormal 
                finding as well as the treatment and appropriate 
                follow-up care of cancer or other chronic disease 
                including providing information about clinical trials; 
                and
                    ``(ii) identifying, anticipating, and helping 
                patients overcome barriers within the health care 
                system to ensure prompt diagnostic and treatment 
                resolution of an abnormal finding of cancer or other 
                chronic disease.
            ``(B) Such term includes representatives of the target 
        health disparity population, such as nurses, social workers, 
        cancer survivors, and patient advocates.
    ``(g) Authorization of Appropriations.--
            ``(1) In general.--
                    ``(A) Model programs.--For the purpose of carrying 
                out subsection (a) (other than the purpose described in 
                paragraph (2)(A)), there are authorized to be 
                appropriated such sums as may be necessary for each of 
                the fiscal years 2004 through 2008.
                    ``(B) Patient navigators.--For the purpose of 
                carrying out subsection (b) (other than the purpose 
                described in paragraph (2)(B)), there are authorized to 
                be appropriated such sums as may be necessary for each 
                of the fiscal years 2004 through 2008.
                    ``(C) Bureau of primary health care.--Amounts 
                appropriated under subparagraph (A) or (B) shall be 
                administered through the Bureau of Primary Health Care.
            ``(2) Programs in rural areas.--
                    ``(A) Model programs.--For the purpose of carrying 
                out subsection (a) by making grants under such 
                subsection for model programs in rural areas, there are 
                authorized to be appropriated such sums as may be 
                necessary for each of the fiscal years 2004 through 
                2008.
                    ``(B) Patient navigators.--For the purpose of 
                carrying out subsection (b) by making grants under such 
                subsection for programs in rural areas, there are 
                authorized to be appropriated such sums as may be 
                necessary for each of the fiscal years 2004 through 
                2008.
                    ``(C) Office of rural health policy.--Amounts 
                appropriated under subparagraph (A) or (B) shall be 
                administered through the Office of Rural Health Policy.
            ``(3) Relation to other authorizations.--Authorizations of 
        appropriations under paragraphs (1) and (2) are in addition to 
        other authorizations of appropriations that are available for 
        the purposes described in such paragraphs.''.

SEC. 323. NCI GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE 
              CARE AND PREVENTION; NCI GRANTS FOR PATIENT NAVIGATORS.

    Subpart 1 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285 et seq.) is amended by adding at the end following:

``SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC DISEASE CARE AND 
              PREVENTION; PATIENT NAVIGATORS.

