[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3459 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 3459

             To improve the health of minority individuals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 6, 2003

  Mr. Cummings (for himself, Mr. Rodriguez, Mr. Kildee, Mr. Wu, Mrs. 
   Christensen, Ms. Solis, Mr. Pallone, Mr. Honda, Ms. Bordallo, Ms. 
Pelosi, Mr. Hoyer, Mr. Menendez, Mr. Clyburn, Mr. Dingell, Mr. Rangel, 
 Mr. Stark, Mr. Rahall, Mr. Brown of Ohio, Ms. Roybal-Allard, and Mr. 
    Case) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
Education and the Workforce, Resources, the Judiciary, Ways and Means, 
  and Agriculture, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
             To improve the health of minority individuals.

    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 ``Healthcare 
Equality and Accountability Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings and purpose.
                   TITLE I--COVERAGE OF THE UNINSURED

                         Subtitle A--FamilyCare

Sec. 101. Short title.
Sec. 102. Renaming of title XXI program.
Sec. 103. Familycare coverage of parents under the medicaid program and 
                            title XXI.
Sec. 104. Automatic enrollment of children born to title XXI parents.
Sec. 105. Optional coverage of children through age 20 under the 
                            medicaid program and title XXI.
Sec. 106. Allowing States to simplify rules for families.
Sec. 107. Demonstration programs to improve medicaid and CHIP outreach 
                            to homeless individuals and families.
Sec. 108. Additional CHIP revisions.
Sec. 109. Coordination of title XXI with the maternal and child health 
                            program.
  Subtitle B--State Option To Provide Coverage for All Residents With 
                  Income At or Below the Poverty Line

Sec. 121. State option to provide coverage for all residents with 
                            income at or below the poverty line.
 Subtitle C--Optional Coverage of Legal Immigrants under the Medicaid 
                         Program and Title XXI

Sec. 131. Equal access to health coverage for legal immigrants.
                 Subtitle D--Indian Healthcare Funding

                     Chapter 1--Guaranteed Funding

Sec. 141. Guaranteed adequate funding for Indian healthcare.
                 Chapter 2--Indian Healthcare Programs

Sec. 145. Programs operated by Indian tribes and tribal organizations.
Sec. 146. Licensing.
Sec. 147. Authorization for emergency contract health services.
Sec. 148. Prompt action on payment of claims.
Sec. 149. Liability for payment.
Sec. 150. Health services for ineligible persons.
Sec. 151. Definitions.
Sec. 152. Authorization of appropriations.
                        Subtitle E--Territories

Sec. 161. Funding for territories.
           Subtitle F--Migrant Workers and Farmworkers Health

Sec. 171. Demonstration project regarding continuity of coverage of 
                            migrant workers and farmworkers under 
                            medicaid and CHIP.
               Subtitle G--Expanded Access to Health Care

Sec. 181. National Commission for Expanded Access to Health Care.
     TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTHCARE

Sec. 201. Amendment to the Public Health Service Act.
                     ``TITLE XXIX--MINORITY HEALTH

        ``Sec. 2900. Definitions.
   ``Subtitle A--Culturally and Linguistically Appropriate Healthcare

        ``Sec. 2901. Improving access to services for individuals with 
                            Limited English Proficiency.
        ``Sec. 2902. National standards for culturally and 
                            linguistically appropriate services in 
                            healthcare.
        ``Sec. 2903. Center for Cultural and Linguistic Competence in 
                            Healthcare.
        ``Sec. 2904. Innovations in language access grants.
        ``Sec. 2905. Research on language access.
        ``Sec. 2906. Toll-free telephone number.
Sec. 203. Standards for language access services.
Sec. 204. Federal reimbursement for culturally and linguistically 
                            appropriate services under the medicare, 
                            medicaid and State Children's Health 
                            Insurance Program.
Sec. 205. Increasing understanding of health literacy.
Sec. 206. Report on Federal efforts to provide culturally and 
                            linguistically appropriate healthcare 
                            services.
Sec. 207. General Accounting Office report on impact of language access 
                            services.
                 TITLE III--HEALTH WORKFORCE DIVERSITY

Sec. 301. Amendment to the Public Health Service Act.
                   ``Subtitle B--Workforce Diversity

        ``Sec. 2911. Report on workforce diversity.
        ``Sec. 2912. National working group on workforce diversity.
        ``Sec. 2913. Technical clearinghouse for health workforce 
                            diversity.
        ``Sec. 2914. Evaluation of workforce diversity initiatives.
        ``Sec. 2915. Data collection and reporting by health 
                            professional schools.
        ``Sec. 2916. Support for institutions committed to workforce 
                            diversity.
        ``Sec. 2917. Career development for scientists and researchers.
        ``Sec. 2918. Career support for non-research health 
                            professionals.
        ``Sec. 2919. Research on the effect of workforce diversity on 
                            quality.
        ``Sec. 2920. Health disparities education program.
        ``Sec. 2920A. Cultural competence training for healthcare 
                            professionals.
Sec. 302. Health careers opportunity program.
Sec. 303. Program of excellence in health professions education for 
                            underrepresented minorities.
Sec. 304. Hispanic-serving health professions schools.
Sec. 305. Health professions student loan fund; authorizations of 
                            appropriations regarding students from 
                            disadvantaged backgrounds.
Sec. 306. National Health Service Corps; recruitment and fellowships 
                            for individuals from disadvantaged 
                            backgrounds.
Sec. 307. Loan repayment program of Centers for Disease Control and 
                            Prevention.
Sec. 308. Cooperative agreements for online degree programs at schools 
                            of public health and schools of allied 
                            health.
Sec. 309. Mid-career health professions scholarship program.
Sec. 310. National report on the preparedness of health professionals 
                            to care for diverse populations.
Sec. 311. Scholarship and fellowship programs.
        ``Sec. 2920B. David Satcher Public Health and Health Services 
                            Corps.
        ``Sec. 2920C. Louis Stokes Public Health Scholars Program.
        ``Sec. 2920D. Patsy Mink Health and Gender Research Fellowship 
                            Program.
        ``Sec. 2920E. Paul David Wellstone International Health 
                            Fellowship Program.
        ``Sec. 2920F. Edward R. Roybal Healthcare Scholar Program.
      TITLE IV--REDUCING DISEASE AND DISEASE-RELATED COMPLICATIONS

   Subtitle A--Eliminating Disparities in Prevention, Detection, and 
                          Treatment of Disease

                     Chapter 1--General Provisions

Sec. 401. Guidelines for disease screening for minority patients.
Sec. 402. Preventive health services block grants, use of allotments.
Sec. 403. Program for increasing immunization rates for adults and 
                            adolescents; collection of additional 
                            immunization data.
Sec. 404. Innovative chronic disease management programs.
Sec. 405. Grants for racial and ethnic approaches to community health.
Sec. 406. IOM study request.
Sec. 407. Strategic plan.
                    Chapter 2--Environmental Justice