    ``(a) Model Community Cancer and Chronic Disease Care and 
Prevention.--
            ``(1) In general.--The Director of the Institute may make 
        grants to eligible entities for the development and operation 
        of model programs that--
                    ``(A) provide to individuals of health disparity 
                populations prevention, early detection, treatment, and 
                appropriate follow-up care services for cancer and 
                chronic diseases;
                    ``(B) ensure that the health services are provided 
                to such individuals in a culturally competent manner;
                    ``(C) assign patient navigators, in accordance with 
                applicable criteria of the Secretary, for managing the 
                care of individuals of health disparity populations 
                to--
                            ``(i) accomplish, to the extent possible, 
                        the follow-up and diagnosis of an abnormal 
                        finding and the treatment and appropriate 
                        follow-up care of cancer or other chronic 
                        disease; and
                            ``(ii) facilitate access to appropriate 
                        health care services within the health care 
                        system to ensure optimal patient utilization of 
                        such services, including aid in coordinating 
                        and scheduling appointments and referrals, 
                        community outreach, assistance with 
                        transportation arrangements, and assistance 
                        with insurance issues and other barriers to 
                        care and providing information about clinical 
                        trials;
                    ``(D) require training for patient navigators 
                employed through such model programs to ensure the 
                ability of navigators to perform all of the duties 
                required in this subsection and in subsection (b), 
                including training to ensure that navigators are 
                informed about health insurance systems and are able to 
                aid patients in resolving access issues; and
                    ``(E) ensure that consumers have direct access to 
                patient navigators during regularly scheduled hours of 
                business operation.
            ``(2) Eligible entities.--For purposes of this section, an 
        eligible entity is a designated cancer center of the Institute, 
        an academic institution, Indian Health Service Clinics, tribal 
        governments, urban Indian organizations, tribal organizations, 
        a hospital, a qualified nonprofit entity that partners with one 
        or more centers providing health care to provide navigation 
        services, which demonstrates the ability to perform all of the 
        functions outlined in this subsection and subsections (b) and 
        (c), or any other public or private entity determined to be 
        appropriate by the Director of the Institute, that provides 
        services described in paragraph (1)(A) for cancer and chronic 
        diseases.
            ``(3) Data collection and report.--In order to allow for 
        effective program evaluation, the grantee shall collect 
        specific patient data recording services provided to each 
        patient served by the program and shall establish and implement 
        procedures and protocols, consistent with applicable Federal 
        and State laws (including 45 C.F.R. 160 and 164) to ensure the 
        confidentiality of all information shared by a participant in 
        the program, or their personal representative and their health 
        care providers, group health plans, or health insurance 
        insurers with the program. The program may, consistent with 
        applicable Federal and State confidentiality laws, collect, use 
        or disclose aggregate information that is not individually 
        identifiable (as defined in 45 CFR 160 and 164). With this 
        data, the grantee shall submit an annual report to the 
        Secretary that summarizes and analyzes these data, provides 
information on needs for navigation services, types of access 
difficulties resolved, sources of repeated resolution and flaws in the 
system of access, including insurance barriers.
            ``(4) Outreach services.--A condition for the receipt of a 
        grant under paragraph (1) is that the applicant involved agree 
        to provide ongoing outreach activities while receiving the 
        grant, in a manner that is culturally competent for the health 
        disparity population served by the program, to inform the 
        public and the specific community that the program is serving 
        of the services of the model program under the grant. Such 
        activities shall include facilitating access to appropriate 
        health care services and patient navigators within the health 
        care system to ensure optimal patient utilization of these 
        services.
            ``(5) Application for grant.--A grant may be made under 
        paragraph (1) only if an application for the grant is submitted 
        to the Director of the Institute and the application is in such 
        form, is made in such manner, and contains such agreements, 
        assurances, and information as the Director determines to be 
        necessary to carry out this section.
            ``(6) Evaluations.--
                    ``(A) In general.--The Director of the Institute, 
                directly or through grants or contracts, shall provide 
                for evaluations to determine which outreach activities 
                under paragraph (3) were most effective in informing 
                the public and the specific community that the program 
                is serving of the model program services and to 
                determine the extent to which such programs were 
                effective in providing culturally competent services to 
                the health disparity population served by the programs.
                    ``(B) Dissemination of findings.--The Director of 
                the Institute shall as appropriate disseminate to 
                public and private entities the findings made in 
                evaluations under subparagraph (A).
            ``(7) Coordination with other programs.--The Secretary 
        shall coordinate the program under this subsection with the 
        program under subsection (b), with the program under section 
330I, and to the extent practicable, with programs for prevention 
centers that are carried out by the Director of the Centers for Disease 
Control and Prevention.
    ``(b) Program for Patient Navigators.--
            ``(1) In general.--The Director of the Institute may make 
        grants to eligible entities for the development and operation 
        of programs to pay the costs of such entities in--
                    ``(A) assigning patient navigators, in accordance 
                with applicable criteria of the Secretary, for managing 
                the care of individuals of health disparity populations 
                for the duration of receiving health services from the 
                health centers, including aid in coordinating and 
                scheduling appointments and referrals, community 
                outreach, assistance with transportation arrangements, 
                and assistance with insurance issues and other barriers 
                to care and providing information about clinical 
                trials;
                    ``(B) ensuring that the services provided by the 
                patient navigators to such individuals include case 
                management and psychosocial assessment and care or 
                information and referral to such services;
                    ``(C) ensuring that the patient navigators with 
                direct knowledge of the communities they serve provide 
                services to such individuals in a culturally competent 
                manner;
                    ``(D) developing model practices for patient 
                navigators, including with respect to--
                            ``(i) coordination of health services, 
                        including psychosocial assessment and care;
                            ``(ii) follow-up services, including 
                        psychosocial assessment and care;
                            ``(iii) determining coverage under health 
                        insurance and health plans for all services;
                            ``(iv) ensuring the initiation, 
                        continuation and/or sustained access to care 
                        prescribed by the patients' health care 
                        providers; and
                            ``(v) aiding patients with health insurance 
                        coverage issues;
                    ``(E) requiring training for patient navigators to 
                ensure the ability of navigators to perform all of the 
                duties required in this subsection and in subsection 
                (a), including training to ensure that navigators are 
                informed about health insurance systems and are able to 
                aid patients in resolving access issues; and
                    ``(F) ensuring that consumers have direct access to 
                patient navigators during regularly scheduled hours of 
                business operation.
            ``(2) Outreach services.--A condition for the receipt of a 
        grant under paragraph (1) is that the applicant involved agree 
        to provide ongoing outreach activities while receiving the 
        grant, in a manner that is culturally competent for the health 
        disparity population served by the program, to inform the 
        public and the specific community that the patient navigator is 
        serving of the services of the model program under the grant.
            ``(3) Data collection and report.--In order to allow for 
        effective patient navigator program evaluation, the grantee 
        shall collect specific patient data recording navigation 
        services provided to each patient served by the program and 
        shall establish and implement procedures and protocols, 
        consistent with applicable Federal and State laws (including 45 
        C.F.R. 160 and 164) to ensure the confidentiality of all 
        information shared by a participant in the program, or their 
        personal representative and their health care providers, group 
        health plans, or health insurance insurers with the program. 
        The patient navigator program may, consistent with applicable 
        Federal and State confidentiality laws, collect, use or 
        disclose aggregate information that is not individually 
        identifiable (as defined in 45 C.F.R. 160 and 164). With this 
        data, the grantee shall submit an annual report to the 
        Secretary that summarizes and analyzes these data, provides 
        information on needs for navigation services, types of access 
        difficulties resolved, sources of repeated resolution and flaws 
        in the system of access, including insurance barriers.
            ``(4) Application for grant.--A grant may be made under 
        paragraph (1) only if an application for the grant is submitted 
        to the Director of the Institute and the application is in such 
        form, is made in such manner, and contains such agreements, 
        assurances, and information as the Director determines to be 
        necessary to carry out this section.
            ``(5) Evaluations.--
                    ``(A) In general.--The Director of the Institute, 
                directly or through grants or contracts, shall provide 
                for evaluations to determine the effects of the 
                services of patient navigators on the health disparity 
                population for whom the services were provided, taking 
                into account the matters referred to in paragraph 
                (1)(C).
                    ``(B) Dissemination of findings.--The Director of 
                the Institute shall as appropriate disseminate to 
                public and private entities the findings made in 
                evaluations under subparagraph (A).
            ``(6) Coordination with other programs.--The Secretary 
        shall coordinate the program under this subsection with the 
        program under subsection (a) and with the program under section 
        330I.
    ``(c) Requirements Regarding Fees.--
            ``(1) In general.--A condition for the receipt of a grant 
        under subsection (a)(1) or (b)(1) is that the program for which 
        the grant is made have in effect--
                    ``(A) a schedule of fees or payments for the 
                provision of its health care services related to the 
                prevention and treatment of disease that is consistent 
                with locally prevailing rates or charges and is 
                designed to cover its reasonable costs of operation; 
                and
                    ``(B) a corresponding schedule of discounts to be 
                applied to the payment of such fees or payments, which 
                discounts are adjusted on the basis of the ability of 
                the patient to pay.
            ``(2) Rule of construction.--Nothing in this section shall 
        be construed to require payment for navigation services or to 
        require payment for health care services in cases where care is 
        provided free of charge, including the case of services 
        provided through programs of the Indian Health Service.
    ``(d) Model.--Not later than five years after the date of the 
enactment of this section, the Director of the Institute shall develop 
a peer-reviewed model of systems for the services provided by this 
section. The Director shall update such model as may be necessary to 
ensure that the best practices are being utilized.
    ``(e) Duration of Grant.--The period during which payments are made 
to an entity from a grant under subsection (a)(1) or (b)(1) may not 
exceed five years. The provision of such payments are subject to annual 
approval by the Director of the Institute of the payments and subject 
to the availability of appropriations for the fiscal year involved to 
make the payments. This subsection may not be construed as establishing 
a limitation on the number of grants under such subsection that may be 
made to an entity.
    ``(f) Definitions.--For purposes of this section:
            ``(1) The term `culturally competent', with respect to 
        providing health-related services, means services that, in 
        accordance with standards and measures of the Secretary, are 
        designed to effectively and efficiently respond to the cultural 
        and linguistic needs of patients.
            ``(2) the term `appropriate follow-up care' includes 
        palliative and end-of-life care.
            ``(3) the term `health disparity population' means a 
        population where there exists a significant disparity in the 
        overall rate of disease incidence, morbidity, mortality, or 
        survival rates in the population as compared to the health 
        status of the general population. Such term includes--
                    ``(A) racial and ethnic minority groups as defined 
                in section 1707; and
                    ``(B) medically underserved groups, such as rural 
                and low-income individuals and individuals with low 
                levels of literacy.
            ``(4)(A) the term `patient navigator' means an individual 
        whose functions include--
                    ``(i) assisting and guiding patients with a symptom 
                or an abnormal finding or diagnosis of cancer or other 
                chronic disease within the health care system to 
                accomplish the follow-up and diagnosis of an abnormal 
                finding as well as the treatment and appropriate 
                follow-up care of cancer or other chronic disease, 
                including providing information about clinical trials; 
                and
                    ``(ii) identifying, anticipating, and helping 
                patients overcome barriers within the health care 
                system to ensure prompt diagnostic and treatment 
                resolution of an abnormal finding of cancer or other 
                chronic disease.
            ``(B) Such term includes representatives of the target 
        health disparity population, such as nurses, social workers, 
        cancer survivors, and patient advocates.
    ``(g) Authorization of Appropriations.--
            ``(1) Model programs.--For the purpose of carrying out 
        subsection (a), there are authorized to be appropriated such 
        sums as may be necessary for each of the fiscal years 2004 
        through 2008.
            ``(2) Patient navigators.--For the purpose of carrying out 
        subsection (b), there are authorized to be appropriated such 
        sums as may be necessary for each of the fiscal years 2004 
        through 2008.
            ``(3) Relation to other authorizations.--Authorizations of 
        appropriations under paragraphs (1) and (2) are in addition to 
        other authorizations of appropriations that are available for 
        the purposes described in such paragraphs.''.

SEC. 324. IHS GRANTS FOR MODEL COMMUNITY CANCER AND CHRONIC DISEASE 
              CARE AND PREVENTION; IHS GRANTS FOR PATIENT NAVIGATORS.

    (a) Model Community Cancer and Chronic Disease Care and 
Prevention.--
            (1) In general.--The Director of the Indian Health Service 
        may make grants to Indian Health Service Centers, tribal 
        governments, urban Indian organizations, tribal organizations, 
        and qualified nonprofit entities demonstrating the ability to 
        perform all of the functions outlined in this subsection and 
        subsections (b) and (c) that partner with providers or centers 
        providing health care serving Native American populations to 
        provide navigation services, for the development and operation 
        of model programs that--
                    (A) provide to individuals of health disparity 
                populations prevention, early detection, treatment, and 
appropriate follow-up care services for cancer and chronic diseases;
                    (B) ensure that the health services are provided to 
                such individuals in a culturally competent manner;
                    (C) assign patient navigators, in accordance with 
                applicable criteria of the Secretary, for managing the 
                care of individuals of health disparity populations 
                to--
                            (i) accomplish, to the extent possible, the 
                        follow-up and diagnosis of an abnormal finding 
                        and the treatment and appropriate follow-up 
                        care of cancer or other chronic disease; and
                            (ii) facilitate access to appropriate 
                        health care services within the health care 
                        system to ensure optimal patient utilization of 
                        such services, including aid in coordinating 
                        and scheduling appointments and referrals, 
                        community outreach, assistance with 
                        transportation arrangements, and assistance 
                        with insurance issues and other barriers to 
                        care and providing information about clinical 
                        trials;
                    (D) require training for patient navigators 
                employed through such model programs to ensure the 
                ability of navigators to perform all of the duties 
required in this subsection and in subsection (b), including training 
to ensure that navigators are informed about health insurance systems 
and are able to aid patients in resolving access issues; and
                    (E) ensure that consumers have direct access to 
                patient navigators during regularly scheduled hours of 
                business operation.
            (2) Outreach services.--A condition for the receipt of a 
        grant under paragraph (1) is that the applicant involved agree 
        to provide ongoing outreach activities while receiving the 
        grant, in a manner that is culturally competent for the health 
        disparity population served by the program, to inform the 
        public and the specific community that the program is serving 
        of the services of the model program under the grant. Such 
        activities shall include facilitating access to appropriate 
        health care services and patient navigators within the health 
        care system to ensure optimal patient utilization of these 
        services.
            (3) Data collection and report.--In order to allow for 
        effective program evaluation, the grantee shall collect 
        specific patient data recording services provided to each 
        patient served by the program and shall establish and implement 
        procedures and protocols, consistent with applicable Federal 
        and State laws (including 45 C.F.R. 160 and 164) to ensure the 
        confidentiality of all information shared by a participant in 
        the program, or their personal representative and their health 
        care providers, group health plans, or health insurance 
        insurers with the program. The program may, consistent with 
        applicable Federal and State confidentiality laws, collect, use 
        or disclose aggregate information that is not individually 
        identifiable (as defined in 45 C.F.R. 160 and 164). With this 
        data, the grantee shall submit an annual report to the 
        Secretary that summarizes and analyzes these data, provides 
        information on needs for navigation services, types of access 
        difficulties resolved, sources of repeated resolution and flaws 
        in the system of access, including insurance barriers.
            (4) Application for grant.--A grant may be made under 
        paragraph (1) only if an application for the grant is submitted 
        to the Secretary and the application is in such form, is made 
        in such manner, and contains such agreements, assurances, and 
        information as the Secretary determines to be necessary to 
        carry out this section.
            (5) Evaluations.--
                    (A) In general.--The Secretary, acting through the 
                Director of the Indian Health Service, shall, directly 
                or through grants or contracts, provide for evaluations 
                to determine which outreach activities under paragraph 
                (2) were most effective in informing the public and the 
                specific community that the program is serving of the 
                model program services and to determine the extent to 
                which such programs were effective in providing 
                culturally competent services to the health disparity 
                population served by the programs.
                    (B) Dissemination of findings.--The Secretary shall 
                as appropriate disseminate to public and private 
                entities the findings made in evaluations under 
                subparagraph (A).
            (6) Coordination with other programs.--The Secretary shall 
        coordinate the program under this subsection with the program 
        under subsection (b), with the program under section 417D, and 
        to the extent practicable, with programs for prevention centers 
        that are carried out by the Director of the Centers for Disease 
        Control and Prevention.
    (b) Program for Patient Navigators.--
            (1) In general.--The Secretary, acting through the Director 
        of the Indian Health Service, may make grants to Indian Health 
        Service Centers, tribal governments, urban Indian 
        organizations, tribal organizations, and qualified nonprofit 
        entities demonstrating the ability to perform all of the 
        functions outlined in this subsection and subsections (a) and 
        (c) that partner with providers or centers providing health 
        care serving Native American populations to provide navigation 
        services, for the development and operation of model programs 
        to pay the costs of such organizations in--
                    (A) assigning patient navigators, in accordance 
                with applicable criteria of the Secretary, for 
                individuals of health disparity populations for the 
                duration of receiving health services from the health 
                centers, including aid in coordinating and scheduling 
                appointments and referrals, community outreach, 
                assistance with transportation arrangements, and 
                assistance with insurance issues and other barriers to 
                care and providing information about clinical trials;
                    (B) ensuring that the services provided by the 
                patient navigators to such individuals include case 
                management and psychosocial assessment and care or 
                information and referral to such services;
                    (C) ensuring that patient navigators with direct 
                knowledge of the communities they serve provide 
                services to such individuals in a culturally competent 
                manner;
                    (D) developing model practices for patient 
                navigators, including with respect to--
                            (i) coordination of health services, 
                        including psychosocial assessment and care;
                            (ii) appropriate follow-up care, including 
                        psychosocial assessment and care;
                            (iii) determining coverage under health 
                        insurance and health plans for all services;
                            (iv) ensuring the initiation, continuation 
                        and/or sustained access to care prescribed by 
                        the patients' health care providers; and
                            (v) aiding patients with health insurance 
                        coverage issues;
                    (E) requiring training for patient navigators to 
                ensure the ability of navigators to perform all of the 
                duties required in this subsection and in subsection 
                (a), including training to ensure that navigators are 
                informed about health insurance systems and are able to 
                aid patients in resolving access issues; and
                    (F) ensuring that consumers have direct access to 
                patient navigators during regularly scheduled hours of 
                business operation.
            (2) Outreach services.--A condition for the receipt of a 
        grant under paragraph (1) is that the applicant involved agree 
        to provide ongoing outreach activities while receiving the 
        grant, in a manner that is culturally competent for the health 
        disparity population served by the program, to inform the 
        public and the specific community that the patient navigator is 
        serving of the services of the model program under the grant.
            (3) Data collection and report.--In order to allow for 
        effective patient navigator program evaluation, the grantee 
        shall collect specific patient data recording navigation 
        services provided to each patient served by the program and 
        shall establish and implement procedures and protocols, 
        consistent with applicable Federal and State laws (including 45 
        C.F.R. 160 and 164) to ensure the confidentiality of all 
        information shared by a participant in the program, or their 
        personal representative and their health care providers, group 
health plans, or health insurance insurers with the program. The 
patient navigator program may, consistent with applicable Federal and 
State confidentiality laws, collect, use or disclose aggregate 
information that is not individually identifiable (as defined in 45 
C.F.R. 160 and 164). With this data, the grantee shall submit an annual 
report to the Secretary that summarizes and analyzes these data, 
provides information on needs for navigation services, types of access 
difficulties resolved, sources of repeated resolution and flaws in the 
system of access, including insurance barriers.
            (4) Application for grant.--A grant may be made under 
        paragraph (1) only if an application for the grant is submitted 
        to the Secretary and the application is in such form, is made 
        in such manner, and contains such agreements, assurances, and 
        information as the Secretary determines to be necessary to 
        carry out this section.
            (5) Evaluations.--
                    (A) In general.--The Secretary, acting through the 
                Director of the Indian Health Service, shall, directly 
                or through grants or contracts, provide for evaluations 
                to determine the effects of the services of patient 
                navigators on the individuals of health disparity 
                populations for whom the services were provided, taking 
                into account the matters referred to in paragraph 
                (1)(C).
                    (B) Dissemination of findings.--The Secretary shall 
                as appropriate disseminate to public and private 
                entities the findings made in evaluations under 
                subparagraph (A).
            (6) Coordination with other programs.--The Secretary shall 
        coordinate the program under this subsection with the program 
        under subsection (a) and with the program under section 417D.
    (c) Requirements Regarding Fees.--
            (1) In general.--A condition for the receipt of a grant 
        under subsection (a)(1) or (b)(1) is that the program for which 
        the grant is made have in effect--
                    (A) a schedule of fees or payments for the 
                provision of its health care services related to the 
                prevention and treatment of disease that is consistent 
                with locally prevailing rates or charges and is 
                designed to cover its reasonable costs of operation; 
                and
                    (B) a corresponding schedule of discounts to be 
                applied to the payment of such fees or payments, which 
discounts are adjusted on the basis of the ability of the patient to 
pay.
            (2) Rule of construction.--Nothing in this section shall be 
        construed to require payment for navigation services or to 
        require payment for health care services in cases, such as with 
        the Indian Health Service, where care is provided free of 
        charge.
    (d) Model.--Not later than five years after the date of the 
enactment of this section, the Secretary shall develop a peer-reviewed 
model of systems for the services provided by this section. The 
Secretary shall update such model as may be necessary to ensure that 
the best practices are being utilized.
    (e) Duration of Grant.--The period during which payments are made 
to an entity from a grant under subsection (a)(1) or (b)(1) may not 
exceed five years. The provision of such payments are subject to annual 
approval by the Secretary of the payments and subject to the 
availability of appropriations for the fiscal year involved to make the 
payments. This subsection may not be construed as establishing a 
limitation on the number of grants under such subsection that may be 
made to an entity.
    (f) Definitions.--For purposes of this section:
            (1) The term ``culturally competent'', with respect to 
        providing health-related services, means services that, in 
        accordance with standards and measures of the Secretary, are 
        designed to effectively and efficiently respond to the cultural 
        and linguistic needs of patients.
            (2) The term ``appropriate follow-up care'' includes 
        palliative and end-of-life care.
            (3) The term ``health disparity population'' means a 
        population where there exists a significant disparity in the 
        overall rate of disease incidence, morbidity, mortality, or 
        survival rates in the population as compared to the health 
        status of the general population. Such term includes--
                    (A) racial and ethnic minority groups as defined in 
                section 1707; and
                    (B) medically underserved groups, such as rural and 
                low-income individuals and individuals with low levels 
                of literacy.
            (4)(A) The term ``patient navigator'' means an individual 
        whose functions include--
                    (i) assisting and guiding patients with a symptom 
                or an abnormal finding or diagnosis of cancer or other 
                chronic disease within the health care system to 
                accomplish the follow-up and diagnosis of an abnormal 
                finding as well as the treatment and appropriate 
                follow-up care of cancer or other chronic disease, 
                including providing information about clinical trials; 
                and
                    (ii) identifying, anticipating, and helping 
                patients overcome barriers within the health care 
                system to ensure prompt diagnostic and treatment 
                resolution of an abnormal finding of cancer or other 
                chronic disease.
            (B) Such term includes representatives of the target health 
        disparity population, such as nurses, social workers, cancer 
        survivors, and patient advocates.
    (g) Authorization of Appropriations.--
            (1) In general.--
                    (A) Model programs.--For the purpose of carrying 
                out subsection (a) (other than the purpose described in 
                paragraph (2)(A)), there are authorized to be 
                appropriated such sums as may be necessary for each of 
                the fiscal years 2004 through 2008.
                    (B) Patient navigators.--For the purpose of 
                carrying out subsection (b) (other than the purpose 
                described in paragraph (2)(B)), there are authorized to 
                be appropriated such sums as may be necessary for each 
                of the fiscal years 2004 through 2008.
                    (C) Bureau of primary health care.--Amounts 
                appropriated under subparagraph (A) or (B) shall be 
                administered through the Bureau of Primary Health Care.
            (2) Programs in rural areas.--
                    (A) Model programs.--For the purpose of carrying 
                out subsection (a) by making grants under such 
                subsection for model programs in rural areas, there are 
                authorized to be appropriated such sums as may be 
                necessary for each of the fiscal years 2004 through 
                2008.
                    (B) Patient navigators.--For the purpose of 
                carrying out subsection (b) by making grants under such 
                subsection for programs in rural areas, there are 
                authorized to be appropriated such sums as may be 
                necessary for each of the fiscal years 2004 through 
                2008.
                    (C) Office of rural health policy.--Amounts 
                appropriated under subparagraph (A) or (B) shall be 
                administered through the Office of Rural Health Policy.
            (3) Relation to other authorizations.--Authorizations of 
        appropriations under paragraphs (1) and (2) are in addition to 
other authorizations of appropriations that are available for the 
purposes described in such paragraphs.