Sec. 410. Short title; purposes.
Sec. 411. Definitions.
Sec. 412. Environmental justice responsibilities of Federal agencies.
Sec. 413. Interagency environmental justice working group.
Sec. 414. Federal agency strategies.
Sec. 415. Federal Environmental Justice Advisory Committee.
Sec. 416. Human health and environmental research, data collection and 
                            analysis.
                        Chapter 3--Border Health

Sec. 421. Short title.
Sec. 422. Definitions.
Sec. 423. Border health grants.
Sec. 424. United States-Mexico Border Health Commission Act Amendments.
        ``Sec. 9. Authorization of appropriations.
 Chapter 4--Patient Navigator, Outreach, and Chronic Disease Prevention

Sec. 425. Short title.
Sec. 426. HRSA grants for model community cancer and chronic disease 
                            care and prevention; HRSA grants for 
                            patient navigators.
Sec. 427. NCI grants for model community cancer and chronic disease 
                            care and prevention; NCI grants for patient 
                            navigators.
Sec. 428. IHS grants for model community cancer and chronic disease 
                            care and prevention; IHS grants for patient 
                            navigators.
                  Chapter 5--Community Health Workers

Sec. 431. Short title.
Sec. 432. Grants to promote positive health behaviors in women.
                  Chapter 6--Health Empowerment Zones

Sec. 440. Health empowerment zones.
    Subtitle B--Targeting Diseases and Conditions with Particularly 
                            Disparate Impact

                      Chapter 1--Cancer Reduction

Sec. 441. Cancer reduction.
                     Chapter 2--HIV/AIDS Reduction

Sec. 442. HIV/AIDS reduction.
                 Chapter 3--Infant Mortality Reduction

Sec. 443. Infant mortality reduction.
       Chapter 4--Fetal Alcohol Syndrome Treatment and Diagnosis

Sec. 444. Fetal alcohol syndrome.
              Chapter 5--Diabetes Prevention and Treatment

Sec. 445. Monitoring the quality of and disparities in diabetes care.
Sec. 446. Diabetes prevention, treatment, and control.
Sec. 447. Genetics of diabetes.
Sec. 448. Research and training on diabetes in underserved and minority 
                            populations.
Sec. 449. Authorization of appropriations.
Sec. 450. Model community diabetes and chronic disease care and 
                            prevention among Pacific Islanders and 
                            Native Hawaiians.
Sec. 451. Programs of Centers for Disease Control and Prevention.
      Chapter 6--Stroke and Heart Disease Prevention and Treatment

Sec. 455. Systems for heart disease and stroke.
           ``Subtitle D--Systems for Heart Disease and Stroke

                       ``Chapter 1--Heart Disease

        ``Sec. 2941. Heart disease.
                 ``Chapter 2--Stroke Education Campaign

        ``Sec. 2945. Stroke education campaign.
              Chapter 7--Obesity and Overweight Reduction

Sec. 461. Overweight and obesity prevention and treatment.
       Chapter 8--Tuberculosis Control, Prevention, and Treatment

Sec. 465. Advisory council for the elimination of tuberculosis.
Sec. 466. National program for tuberculosis elimination.
Sec. 467. Inclusion of inpatient hospital services for the treatment of 
                            TB-infected individuals.
                           Chapter 9--Asthma

Sec. 471. Provisions regarding national asthma education and prevention 
                            program of National Heart, Lung, and Blood 
                            Institute.
Sec. 472. Asthma-related activities of Centers for Disease Control and 
                            Prevention.
Sec. 473. Grants for community outreach regarding asthma information, 
                            education, and services.
Sec. 474. Action plans of local educational agencies regarding asthma.
                    Chapter 10--Sickle Cell Disease

Sec. 481. Demonstration program for the development and establishment 
                            of systemic mechanisms for the prevention 
                            and treatment of sickle cell disease.
         Chapter 11--Autoimmune Disease in Minority Populations

Sec. 482. Research funding for autoimmune disease in minority 
                            populations.
  Chapter 12--Prevention And Control of Sexually Transmitted Diseases

Sec. 485. Prevention and control of sexually transmitted diseases.
                       Chapter 13--Dental Disease

Sec. 486. Grants to improve the provision of dental services under 
                            medicaid and SCHIP.
Sec. 487. State option to provide wrap-around SCHIP coverage to 
                            children who have other health coverage.
Sec. 488. Grants to improve the provision of dental health services 
                            through community health centers and public 
                            health departments.
             Chapter 14--Prevention And Control of Injuries

Sec. 491. Prevention and control of injuries.
           Chapter 15--Uterine Fibroid Research and Education

Sec. 495. Research with respect to uterine fibroids.
Sec. 496. Information and education with respect to uterine fibroids.
                 TITLE V--DATA COLLECTION AND REPORTING

                     Subtitle A--General Provisions

Sec. 501. Amendment to the Public Health Service Act.
              ``Subtitle E--Data Collection and Reporting

        ``Sec. 2951. Data on race, ethnicity and primary language.
        ``Sec. 2952. Provisions relating to Native Americans.
Sec. 502. Collection of race and ethnicity data by the Social Security 
                            Administration.
Sec. 503. Revision of HIPAA claims standards.
Sec. 504. National Center for Health Statistics.
          Subtitle B--Minority Health and Genomics Commission

Sec. 511. Short title.
Sec. 512. Minority Health and Genomics Commission.
Sec. 513. Report.
Sec. 514. Membership.
Sec. 515. Powers of Commission.
Sec. 516. Termination.
                        TITLE VI--ACCOUNTABILITY

Sec. 601. Report on workforce diversity.
Sec. 602. Federal agency plan to eliminate disparities and improve the 
                            health of minority populations.
Sec. 603. Accountability within the Department of Health and Human 
                            Services.
                      ``Subtitle F--Accountability

        ``Sec. 2961. Elevation of the Office of Civil Rights.
        ``Sec. 2962. Establishment of Health Program Offices for Civil 
                            Rights within Federal health and human 
                            services agencies.
Sec. 604. Office of Minority Health.
Sec. 605. Establishment of the Indian Health Service as an agency of 
                            the Public Health Service.
Sec. 606. Office of Minority Health at the Centers for Medicare and 
                            Medicaid Services.
Sec. 607. Office of Minority Affairs at the Food and Drug 
                            Administration.
Sec. 608. Safety and effectiveness of drugs with respect to racial and 
                            ethnic background.
Sec. 609. United States Commission on Civil Rights.
Sec. 610. Sense of Congress concerning full funding of activities to 
                            eliminate racial and ethnic health 
                            disparities.
TITLE VII--STRENGTHENING HEALTH INSTITUTIONS THAT PROVIDE HEALTHCARE TO 
                          MINORITY POPULATIONS

Sec. 701. Amendment to the Public Health Service Act.
``Subtitle G--Strengthening Health Institutions that Provide Healthcare 
                        to Minority Populations

                     ``Chapter 1--General Programs

        ``Sec. 2971. Grant support for quality improvement initiatives.
        ``Sec. 2971A. Centers of excellence.
        ``Sec. 2971B. Consultation, construction and renovation of 
                            American Indian and Alaska Native 
                            facilities; reports.
        ``Sec. 2971C. Reconstruction and improvement grants for public 
                            health care facilities serving Pacific 
                            Islanders and the insular areas.
         ``Chapter ``subchapter a--general provisionsastructure
        ``Sec. 2972. Payments to healthcare facilities.
        ``Sec. 2972A. Application for assistance.
        ``Sec. 2972B. Public service responsibilities.
        ``Sec. 2972C. Health Safety Net Infrastructure Trust Fund.
        ``Sec. 2972D``subchapter b--loan guarantees
        ``Sec. 2973. Provision of loan guarantees to safety net 
                            healthcare facilities.
        ``Sec. 2973A. Eligible loans.
        ``Sec. 2973B. Guarantee allotments.
        ``Sec. 2973C. Terms and conditions of loan guarantees.
        ``Sec. 2973D. Premiums for loan guarantees.
        ``Se``subchapter c--grants for urgent capital needslt.
        ``Sec. 2976. Provision of grants.
        ``Sec. 2976B. Eligible projects.
                  TITLE VIII--MISCELLANEOUS PROVISIONS

Sec. 801. Definitions.
Sec. 802. Davis-Bacon Act.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress makes the following findings:
            (1) Despite significant advances in public health and 
        health care, the health status of racial and ethnic minority 
        populations continues to lag behind that of the white 
        population.
            (2) The United States is becoming increasingly diverse. 
        According to the 2000 United States Census, African Americans, 
        American Indians and Alaska Natives, Asians, Hispanics, and 
        Native Hawaiians and other Pacific Islanders comprise 30 
        percent of the United States population. Racial and ethnic 
        minorities are expected to comprise 40 percent of the United 
        States population by 2030.
            (3) To improve the health care of racial and ethnic 
        minorities and to reduce and eliminate disparities in health 
        care and health outcomes, the following issues must be 
        addressed:
                    (A) Need for insurance coverage.--
                            (i) Disparities in health status can be 
                        attributed largely to underlying differences in 
                        socioeconomic status and insurance coverage. 
                        Minorities are at a greater risk of being 
                        uninsured than their white counterparts. Lack 
                        of health insurance has consistently been 
                        associated with worse health outcomes.
                            (ii) Even after adjusting for differences 
                        in socioeconomic and insurance status, however, 
                        racial and ethnic health and health care 
                        disparities remain.
                            (iii) Through treaties and Federal 
                        statutes, the Federal Government has 
                        established a trust responsibility to provide 
                        health care to American Indians and Alaska 
                        Natives. In the Indian Health Amendments of 
                        1992, Congress specifically pledged to ``assure 
                        the highest possible health status for Indians 
                        and urban Indians and to provide all resources 
                        necessary to effect that policy.'' Despite 
                        those commitments, the unmet health needs of 
                        American Indians and Alaska Natives remain 
                        alarmingly severe and their health status is 
                        far below the health status of the general 
                        population of the United States. The critical 
                        shortfall of funding for the Indian Health 
                        Service is a major source of this problem.
                    (B) Need for culturally and linguistically 
                appropriate care.--
                            (i) Limited English proficiency adversely 
                        affects the care of many racial and ethnic 
                        minority patients. The lack of available 
                        interpretation and translation services or 
                        bilingual providers contributes to racial and 
                        ethnic disparities in health and health care. 
                        The Federal Government provides and funds an 
array of services that should be made accessible to eligible persons 
who are not proficient in the English language.
                            (ii) Title VI of the Civil Rights Act of 
                        1964 (42 U.S.C. 2000d et seq.) prohibits 
                        discrimination on the basis of race, color, and 
                        national origin in programs and activities 
                        receiving Federal financial assistance. 
                        Discrimination on the basis of primary language 
                        has consistently been interpreted as 
                        discrimination on the basis of national origin.
                            (iii) The provision of effective language 
                        services has been shown to improve care for 
                        limited English proficient (referred to in this 
                        section as ``LEP'') patients by increasing 
                        patient satisfaction, access to care, 
                        compliance with recommended medical advice, and 
                        appropriate utilization.
                            (iv) A 2002 study by the Office of 
                        Management and Budget found that language 
                        assistance services can substantially improve 
                        the health and quality of life of LEP 
                        individuals and their families, increase the 
                        efficiency of distribution of government 
                        services to LEP individuals, and measurably 
                        increase the effectiveness of public health and 
                        safety programs.
                            (v) The same study estimated that language 
                        translation services would only increase the 
                        cost of the average health care visit by less 
                        than one percent.
                    (C) Need for health workforce diversity.--
                            (i) Research has demonstrated that minority 
                        health professionals dramatically increase 
                        access to care for minority patients and 
                        improve the quality of care that they receive. 
                        African Americans, American Indians and Alaska 
                        Natives, Hispanics, Native Hawaiians and other 
                        Pacific Islanders, and Southeast Asians are 
                        significantly underrepresented in the health 
                        professions, exacerbating health disparities.
                            (ii) Minority physicians are more likely 
                        than white physicians to serve minority 
                        populations. Nearly 40 percent of all minority 
                        medical school graduates will practice medicine 
                        in underserved areas, compared to 10 percent of 
                        their white colleagues.
                            (iii) Minorities often report experiences 
                        with discrimination when seeking health care.
                            (iv) There is substantial evidence to 
                        demonstrate that race concordance between 
                        physicians and patients increases patient 
                        satisfaction and participation in health 
                        decisionmaking.
                            (v) Minority health care providers can 
                        bridge linguistic, cultural, and other barriers 
                        that hamper access to care.
                            (vi) African Americans, Hispanics, and 
                        American Indians remain severely 
                        underrepresented in health professions schools. 
                        African Americans and Hispanics constitute 20 
                        percent and 16 percent, respectively, of the 
                        students in public health and baccalaureate 
                        nursing programs, and less than 15 percent of 
                        students in all other health professions.
                            (vi) The number of minorities enrolling in 
                        health professional schools has remained 
                        stagnant. For example, in 1994, 1,307 African 
                        American and 1,090 Hispanic students enrolled 
                        in American medical colleges. In 2000, the 
                        figures were essentially unchanged at 1,307 
                        African American and 1,033 Hispanic students.
                    (D) Need for reduction of disease occurrence and 
                disease-related complications among minorities.--
                            (i) Despite notable progress in the overall 
                        health of the Nation, there are continuing 
                        disparities in the burden of illness and death 
                        experienced by minorities compared to the 
                        United States population as a whole. Minority 
                        populations are disproportionately impacted by 
                        acute and chronic diseases.
                            (ii) Despite suffering a greater burden of 
                        acute and chronic disease, minorities are less 
                        likely to receive needed health care. Numerous 
                        studies have documented that minorities receive 
                        less preventive care, medical therapy, and 
                        surgical interventions.
                    (E) Need for minority health data collection and 
                reporting.--
                            (i) Efforts to study disparities in health 
                        and health care for minorities have been 
                        hampered by the lack of available data on race, 
                        ethnicity, and primary language.
                            (ii) Data collection, analysis, and 
                        reporting by race, ethnicity, and primary 
                        language is permissible under the law and 
                        necessary to assure equity and 
                        nondiscrimination in the quality of health care 
                        services. Collection, analysis, and reporting 
                        of such data is authorized under Title VI of 
                        the Civil Rights Act of 1964 (42 U.S.C. 2000d 
                        et seq.). Such collection, analysis, and 
                        reporting should be conducted with appropriate 
                        privacy protections in place.
                    (F) Need for greater accountability in government 
                institutions.--A number of studies have shown that 
                differences in health care quality contribute to health 
                disparities among minority populations. These 
                differences may result from bias, stereotyping, and 
                discrimination. Government institutions must be held 
                accountable for the quality of healthcare delivered to 
                all patient populations and resultant health outcomes.
                    (G) Need for strengthening health institutions that 
                provide care to minority populations.--
                            (i) A small segment of health care 
                        institutions provide a disproportionate amount 
                        of health care to minority populations.
                            (ii) Safety net institutions, including 
                        public hospitals, community health centers and 
                        community clinics, provide a disproportionate 
                        share of health care to minority and 
                        underserved populations.
                            (iii) Financial stress, negative operating 
                        margins, and the overall burden of caring for 
                        the uninsured and delivering high-cost 
                        specialty care to the entire community place 
                        undue pressure on core safety net providers. 
                        These providers are increasingly challenged in 
                        their ability to meet the day-to-day needs of 
                        their patients.
    (b) Purposes.--It is the purpose of this Act to improve the health 
and healthcare of minority populations and to eliminate racial and 
ethnic disparities in health and healthcare by--
            (1) increasing access to health care for all populations;
            (2) expanding culturally and linguistically appropriate 
        health services for all populations;
            (3) promoting health workforce diversity;
            (4) supporting and expanding programs and activities that 
        will improve the prevention, diagnosis, and management of 
        disease in minority populations;
            (5) enhancing racial, ethnic, and primary language health 
        data collection at the local, State, and Federal level;
            (6) ensuring accountability for the quality of health care 
        and health outcomes for minority populations; and
            (7) strengthening the technical and financial resources of 
        the safety net institutions of the United States.