           TITLE IV--STRENGTHENING OUR HEALTH CARE WORKFORCE

        Subtitle A--Hispanic-Serving Health Professions Schools

SEC. 401. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.

    (a) In General.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, shall make grants to 
Hispanic-serving health professions schools for the purpose of carrying 
out programs to recruit Hispanic individuals to enroll in and graduate 
from the schools, which may include providing scholarships and other 
financial assistance as appropriate.
    (b) Eligibility.--For purposes of subsection (a), an entity is a 
Hispanic-serving health professions school if the entity--
            (1) is a school or program under section 799B of the Public 
        Health Service Act (42 U.S.C. 295p);
            (2) has an enrollment of full-time equivalent students that 
        is at least 9 percent Hispanic students;
            (3) has been effective in carrying out programs to recruit 
        Hispanic individuals to enroll in and graduate from the school;
            (4) has been effective in recruiting and retaining Hispanic 
        faculty members; and
            (5) has a significant number of graduates who are providing 
        health services to medically underserved populations or to 
        individuals in health professional shortage areas.
    (c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $80,000,000 
for each of fiscal years 2004 through 2008.

Subtitle B--Health Career Opportunity Program and Centers of Excellence

SEC. 411. EDUCATIONAL ASSISTANCE REGARDING UNDERGRADUATES.