                   TITLE I--COVERAGE OF THE UNINSURED

                         Subtitle A--FamilyCare

SEC 101. SHORT TITLE.

    This subtitle may be cited as the ``FamilyCare Act of 2003''.

SEC. 102. RENAMING OF TITLE XXI PROGRAM.

    (a) In General.--The heading of title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) is amended to read as follows:

                   ``TITLE XXI--FAMILYCARE PROGRAM''.

    (b) Program References.--Any reference in any provision of Federal 
law or regulation to ``SCHIP'' or ``State children's health insurance 
program'' under title XXI of the Social Security Act shall be deemed a 
reference to the FamilyCare program under such title.

SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER THE MEDICAID PROGRAM AND 
              TITLE XXI.

    (a) Incentives To Implement FamilyCare Coverage.--
            (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 or resources 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 or 
        resource level (if any) 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) 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 or otherwise insured.
    ``(D) In this subsection, the term `parent' includes an individual 
treated as a caretaker for purposes of carrying out section 1931.
    ``(E) In this subsection, the term `effective income level' means 
the income level expressed as a percent of the poverty line and 
considering applicable income disregards.
    ``(2) The State shall provide for coverage of a parent described in 
paragraph (1) or section 2111 of a child who is covered under this 
title or title XXI under the same title as the title as such child is 
covered. 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) FamilyCare parents.--The expenditures described in 
        this subparagraph are the expenditures described in the 
        following clauses (i) and (ii):
                    ``(i) Parents.--If the conditions described in 
                clauses (iii) and (iv) 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 (v) 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, 2004.
                    ``(iii) Conditions relating to ensuring children's 
                coverage for enhanced match 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) Such 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) Effective for determinations of 
                        eligibility made on or after the date that is 1 
                        year after the date of the enactment of this 
                        clause, the application and renewal procedures 
                        for individuals under 19 years of age (or such 
                        higher age as the State has elected under 
                        section 1902(l)(1)(D)) for medical assistance 
                        under section 1902(a)(10)(A) are not be more 
                        restrictive or burdensome than such procedures 
                        used for children with higher income under the 
                        State child health plan under title XXI.
                    ``(iv) Conditions relating to minimum coverage for 
                parents for enhanced match for parents.--The conditions 
                described in this clause are the following:
                            ``(I) 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, 
                        2004, to be eligible for medical assistance as 
                        a parent under this title.
                            ``(II) 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.
                    ``(v) Conditions for enhanced match for certain 
                pregnant women.--The conditions described in this 
                clause are the following:
                            ``(I) The State has established an 
                        effective income eligibility level for pregnant 
                        women under subsection (a)(10)(A)(i)(III) or 
                        (l)(2)(A) of section 1902 that is at least 185 
                        percent of the poverty line.
                            ``(II) 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.
                            ``(III) The State does not apply an income 
                        level for pregnant women that is lower than the 
                        effective income level 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, 2004, to be eligible for 
                        medical assistance as a pregnant woman.
                            ``(IV) The State satisfies the conditions 
                        described in subclauses (I) and (II) of clause 
                        (iii).
                    ``(vi) 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 
                certain medicaid expansion costs.--Section 2105(a) of 
                the Social Security Act (42 U.S.C. 1397ee(a)) is 
                amended--
                            (i) in paragraph (1), by redesignating 
                        subparagraphs (B) through (D) as subparagraphs 
                        (C) through (E), respectively, and by inserting 
                        after subparagraph (A) the following new 
                        subparagraph:
                    ``(B) for medical assistance that is attributable 
                to expenditures described in section 1905(u)(4)(A);''; 
                and
                            (ii) in paragraph (2), by adding at the end 
                        the following new subparagraph:
                    ``(E) Fifth, for expenditures for items described 
                in paragraph (1)(E).''.
            (2) Under title xxi.--
                    (A) FamilyCare 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 FAMILYCARE COVERAGE OF PARENTS OF TARGETED LOW-
              INCOME CHILDREN.