    (a) In General.--Subpart 2 of part E of title VII of the Public 
Health Service Act (42 U.S.C. 295 et seq) is amended by adding at the 
end the following:

``SEC. 771. HEALTH CAREERS OPPORTUNITY PROGRAM.

    ``(a) In General.--Subject to the provisions of this section, the 
Secretary may make grants and enter into cooperative agreements and 
contracts for any of the following purposes:
            ``(1) Identifying and recruiting individuals who--
                    ``(A) are students of elementary schools, or 
                students or graduates of secondary schools or of 
                institutions of higher education;
                    ``(B) are from disadvantaged backgrounds; and
                    ``(C) are interested in a career in the health 
                professions.
            ``(2) Facilitating the entry of such individuals into a 
        health professions school.
            ``(3) Providing counseling or other services designed to 
        assist such individuals in successfully completing their 
        education at such a school.
            ``(4) Providing, for a period prior to the entry of such 
        individuals into the regular course of education of such a 
        school, preliminary education designed to assist the 
        individuals in successfully completing such regular course of 
        education at such a school, or referring such individuals to 
        institutions providing such preliminary education.
            ``(5) Paying such stipends as the Secretary may approve for 
        such individuals for any period of education in student-
        enhancement programs (other than regular courses) at a health 
        professions school, except that such a stipend may not be 
        provided to an individual for more than 12 months, and such a 
        stipend may not exceed $25 per day (notwithstanding any other 
        provision of law regarding the amount of stipends).
            ``(6) Carrying out programs under which such individuals 
        both--
                    ``(A) gain experience regarding a career in a field 
                of primary health care through working at facilities of 
                nonprofit private community-based providers of primary 
                health services; and
                    ``(B) receive academic instruction to assist in 
                preparing the individuals to enter health professions 
                schools in such fields.
    ``(b) Receipt of Award.--
            ``(1) Eligible entities; requirement of consortium.--The 
        Secretary may make an award under subsection (a) only if the 
        following conditions are met:
                    ``(A) The applicant for the award is a public or 
                nonprofit private entity, and the applicant has 
                established a consortium consisting of nonprofit 
private community-based organizations and health professions schools.
                    ``(B) The health professions schools of the 
                consortium are schools of medicine or osteopathic 
                medicine, public health, dentistry, veterinary 
                medicine, optometry, pharmacy, allied health, 
                chiropractic, or podiatric medicine, or graduate 
                programs in mental health practice (including such 
                programs in clinical psychology).
                    ``(C) Except as provided in subparagraph (D), the 
                membership of the consortium includes not less than one 
                nonprofit private community-based organization and not 
                less than three health professions schools.
                    ``(D) In the case of an applicant whose exclusive 
                activity under the award will be carrying out one or 
                more programs described in subsection (a)(6), the 
                membership of the consortium includes not less than one 
                nonprofit private community-based organization and not 
                less than one health professions schools.
                    ``(E) The members of the consortium have entered 
                into an agreement specifying--
                            ``(i) that each of the members will comply 
                        with the conditions upon which the award is 
                        made; and
                            ``(ii) whether and to what extent the award 
                        will be allocated among the members.
            ``(2) Requirement of competitive awards.--Awards under 
        subsection (a) shall be made only on a competitive basis.
    ``(c) Financial Requirements.--
            ``(1) Assurances regarding capacity.--The Secretary may 
        make an award under subsection (a) only if the Secretary 
        determines that, in the case of activities carried out under 
        the award that prove to be effective toward achieving the 
        purposes of the
        activities--
                    ``(A) the members of the consortium involved have 
                or will have the financial capacity to continue the 
                activities, regardless of whether financial assistance 
                under subsection (a) continues to be available; and
                    ``(B) the members of the consortium demonstrate to 
                the satisfaction of the Secretary a commitment to 
                continue such activities, regardless of whether such 
                assistance continues to be available.
            ``(2) Matching funds.--
                    ``(A) In general.--With respect to the costs of the 
                activities to be carried out under subsection (a) by an 
                applicant, the Secretary may make an award under such 
                subsection only if the applicant agrees to make 
                available in cash (directly or through donations from 
                public or private entities) non-Federal contributions 
                toward such costs in an amount that, for any fourth or 
                subsequent fiscal year for which the applicant receives 
                such an award, is not less than 50 percent of such 
                costs.
                    ``(B) Federal amounts.--Amounts provided by the 
                Federal Government may not be included in determining 
                the amount of non-Federal contributions required in 
                subparagraph (A).
                    ``(C) Limitation.--The Secretary may not require 
                non-Federal contributions for the first three fiscal 
                years for which an applicant receives a grant under 
                subsection (a).
    ``(d) Preference in Making Awards.--
            ``(1) In general.--
                    ``(A) Requirement.--In making awards under 
                subsection (a), the Secretary shall, subject to 
                paragraph (3), give preference to any applicant that, 
for the purpose described in subparagraph (B), has made an arrangement 
with not less than one entity from each of the following categories of 
entities: Community-based organizations, elementary schools, secondary 
schools, institutions of higher education, and health professions 
schools.
                    ``(B) Purpose.--The purpose of arrangements under 
                subparagraph (A) is to establish a program for 
                individuals identified under subsection (a) under 
                which--
                            ``(i) the activities described in such 
                        subsection are carried out on behalf of the 
                        individuals; and
                            ``(ii) health professions schools make a 
                        commitment to admit as students of the schools 
                        such individuals who participate in the 
                        program, subject to the individuals meeting 
                        reasonable academic standards for admission to 
                        the schools.
            ``(2) Additional preferences.--Of the applicants under 
        subsection (a) that are receiving preference for purposes of 
        paragraph (1), the Secretary shall, subject to paragraph (3), 
        give additional preference to applicants whose consortium under 
        subsection (b) includes as members one or more health 
        professions schools that have not previously received any award 
        under this section (including this section as in effect prior 
        to fiscal year 1997).
            ``(3) Limitation.--An applicant may not receive preference 
        for purposes of paragraph (1) or (2) unless the consortium 
        under subsection (b) includes not less than one health 
        professions school that has demonstrated success in enrolling 
        students from disadvantaged backgrounds.
    ``(e) Objectives Under Awards.--
            ``(1) Establishment of objectives.--Before making a first 
        award to an applicant under subsection (a), the Secretary shall 
        establish objectives regarding the activities to be carried out 
        under the award, which objectives are applicable until the next 
        fiscal year for which such award is made after a competitive 
        process of review. In making an award after such a review, the 
        Secretary shall establish additional objectives for the 
        applicant.
            ``(2) Precondition for subsequent awards.--In the case of 
        an applicant seeking an award under subsection (a) pursuant to 
        a competitive process of review, the Secretary may make the 
        award only if the applicant demonstrates to the satisfaction of 
        the Secretary that the applicant has met the objectives that 
        were applicable under paragraph (1) to the preceding awards 
        under such subsection.
    ``(f) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $33,000,000 
for fiscal year 2004, $40,000,000 for fiscal year 2005, and such sums 
as may be necessary for each subsequent fiscal year.''.
    (b) Technical Amendment.--Section 770(a) of the Public Health 
Service Act (42 U.S.C. 295e(a)) is amended by inserting ``(other than 
section 771)'' after ``this subpart''.

SEC. 412. CENTERS OF EXCELLENCE.

    For the purpose of establishing and operating health careers 
centers of excellence, there are authorized to be appropriated 
$80,000,000 for fiscal year 2004 and each subsequent fiscal year.

               Subtitle C--Bilingual Health Professionals

SEC. 421. TRAINING OF BILINGUAL HEALTH PROFESSIONALS WITH RESPECT TO 
              MINORITY HEALTH CONDITIONS.

    (a) In General.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, shall (directly or 
through awards of grants or contracts to public or nonprofit private 
entities) carry out a program--
            (1) to identify health professionals who speak both English 
        and a language used by racial or ethnic minority groups in the 
        United States; and
            (2) to train such health professionals with respect to the 
        treatment of health conditions known to disproportionately 
        affect racial/ethnic minorities, such as diabetes, asthma, 
        obesity, injuries, under-immunization, oral health, HIV 
        infection, substance abuse, and conditions regarding mental 
        health.
    (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 each of the fiscal years 2004 through 2008.

                    Subtitle D--Cultural Competence

SEC. 431. DEFINITION.

    (a) In General.--In this Act, the term ``culturally competent'', 
with respect to the manner in which health-related services, education, 
and training are provided, means providing the services, education, and 
training in the language and cultural context that is most appropriate 
for the individuals for whom the services, education, and training are 
intended, including as necessary the provision of bilingual services.
    (b) Modification.--The definition established in subsection (a) may 
be modified as needed at the discretion of the Secretary after 
providing a 30-day notice to Congress.

SEC. 432. ACTIVITIES OF OFFICE OF MINORITY HEALTH; CENTER FOR 
              LINGUISTIC AND CULTURAL COMPETENCE IN HEALTH CARE.

    (a) Educational Materials; Technical Assistance.--
            (1) In general.--The Secretary, acting through the Office 
        of Minority Health under section 1707 of the Public Health 
        Service Act (42 U.S.C. 300u-6), shall--
                    (A) provide for the development of educational 
                materials on providing health services in a culturally 
                competent manner;
                    (B) provide technical assistance in carrying out 
                programs that use such materials; and
                    (C) provide technical assistance on other matters 
                regarding the provision of health services in a 
                culturally competent manner.
            (2) Authorization of appropriations.--For the purpose of 
        carrying out paragraph (1), there are authorized to be 
        appropriated $5,000,000 for fiscal year 2004, and such sums as 
        may be necessary for each of the fiscal years 2005 through 
        2008.
    (b) Center for Linguistic and Cultural Competence in Health Care.--
            (1) In general.--The Secretary, acting through the Office 
        of Minority Health under section 1707 of the Public Health 
        Service Act (42 U.S.C. 300u-6), shall provide for a Center for 
        Linguistic and Cultural Competence in Health Care to carry out 
        programs to promote and facilitate the provision of health-
        related services, education, and training in a culturally 
        competent manner.
            (2) Authorization of appropriations.--For the purpose of 
        carrying out paragraph (1), there are authorized to be 
        appropriated $5,000,000 for fiscal year 2004, and such sums as 
        may be necessary for each of the fiscal years 2005 through 
        2008.

SEC. 433. CULTURAL COMPETENCE DEMONSTRATION PROJECTS.

    (a) In General.--The Secretary, acting through the Administrator of 
the Centers for Medicare & Medicaid Services, shall conduct a cultural 
competence demonstration project under which grants are made to two 
hospitals with a history in medicare, medicaid, and the uninsured to 
enable them to implement standards for the culturally competent 
provision of services to address the specific needs of any population 
that constitutes at least 5 percent of the population served by the 
hospital involved.
    (b) Number and Type.--Of the hospitals provided grants under this 
section, one shall be located in an urban and the other in a rural area 
(as defined in section 1886(d)(2)(D) of the Social Security Act (42 
U.S.C. 1395ww(d)(2)(d)). The urban hospital shall serve a significant 
limited English proficient population and be within 175 miles of the 
border with Mexico. In selecting such hospitals, the Secretary shall 
give preference to hospitals that serve large immigrant populations.
    (c) Amount and Duration of Grant.--A grant under this section for a 
hospital shall be in the amount of $5,000,000 and shall be for a period 
of 5 years.
    (d) Evaluation and Report.--
            (1) Evaluation.--The Secretary shall also provide for a 
        grant to an appropriate qualified entity in an amount not to 
        exceed $1,000,000 to evaluate the demonstration projects 
        conducted under this section.
            (2) Report.--The Secretary shall submit to Congress a 
        report on the projects conducted under this section. The 
        Secretary shall include in such report the results of the 
        evaluation conducted under paragraph (1) and recommendations on 
        whether on going medicare funding should be provided for 
        implementation of standards for cultural competency in 
        hospitals.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated from the Federal Hospital Insurance Trust Fund (under 
section 1817 of the Social Security Act (42 U.S.C. 1395i) to carry out 
this section, $11,000,000, which shall remain available until expended.

                      TITLE V--ADDITIONAL PROGRAMS

             Subtitle A--Data Regarding Race and Ethnicity

SEC. 501. COLLECTION OF DATA.

    Part A of title III of the Public Health Service Act (42 U.S.C. 241 
et seq.) is amended by inserting after section 306 the following:

``SEC. 306A. DATA ON RACE AND ETHNICITY.

    ``(a) In General.--The Secretary shall by regulation provide for 
the following:
            ``(1) Health data collected under programs carried out by 
        the Secretary (whether collected directly or pursuant to 
        grants, cooperative agreements, or contracts) shall include 
        data on race, ethnicity, and spoken and written language and 
        shall, at a minimum, use the categories for race and ethnicity 
        described in OMB Directive 15.
            ``(2) Data collected by the Secretary pursuant to title VI 
        of the Civil Rights Act of 1964 shall include data on race and 
        ethnicity and shall, at a minimum, use such categories.
            ``(3) Data on race and ethnicity that is collected under 
        paragraph (1) or (2) shall use the procedures described in such 
        Directive for collecting data from an individual, and shall be 
        maintained and presented (including for reporting purposes) in 
        accordance with such Directive.
            ``(4) For health encounters that require the presence of a 
        legal parent or guardian who does not speak English or who is 
        limited English proficient, health data collected by the 
        Secretary pursuant to this section shall also include data on 
        the of the accompanying adult or guardian.
            ``(5) Such other data as the Secretary may designate 
        (including administrative records) shall be collected, 
        maintained, and presented in accordance with such Directive, to 
        the extent that such data are collected by the Secretary and 
        relate to health-related programs that are carried out by the 
        Secretary.
            ``(6) The Secretary is directed to include Puerto Rico in 
        the collection of data provider under this section.
    ``(b) Definition.--In this section, the term `OMB Directive 15' 
means Statistical Policy Directive No. 15, Race and Ethnic Standards 
for Federal Statistics and Administrative Reporting, as established by 
the Director of the Office of Management and Budget through the notice 
issued October 30, 1997 (62 FR 58782). Such term includes any 
subsequent revisions to such Directive.''.

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

    (a) Development of Standards.--Not later than 1 year after the date 
of the enactment of this Act, the Secretary, 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.; 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 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).

       Subtitle B--National Assessment of Status of Latino Health

SEC. 511. NATIONAL ASSESSMENT OF STATUS OF LATINO HEALTH.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a national assessment of the status of Latino health to be 
known as the ``Hispanic Health and Nutrition Examination Survey'' or 
``HHANES II''.
    (b) Goal.--The goal of the national assessment, including Puerto 
Rice, under subsection (a) shall be to produce estimates of health and 
nutritional status for Mexican Americans, Puerto Ricans, Cuban 
Americans, and other Hispanic subpopulations.
    (c) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary in each of fiscal years 2004 
through 2006 to carry out this section.