    ``(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, health care 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 health care 
        assistance for pregnant women, 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) Health care assistance for pregnant women.--The term 
        `health care assistance for pregnant women' 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.
            ``(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, 2004, shall be 
                substituted for July 1, 1997; and
                    ``(C) in paragraph (4), January 1, 2004, 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, 2004, shall be 
                substituted for July 1, 1997; and
                    ``(C) in paragraph (4), January 1, 2004, shall be 
                substituted for March 31, 1997.
    ``(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 health care 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 health care assistance for 
                pregnant women.
            ``(3) In applying section 2103(e)(3)(B) in the case of a 
        family (consisting of a parent and one or more children) 
        provided coverage under this section or a pregnant woman 
        provided coverage under this section without covering other 
        family members, the limitation on total annual aggregate cost-
        sharing shall be applied to such entire family or such pregnant 
        woman, respectively.
            ``(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 
                familycare.--
                            (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 Providing FamilyCare.--
            ``(1) Appropriation; total allotment.--For the purpose of 
        providing additional allotments to States to provide FamilyCare 
        coverage under section 2111, there is appropriated, out of any 
        money in the Treasury not otherwise appropriated--
                    ``(A) for fiscal year 2004, $2,000,000,000;
                    ``(B) for fiscal year 2005, $2,000,000,000;
                    ``(C) for fiscal year 2006, $3,000,000,000; and
                    ``(D) for fiscal year 2007, $3,000,000,000.
            ``(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 
                        clause (ii), the same proportion as the 
                        proportion of the State's allotment under 
                        subsection (b) (determined without regard to 
                        subsection (f)) to 98.95 percent of the total 
                        amount of the allotments under such section for 
                        such States eligible for an allotment under 
                        this subparagraph 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 1.05 percent of the total 
                        amount of the allotments under such section for 
commonwealths and territories eligible for an allotment under this 
subparagraph 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 
        health care 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 health care 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''.
            (3) Effective date.--The amendments made by this subsection 
        apply to items and services furnished on or after October 1, 
        2003, whether or not regulations implementing such amendments 
        have been issued.
    (b) Rules for Implementation Beginning With Fiscal Year 2005.--
            (1) Expansion of availability of enhanced match under 
        medicaid for pre-chip expansions.--Paragraph (4) of section 
        1905(u) of the Social Security Act (42 U.S.C. 1396d(u)), as 
        inserted by subsection (a)(1)(C), is amended--
                    (A) by amending clause (ii) of subparagraph (A) to 
                read as follows:
                    ``(ii) Certain pregnant women.--Expenditures for 
                medical assistance for pregnant women under section 
                1902(l)(1)(A) in a family the income of which exceeds 
                the 133 percent of the income official poverty line, 
                but only if the income level established under section 
                1902(l)(2) (or under a Statewide waiver under section 
                1115) for pregnant women is 185 percent of the income 
                official poverty line.''; and
                    (B) by adding at the end the following:
            ``(B) Children in families with income above medicaid 
        mandatory level not previously described.--The expenditures 
        described in this subparagraph are expenditures (other than 
        expenditures described in paragraph (2) or (3)) for medical 
        assistance made available to any child who is eligible for 
        assistance under section 1902(a)(10)(A) (other than under 
        clause (i)) and the income of whose family exceeds the minimum 
        income level required under subsection 1902(l)(2) (or, if 
        higher, the minimum level required under section 1931 for that 
        State) for a child of the age involved (treating any child who 
        is 19 or 20 years of age as being 18 years of age).''.
            (2) Offset of additional expenditures for enhanced match 
        for pre-chip expansion.--Section 1905 of the Social Security 
        Act (42 U.S.C. 1396d) is amended--
                    (A) in the fourth sentence of subsection (b), by 
                inserting ``(except in the case of expenditures 
                described in subsection (u)(5))'' after ``do not 
                exceed'';
                    (B) 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 133 percent of poverty.--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.
            ``(B) FamilyCare parents.--Payments for expenditures 
        described in paragraph (4)(A)(i).
            ``(C) Regular fmap for expenditures for certain children in 
        families with income above medicaid mandatory level.--The 
        portion of the payments made for expenditures described in 
        paragraph (4)(B) that represents the amount that would have 
        been paid if the enhanced FMAP had not been substituted for the 
        Federal medical assistance percentage.''.
                    (B) Conforming amendments.--Subparagraph (B) of 
                section 2105(a)(1) of the Social Security Act, as 
                amended by subsection (a)(1)(D), is amended to read as 
                follows:
                    ``(B) Certain familycare parents and others.--
                Expenditures for medical assistance that is 
                attributable to expenditures described in section 
                1905(u)(4), except as provided in section 
                1905(u)(5).''.
            (3) Effective date.--The amendments made by this subsection 
        apply as of October 1, 2004, to fiscal years beginning on or 
        after such date and to expenditures under the State plan on and 
        after such date, whether or not regulations implementing such 
        amendments have been issued.
    (c) GAO Study.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study regarding funding under title XXI of the 
        Social Security Act that examines--
                    (A) the adequacy of overall funding under such 
                title;
                    (B) the formula for determining allotments and for 
                redistribution of unspent funds under such title; and
                    (C) the effect of waiting lists and caps on 
                enrollment under such title.
            (2) Report.--Not later than July 1, 2005, the Comptroller 
        General shall submit a report on the study conducted under 
        paragraph (1). Such report shall include recommendations 
        regarding a better mechanism for determining State allotments 
        and redistribution of unspent funds under such title in order 
        to ensure all eligible families in need can access coverage 
        through such title.
    (d) 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.''.

SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN TO TITLE XXI PARENTS.

    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 a 
                parent being provided familycare.--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.''.

SEC. 105. 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 January 1, 2004, and apply to medical assistance and child 
health assistance provided on or after such date, whether or not 
regulations implementing such amendments have been issued.

SEC. 106. ALLOWING STATES TO SIMPLIFY RULES FOR FAMILIES.

    (a) Presumptive Eligibility.--
            (1) 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).''.
            (2) 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 of a child with respect to whom such a period 
is provided under this section.''.
            (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) 12-Months Continuous Eligibility.--
            (1) Medicaid.--Section 1902(e)(12) of the Social Security 
        Act (42 U.S.C. 1396a(e)(12)) is amended--
                    (A) by striking ``At the option of the State, the 
                plan may'' and inserting ``The plan shall'';
                    (B) by striking ``an age specified by the State 
                (not to exceed 19 years of age)'' and inserting ``19 
                years of age (or such higher age as the State has 
                elected under subsection (l)(1)(D)) or, at the option 
                of the State, who is eligible for medical assistance as 
                the parent of such a child''; and
                    (C) in subparagraph (A), by striking ``a period 
                (not to exceed 12 months) '' and inserting ``the 12-
                month period beginning on the date''.
            (2) Title xxi.--Section 2102(b)(2) of such Act (42 U.S.C. 
        1397bb(b)(2)) is amended by adding at the end the following: 
        ``Such methods shall provide continuous eligibility for 
        children under this title in a manner that is no less generous 
        than the 12-months continuous eligibility provided under 
        section 1902(e)(12) for children described in such section 
        under title XIX. If a State has elected to apply section 
        1902(e)(12) to parents, such methods may provide continuous 
eligibility for parents under this title in a manner that is no less 
generous than the 12-months continuous eligibility provided under such 
section for parents described in such section under title XIX.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on July 1, 2004 (or, if later, 60 days after 
        the date of the enactment of this Act), whether or not 
        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 FamilyCare 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).''.