                 Subtitle C--Office of Minority Health

SEC. 521. REVISION AND EXTENSION OF PROGRAMS OF OFFICE OF MINORITY 
              HEALTH.

    Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is 
amended by striking subsection (b) and all that follows and inserting 
the following:
    ``(b) Duties.--With respect to improving the health of racial and 
ethnic minority groups, the Secretary, acting through the Deputy 
Assistant Secretary for Minority Health (in this section referred to as 
the `Deputy Assistant Secretary'), shall carry out the following:
            ``(1) Establish short-range and long-range goals and 
        objectives and coordinate all other activities within the 
        Public Health Service that relate to disease prevention, health 
        promotion, service delivery, and research concerning such 
        individuals. The heads of each of the agencies of the Service 
        shall consult with the Deputy Assistant Secretary to ensure the 
        coordination of such activities.
            ``(2) Carry out the following types of activities by 
        entering into interagency agreements with other agencies of the 
        Public Health Service:
                    ``(A) Support research, demonstrations and 
                evaluations to test new and innovative models.
                    ``(B) Increase knowledge and understanding of 
                health risk factors.
                    ``(C) Develop mechanisms that support better 
                information dissemination, education, prevention, and 
                service delivery to individuals from disadvantaged 
                backgrounds, including individuals who are members of 
                racial or ethnic minority groups.
                    ``(D) Ensure that the National Center for Health 
                Statistics collects data on the health status of each 
                minority group.
                    ``(E) With respect to individuals who lack 
                proficiency in speaking the English language, enter 
                into contracts with public and nonprofit private 
                providers of primary health services for the purpose of 
                increasing the access of the individuals to such 
                services by developing and carrying out programs to 
                provide bilingual or interpretive services.
            ``(3) Support a national minority health resource center to 
        carry out the following:
                    ``(A) Facilitate the exchange of information 
                regarding matters relating to health information and 
                health promotion, preventive health services, and 
                education in the appropriate use of health care.
                    ``(B) Facilitate access to such information.
                    ``(C) Assist in the analysis of issues and problems 
                relating to such matters.
                    ``(D) Provide technical assistance with respect to 
                the exchange of such information (including 
                facilitating the development of materials for such 
                technical assistance).
            ``(4) Carry out programs to improve access to health care 
        services for individuals with limited proficiency in speaking 
        the English language by facilitating the removal of impediments 
        to the receipt of health care that result from such limitation. 
        Activities under the preceding sentence shall include 
        conducting research and developing and evaluating model 
        projects.
            ``(5) Not later than June 8 of each year, the Deputy 
        Assistant Secretary shall submit to the Secretary a report 
        summarizing the activities of each of the minority health 
        offices under section 1707A.
    ``(c) Advisory Committee.--
            ``(1) In general.--The Secretary shall establish an 
        advisory committee to be known as the Advisory Committee on 
        Minority Health (in this subsection referred to as the 
        `Committee'). The Deputy Assistant Secretary shall consult with 
        the Committee in carrying out this section.
            ``(2) Duties.--The Committee shall provide advice to the 
        Secretary, including advice on the development of goals and 
        specific program activities under paragraphs (1) and (2) of 
subsection (b) for each racial and ethnic minority group.
            ``(3) Chairperson.--The Deputy Assistant Secretary shall 
        serve as the chairperson of the Committee.
            ``(4) Composition.--
                    ``(A) In general.--The Committee shall be composed 
                of 12 voting members appointed in accordance with 
                subparagraph (B), and nonvoting, ex officio members 
                designated under subparagraph (C).
                    ``(B) Voting members.--The voting members of the 
                Committee shall be appointed by the Secretary from 
                among individuals who are now officers or employees of 
                the Federal Government and who have expertise regarding 
                issues of minority health. The racial and ethnic 
                minority groups shall be equally represented among such 
                members.
                    ``(C) Nonvoting members.--The nonvoting, ex officio 
                members of the Committee shall be the directors of each 
                of the minority health office established under section 
                707A, and such additional officials of the Department 
                of Health and Human Services as the Secretary 
                determines to be appropriate.
            ``(5) Terms.--Each member of the Committee shall serve for 
        a term of 4 years, except that the Secretary shall initially 
        appoint a portion of the members to terms of 1 year, 2 years, 
        and 3 years.
            ``(6) Vacancies.--If a vacancy occurs on the Committee, a 
        new member shall be appointed by the Secretary within 90 days 
        from the date on which the vacancy occurs, and shall serve for 
        the remainder of the term for which the predecessor of such 
        member was appointed. A vacancy shall not affect the power of 
        the remaining members to execute the duties of the Committee.
            ``(7) Compensation.--Members of the Committee who are 
        officers or employees of the United States shall serve without 
        compensation. Members of the Committee who are not officers or 
        employees of the United States shall receive, for each day 
        (including travel time) they are engaged in the performance of 
        the functions of the Committee compensation in an amount that 
        is not in excess of the daily equivalent of the annual maximum 
        rate of basic pay payable under the General Schedule (under 
        title 5, United States Code) for positions above GS-15.
    ``(d) Certain Requirements Regarding Duties.--
            ``(1) Recommendations regarding language as impediment to 
        health care.--The directors of the offices of minority health 
        within the Department of Health and Human Services, the 
        Director of the Office of Civil Rights, and the Director of the 
        Office of Refugee Health shall seek input from the State 
        minority health offices and make recommendations to the 
        Secretary regarding activities under subsection (b)(4).
            ``(2) Equitable allocation regarding activities.--
                    ``(A) In making awards of grants, cooperative 
                agreements, or contracts under this section or section 
                338A, 338B, 724, 736, 737, 738, or 740, the Secretary, 
                acting as appropriate through the Deputy Assistant 
                Secretary or the Administrator of the Health Resources 
                and Services Administration, shall ensure that such 
                awards are equitably allocated with respect to the 
                various racial and minority populations.
                    ``(B) With respect to grants, cooperative 
                agreements, and contracts that are available under the 
                sections specified in subparagraph (A), the Secretary 
                shall--
                            ``(i) carry out activities to inform 
                        entities, as appropriate, that the entities may 
                        be eligible for awards of such assistance;
                            ``(ii) provide technical assistance to such 
                        entities in the process of preparing and 
                        submitting applications for the awards in 
                        accordance with the policies of the Secretary 
                        regarding such application; and
                            ``(iii) inform populations, as appropriate, 
                        that members of the populations may be eligible 
                        to receive services or otherwise participate in 
                        the activities carried out with such awards.
            ``(3) Cultural competency of services.--The Secretary shall 
        ensure that information and services provided pursuant to 
        subsection (b) are provided in the language and cultural 
        context that is most appropriate for the individuals for whom 
        the information and services are intended.
    ``(e) Grants and Contracts Regarding Duties.--
            ``(1) In general.--In carrying out subsection (b), the 
        Deputy Assistant Secretary may make awards of grants, 
cooperative agreements, and contracts to public and nonprofit private 
entities.
            ``(2) Process for making awards.--The Deputy Assistant 
        Secretary shall ensure that awards under paragraph (1) are made 
        to the extent practicable on a competitive basis, and that an 
        award is made for a proposal only if the proposal has been 
        recommended for such an award through a process of peer review.
            ``(3) Evaluation and dissemination.--The Deputy Assistant 
        Secretary, directly or through contracts with public and 
        private entities, shall provide for evaluations of projects 
        carried out with awards made under paragraph (1) during the 
        preceding 2 fiscal years. The report shall be included in the 
        report required under subsection (f) for the fiscal year 
        involved.
    ``(f) Biennial Reports.--Not later than February 1 of fiscal year 
1998 and of each second year thereafter, the Deputy Assistant Secretary 
shall submit to the Committee on Energy and Commerce of the House of 
Representatives, and to the Committee on Labor and Human Resources of 
the Senate, a report describing the activities carried out under this 
section during the preceding 2 fiscal years and evaluating the extent 
to which such activities have been effective in improving the health of 
racial and ethnic minority groups. Each such report shall include the 
biennial reports submitted to the Deputy Assistant Secretary under 
section 1707A(e) for such years by the heads of the minority health 
offices.
    ``(g) Definition.--For purposes of this section:
            ``(1) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' means American Indians (including 
        Alaskan Natives, Eskimos, and Aleuts); Asian Americans and 
        Pacific Islanders; Blacks; and Hispanics/Latinos.
            ``(2) Hispanic/latinos.--The term `Hispanic/Latinos' means 
        individuals whose origin is Mexican, Puerto Rican, Cuban, 
        Central or South American, or any other Spanish-speaking 
        country.
    ``(h) Funding.--
            ``(1) Authorization of appropriations.--For the purpose of 
        carrying out this section, there are authorized to be 
        appropriated $150,000,000 for each of fiscal years 2004 through 
        2006.
            ``(2) Allocation of funds by secretary.--Of the amounts 
        appropriated under paragraph (1) for a fiscal year in excess of 
        $50,000,000, the Secretary shall make available not less than 
        $3,000,000 for carrying out subsection (b)(2)(E).''.

SEC. 522. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN 
              AGENCIES OF PUBLIC HEALTH SERVICE.

    Title XVII of the Public Health Service Act (42 U.S.C. 300u et 
seq.) is amended by inserting after section 1707 the following section:

``SEC. 1707A. INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN PUBLIC 
              HEALTH SERVICE.

    ``(a) In General.--The head of each agency specified in subsection 
(b)(1) shall establish within the agency an office to be known as the 
Office of Minority Health. Each such Office shall be headed by a 
director, who shall be appointed by the head of the agency within which 
the Office is established, and who shall report directly to the head of 
the agency. The head of such agency shall carry out this section (as 
this section relates to the agency) acting through such Director.
    ``(b) Specified Agencies.--
            ``(1) In general.--The agencies referred to in subsection 
        (a) are the following:
                    ``(A) The Centers for Disease Control and 
                Prevention.
                    ``(B) The Agency for Healthcare Research and 
                Quality.
                    ``(C) The Health Resources and Services 
                Administration.
                    ``(D) The Substance Abuse and Mental Health 
                Services Administration.
                    ``(E) The Centers for Medicare & Medicaid Services.
                    ``(F) The Agency for Toxic Substances and Disease 
                Registry.
            ``(2) National institutes of health.--For purposes of 
        subsection (c) and the subsequent provisions of this section, 
        the term `minority health office' includes the National Center 
        on Minority Health and Health Disparities established within 
        the National Institutes of Health. The Director of the National 
        Institutes of Health shall carry out this section (as this 
        section relates to the agency) acting through the Director of 
        such Office.
    ``(c) Composition.--The head of each specified agency shall ensure 
that the officers and employees of the minority health office of the 
agency are, collectively, experienced in carrying out community-based 
health programs for each of the various racial and ethnic minority 
groups that are present in significant numbers in the United States. 
The head of such agency shall ensure that, of such officers and 
employees who are members of racial and ethnic minority groups, no one 
group is disproportionately represented in the overall office 
composition.
    ``(d) Duties.--Each Director of a minority health office shall 
monitor the programs of the specified agency of such office in order to 
carry out the following:
            ``(1) Determine the extent to which the purposes of the 
        programs are being carried out with respect to racial and 
        ethnic minority groups;
            ``(2) Determine the extent to which members of such groups 
        are represented among the Federal officers and employees who 
        administer the programs; and
            ``(3) Make recommendations to the head of such agency on 
        carrying out the programs with respect to such groups. In the 
        case of programs that provide services, such recommendations 
        shall include recommendations toward ensuring that--
                    ``(A) the services are equitably delivered with 
                respect to racial and ethnic minority groups;
                    ``(B) the programs provide the services in the 
                language and cultural context that is most appropriate 
                for the individuals for whom the services are intended; 
                and
                    ``(C) the programs utilize racial and ethnic 
                minority community-based organizations to deliver the 
                services.
    ``(e) Biennial Reports to Secretary.--The head of each specified 
agency shall submit to the Secretary for inclusion in each biennial 
report under section 1707(g) (without change) a biennial report 
describing--
            ``(1) the extent to which the minority health office of the 
        agency employs individuals who are members of racial and ethnic 
        minority groups, including a specification by minority group of 
        the number, series, and grade levels of such individuals 
        employed by such office;
            ``(2) the manner in which the agency is complying with 
        Public Law 94-311 (relating to collecting and reporting data on 
        Americans of Spanish origin or descent); and
            ``(3) the manner in which the agency is complying with 
        services for Limited English Proficient persons.
    ``(f) Definitions.--For purposes of this section:
            ``(1) Minority health office.--The term `minority health 
        office' means an office established under subsection (a), 
        subject to subsection (b)(2).
            ``(2) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' has the meaning given such term in 
        section 1707(g).
            ``(3) Specified agency.--The term `specified agency' 
        means--
                    ``(A) an agency specified in subsection (b)(1); and
                    ``(B) the National Institutes of Health.
    ``(g) Funding.--
            ``(1) Allocations.--Of the amounts appropriated for a 
        specified agency for a fiscal year, the Secretary may reserve 
        not more than 0.5 percent for the purpose of carrying out 
        activities under this section through the minority health 
        office of the agency. In reserving an amount under the 
        preceding sentence for a minority health office for a fiscal 
        year, the Secretary shall reduce, by substantially the same 
        percentage, the amount that otherwise would be available for 
        each of the programs of the designated agency involved.
            ``(2) Availability of funds for staffing.--The purposes for 
        which amounts made available under paragraph (1) may be 
        expended by a minority health office include the costs of 
        employing staff for such office.''.

SEC. 523. ASSISTANT SECRETARY OF HEALTH AND HUMAN SERVICES FOR CIVIL 
              RIGHTS.

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

``SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS.

    ``(a) Establishment of Position.--There shall be in the Department 
of Health and Human Services an Assistant Secretary for Civil Rights, 
who shall be appointed by the President, by and with the advice and 
consent of the Senate.
    ``(b) Responsibilities.--The Assistant Secretary shall perform such 
functions relating to civil rights as the Secretary may assign.''.
    (b) Conforming Amendment.--Section 5315 of title 5, United States 
Code, is amended, in the item relating to Assistant Secretaries of 
Health and Human Services, by striking ``(6)'' and inserting ``(7)''.
                                 <all>