SEC. 107. DEMONSTRATION PROGRAMS TO IMPROVE MEDICAID AND CHIP OUTREACH 
              TO HOMELESS INDIVIDUALS AND FAMILIES.

    (a) Authority.--The Secretary of Health and Human Services may 
award demonstration grants to not more than 7 States (or other 
qualified entities) to conduct innovative programs that are designed to 
improve outreach to homeless individuals and families under the 
programs described in subsection (b) with respect to enrollment of such 
individuals and families under such programs and the provision of 
services (and coordinating the provision of such services) under such 
programs.
    (b) Programs for Homeless Described.--The programs described in 
this subsection are as follows:
            (1) Medicaid.--The program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.).
            (2) CHIP.--The program under title XXI of the Social 
        Security Act (42 U.S.C. 1397aa et seq.).
            (3) TANF.--The program under part of A of title IV of the 
        Social Security Act (42 U.S.C. 601 et seq.).
            (4) SAMHSA block grants.--The program of grants under part 
        B of title XIX of the Public Health Service Act (42 U.S.C. 
        300x-1 et seq.).
            (5) Food stamp program.--The program under the Food Stamp 
        Act of 1977 (7 U.S.C. 2011 et seq.).
            (6) Workforce investment act.--The program under the 
        Workforce Investment Act of 1999 (29 U.S.C. 2801 et seq.).
            (7) Welfare-to-work.--The welfare-to-work program under 
        section 403(a)(5) of the Social Security Act (42 U.S.C. 
        603(a)(5)).
            (8) Other programs.--Other public and private benefit 
        programs that serve low-income individuals.
    (c) Appropriations.--For the purposes of carrying out this section, 
there is appropriated for fiscal year 2004, out of any funds in the 
Treasury not otherwise appropriated, $10,000,000, to remain available 
until expended.

SEC. 108. ADDITIONAL CHIP REVISIONS.

    (a) Limiting Cost-Sharing to 2.5 Percent for Families With Income 
Below 150 Percent of Poverty.--Section 2103(e)(3)(A) of the Social 
Security Act (42 U.S.C. 1397cc(e)(3)(A)) is amended--
            (1) by striking ``and'' at the end of clause (i);
            (2) by striking the period at the end of clause (ii) and 
        inserting ``; and''; and
            (3) by adding at the end the following new clause:
                            ``(iii) total annual aggregate cost-sharing 
                        described in clauses (i) and (ii) with respect 
                        to all such targeted low-income children in a 
                        family under this title that exceeds 2.5 
                        percent of such family's income for the year 
                        involved.''.
    (b) Employer Coverage Waiver Changes.--Section 2105(c)(3) of such 
Act (42 U.S.C. 1397ee(c)(3)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii) and indenting appropriately;
            (2) by designating the matter beginning with ``Payment may 
        be made'' as a subparagraph (A) with the heading ``In general'' 
        and indenting appropriately; and
            (3) by adding at the end the following new subparagraph:
                    ``(B) Application of requirements.--In carrying out 
                subparagraph (A)--
                            ``(i) in determining cost-effectiveness, 
                        the Secretary shall measure against family 
                        coverage costs to the extent that a State has 
                        expanded coverage to parents pursuant to 
                        section 2111;
                            ``(ii) subject to clause (iii), the State 
                        shall provide satisfactory assurances that the 
                        minimum benefits and cost-sharing protections 
                        established under this title are provided, 
                        either through the coverage under subparagraph 
                        (A) or as a supplement to such coverage; and
                            ``(iii) coverage under such subparagraph 
                        shall not be considered to violate clause (ii) 
                        because it does not comply with requirements 
                        relating to reviews of health service decisions 
                        if the enrollee involved is provided the option 
                        of being provided benefits directly under this 
                        title.''.
    (c) Effective Date.--The amendments made by this section apply as 
of January 1, 2004, whether or not regulations implementing such 
amendments have been issued.

SEC. 109. COORDINATION OF TITLE XXI WITH THE MATERNAL AND CHILD HEALTH 
              PROGRAM.

    (a) In General.--Section 2102(b)(3) of the Social Security Act (42 
U.S.C. 1397bb(b)(3)) is amended--
            (1) in subparagraph (D), by striking ``and'' at the end;
            (2) in subparagraph (E), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(F) that operations and activities under this 
                title are developed and implemented in consultation and 
                coordination with the program operated by the State 
                under title V in areas including outreach and 
                enrollment, benefits and services, service delivery 
                standards, public health and social service agency 
                relationships, and quality assurance and data 
                reporting.''.
    (b) Conforming Medicaid Amendment.--Section 1902(a)(11) of such Act 
(42 U.S.C. 1396a(a)(11)) is amended--
            (1) by striking ``and'' before ``(C)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (D) provide that operations and activities 
        under this title are developed and implemented in consultation 
        and coordination with the program operated by the State under 
title V in areas including outreach and enrollment, benefits and 
services, service delivery standards, public health and social service 
agency relationships, and quality assurance and data reporting''.
    (c) Effective Date.--The amendments made by this section take 
effect on January 1, 2004.

  Subtitle B--State Option To Provide Coverage for All Residents With 
                  Income At or Below the Poverty Line

SEC. 121. STATE OPTION TO PROVIDE COVERAGE FOR ALL RESIDENTS WITH 
              INCOME AT OR BELOW THE POVERTY LINE.

    (a) In General.--Section 1902(a)(10)(A)(ii) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--
            (1) by striking ``or'' at the end of subclause (XVII);
            (2) by adding ``or'' at the end of subclause (XVIII); and
            (3) by adding at the end the following new subclause:
                                    ``(XIX) any individual whose family 
                                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 and who is not otherwise 
                                eligible for medical assistance under 
                                this title;''.
    (b) Conforming Amendments.--
            (1) Section 1905(a) of such 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 adding ``or'' at the end of clause (xiii); 
                and
                    (C) by inserting after clause (xiii) the following 
                new clause:
            ``(xii) individuals described in section 
        1902(a)(10)(A)(ii)(XIX),''.
            (2) Section 1903(f)(4) of such 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),''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 2004.

 Subtitle C--Optional Coverage of Legal Immigrants under the Medicaid 
                         Program and Title XXI

SEC. 131. EQUAL ACCESS TO HEALTH COVERAGE FOR LEGAL IMMIGRANTS.

    (a) In General.--Section 401(b)(1) of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1611(b)(1)) 
is amended--
            (1) by striking subparagraph (A) and inserting the 
        following:
                    ``(A) Medical assistance under title XIX of the 
                Social Security Act.''; and
            (2) by adding at the end the following:
                    ``(F) Child health assistance under title XXI of 
                the Social Security Act.''.
    (b) Conforming Amendments.--
            (1) Section 402(b) of the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(b)) is 
        amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by striking clause (i);
                                    (II) by redesignating clause (ii) 
                                as subparagraph (A) and realigning the 
                                margins accordingly; and
                                    (III) by redesignating subclauses 
                                (I) through (V) of subparagraph (A), as 
                                so redesignated, as clauses (i) through 
                                (v), respectively and realigning the 
                                margins accordingly; and
                            (ii) by striking subparagraphs (E) and (F); 
                        and
                    (B) in paragraph (3), by striking subparagraph (C).
            (2) Section 403 of the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996 (8 U.S.C. 1613)) is 
        amended--
                    (A) in subsection (c), by adding at the end the 
                following:
                    ``(M) Child health assistance provided under title 
                XXI of the Social Security Act.''; and
                    (B) in subsection (d)(1), by striking ``programs 
                specified in subsections (a)(3) and (b)(3)(C)'' and 
                inserting ``program specified in subsection (a)(3)''.
            (3) Section 421 of the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996 (8 U.S.C. 1631)) is 
        amended by adding at the end the following:
    ``(g) Exceptions.--This section shall not apply to--
            ``(1) medical assistance provided under a State plan 
        approved under title XIX of the Social Security Act; and
            ``(2) child health assistance provided under title XXI of 
        the Social Security Act.''.
            (4) Section 423(d) of the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996 is amended by adding at 
        the end the following:
            ``(12) Child health assistance provided under title XXI of 
        the Social Security Act.''.
    (c) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section take effect on the date of 
        enactment of this Act and apply to medical assistance provided 
        under title XIX of the Social Security Act and child health 
        assistance provided under title XXI of the Social Security Act 
        on or after that date.
            (2) Requirements for sponsor's affidavit of support.--
        Section 423(d) of the Personal Responsibility and Work 
        Opportunity Reconciliation Act of 1996 shall be applied as if 
        the amendments made by this Act were enacted on December 1, 
        2002.

                 Subtitle D--Indian Healthcare Funding

                     CHAPTER 1--GUARANTEED FUNDING

SEC. 141. GUARANTEED ADEQUATE FUNDING FOR INDIAN HEALTHCARE.

    Section 825 of the Indian Health Care Improvement Act (25 U.S.C. 
1680o) is amended to read as follows:

``SEC. 825. FUNDING.

    ``(a) In General.--Notwithstanding any other provision of law, not 
later than 30 days after the date of enactment of this section, on 
October 1, 2003, and on each October 1 thereafter, out of any funds in 
the Treasury not otherwise appropriated, the Secretary of the Treasury 
shall transfer to the Secretary to carry out this title the amount 
determined under subsection (d).
    ``(b) Use and Availability.--
            ``(1) In general.--An amount transferred under subsection 
        (a)--
                    ``(A) shall remain available until expended; and
                    ``(B) shall be used to carry out any programs, 
                functions, and activities relating to clinical services 
                (as defined in paragraph (2)) of the Service and 
                Service units.
            ``(2) Clinical services defined.--For purposes of paragraph 
        (1)(B), the term `clinical services' includes all programs of 
        the Indian Health Service which are funded directly or under 
        the authority of the Indian Self-Determination and Education 
        Assistance Act, for the purposes of--
                    ``(A) clinical care, including inpatient care, 
                outpatient care (including audiology, clinical eye and 
                vision care), primary care, secondary and tertiary 
                care, and long term care;
                    ``(B) preventive health, including mammography and 
                other cancer screening;
                    ``(C) dental care;
                    ``(D) mental health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers;
                    ``(E) emergency medical services;
                    ``(F) treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians;
                    ``(G) accident prevention programs;
                    ``(H) home healthcare;
                    ``(I) community health representatives;
                    ``(J) maintenance and repair; and
                    ``(K) traditional healthcare practices and training 
                of traditional healthcare practitioners.
    ``(c) Receipt and Acceptance.--The Secretary shall be entitled to 
receive, shall accept, and shall use to carry out this title the funds 
transferred under subsection (a), without further appropriation.
    ``(d) Amount.--The amount referred to in subsection (a) is--
            ``(1) for fiscal year 2004, the amount equal to 390 percent 
        of the amount obligated by the Service during fiscal year 2002 
        for the purposes described in subsection (b)(2); and
            ``(2) for fiscal year 2005 and each fiscal year thereafter, 
        the amount equal to the product obtained by multiplying--
                    ``(A) the number of Indians served by the Service 
                as of September 30 of the preceding the fiscal year; 
                and
                    ``(B) the per capita baseline amount, as determined 
                under subsection (e).
    ``(e) Per Capita Baseline Amount.--
            ``(1) In general.--For the purpose of subsection (d)(2)(B), 
        the per capita baseline amount shall be equal to the sum of--
                    ``(A) the quotient obtained by dividing--
                            ``(i) the amount specified in subsection 
                        (d)(1); by
                            ``(ii) the number of Indians served by the 
                        Service as of September 30, 2002; and
                    ``(B) any applicable increase under paragraph (2).
            ``(2) Increase.--For each fiscal year, the Secretary shall 
        provide a percentage increase (rounded to the nearest dollar) 
        in the per capita baseline amount equal to the percentage by 
        which--
                    ``(A) the Consumer Price Index for all Urban 
                Consumers published by the Department of Labor 
                (relating to the United States city average for medical 
                care and not seasonally adjusted) for the 1-year period 
                ending on the June 30 of the fiscal year preceding the 
                fiscal year for which the increase is made; exceeds
                    ``(B) that Consumer Price Index for the 1-year 
                period preceding the 1-year period described in 
                subparagraph (A).''.

                 CHAPTER 2--INDIAN HEALTHCARE PROGRAMS

SEC. 145. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS.

    The Service shall provide funds for healthcare programs and 
facilities operated by Indian tribes and tribal organizations under 
funding agreements with the Service entered into under the Indian Self-
Determination and Education Assistance Act on the same basis as such 
funds are provided to programs and facilities operated directly by the 
Service.

SEC. 146. LICENSING.

    Healthcare professionals employed by Indian tribes and tribal 
organizations to carry out agreements under the Indian Self-
Determination and Education Assistance Act, shall, if licensed in any 
State, be exempt from the licensing requirements of the State in which 
the agreement is performed.

SEC. 147. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES.

    With respect to an elderly Indian or an Indian with a disability 
receiving emergency medical care or services from a non-Service 
provider or in a non-Service facility under the authority of the Indian 
Health Care Improvement Act, the time limitation (as a condition of 
payment) for notifying the Service of such treatment or admission shall 
be 30 days.

SEC. 148. PROMPT ACTION ON PAYMENT OF CLAIMS.

    (a) Requirement.--The Service shall respond to a notification of a 
claim by a provider of a contract care service with either an 
individual purchase order or a denial of the claim within 5 working 
days after the receipt of such notification.
    (b) Failure To Respond.--If the Service fails to respond to a 
notification of a claim in accordance with subsection (a), the Service 
shall accept as valid the claim submitted by the provider of a contract 
care service.
    (c) Payment.--The Service shall pay a valid contract care service 
claim within 30 days after the completion of the claim.

SEC. 149. LIABILITY FOR PAYMENT.

    (a) No Liability.--A patient who receives contract healthcare 
services that are authorized by the Service shall not be liable for the 
payment of any charges or costs associated with the provision of such 
services.
    (b) Notification.--The Secretary shall notify a contract care 
provider and any patient who receives contract healthcare services 
authorized by the Service that such patient is not liable for the 
payment of any charges or costs associated with the provision of such 
services.
    (c) Limitation.--Following receipt of the notice provided under 
subsection (b), or, if a claim has been deemed accepted under section 
154(b), the provider shall have no further recourse against the patient 
who received the services involved.

SEC. 150. HEALTH SERVICES FOR INELIGIBLE PERSONS.

    (a) Ineligible Persons.--
            (1) In general.--Any individual who--
                    (A) has not attained 19 years of age;
                    (B) is the natural or adopted child, step-child, 
                foster-child, legal ward, or orphan of an eligible 
                Indian; and
                    (C) is not otherwise eligible for the health 
                services provided by the Service,
        shall be eligible for all health services provided by the 
        Service on the same basis and subject to the same rules that 
        apply to eligible Indians until such individual attains 19 
        years of age. The existing and potential health needs of all 
        such individuals shall be taken into consideration by the 
        Service in determining the need for, or the allocation of, the 
        health resources of the Service. If such an individual has been 
determined to be legally incompetent prior to attaining 19 years of 
age, such individual shall remain eligible for such services until one 
year after the date such disability has been removed.
            (2) Spouses.--Any spouse of an eligible Indian who is not 
        an Indian, or who is of Indian descent but not otherwise 
        eligible for the health services provided by the Service, shall 
        be eligible for such health services if all of such spouses or 
        spouses who are married to members of the Indian tribe being 
        served are made eligible, as a class, by an appropriate 
        resolution of the governing body of the Indian tribe or tribal 
        organization providing such services. The health needs of 
        persons made eligible under this paragraph shall not be taken 
        into consideration by the Service in determining the need for, 
        or allocation of, its health resources.
    (b) Programs and Services.--
            (1) Programs.--
                    (A) In general.--The Secretary may provide health 
                services under this subsection through health programs 
                operated directly by the Service to individuals who 
                reside within the service area of a service unit and 
                who are not eligible for such health services under any 
                other subsection of this section or under any other 
                provision of law if--
                            (i) the Indian tribe (or, in the case of a 
                        multi-tribal service area, all the Indian 
                        tribes) served by such service unit requests 
                        such provision of health services to such 
                        individuals; and
                            (ii) the Secretary and the Indian tribe or 
                        tribes have jointly determined that--
                                    (I) the provision of such health 
                                services will not result in a denial or 
                                diminution of health services to 
                                eligible Indians; and
                                    (II) there is no reasonable 
                                alternative health program or services, 
                                within or without the service area of 
                                such service unit, available to meet 
                                the health needs of such individuals.
                    (B) Funding agreements.--In the case of health 
                programs operated under a funding agreement entered 
                into under the Indian Self-Determination and 
                Educational Assistance Act, the governing body of the 
                Indian tribe or tribal organization providing health 
                services under such funding agreement is authorized to 
                determine whether health services should be provided 
                under such funding agreement to individuals who are not 
                eligible for such health services under any other 
                subsection of this section or under any other provision 
                of law. In making such determinations, the governing 
                body of the Indian tribe or tribal organization shall 
                take into account the considerations described in 
                subparagraph (A)(ii).
            (2) Liability for payment.--
                    (A) In general.--Persons receiving health services 
                provided by the Service by reason of this subsection 
                shall be liable for payment of such health services 
                under a schedule of charges prescribed by the Secretary 
                which, in the judgment of the Secretary, results in 
                reimbursement in an amount not less than the actual 
                cost of providing the health services. Notwithstanding 
                section 1880 of the Social Security Act or any other 
                provision of law, amounts collected under this 
                subsection, including medicare or medicaid 
                reimbursements under titles XVIII and XIX of the Social 
                Security Act, shall be credited to the account of the 
                program providing the service and shall be used solely 
                for the provision of health services within that 
                program. Amounts collected under this subsection shall 
                be available for expenditure within such program for 
                not to exceed 1 fiscal year after the fiscal year in 
                which collected.
                    (B) Services for indigent persons.--Health services 
                may be provided by the Secretary through the Service 
                under this subsection to an indigent person who would 
                not be eligible for such health services but for the 
                provisions of paragraph (1) only if an agreement has 
                been entered into with a State or local government 
                under which the State or local government agrees to 
                reimburse the Service for the expenses incurred by the 
                Service in providing such health services to such 
                indigent person.
            (3) Service areas.--
                    (A) Service to only one tribe.--In the case of a 
                service area which serves only one Indian tribe, the 
                authority of the Secretary to provide health services 
                under paragraph (1)(A) shall terminate at the end of 
                the fiscal year succeeding the fiscal year in which the 
                governing body of the Indian tribe revokes its 
                concurrence to the provision of such health services.
                    (B) Multi-tribal areas.--In the case of a multi-
                tribal service area, the authority of the Secretary to 
                provide health services under paragraph (1)(A) shall 
                terminate at the end of the fiscal year succeeding the 
                fiscal year in which at least 51 percent of the number 
                of Indian tribes in the service area revoke their 
                concurrence to the provision of such health services.
    (c) Purpose for Providing Services.--The Service may provide health 
services under this subsection to individuals who are not eligible for 
health services provided by the Service under any other subsection of 
this section or under any other provision of law in order to--
            (1) achieve stability in a medical emergency;
            (2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
            (3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the pregnancy 
        through post partum; or
            (4) provide care to immediate family members of an eligible 
        person if such care is directly related to the treatment of the 
        eligible person.
    (d) Hospital Privileges.--Hospital privileges in health facilities 
operated and maintained by the Service or operated under a contract 
entered into under the Indian Self-Determination Education Assistance 
Act may be extended to non-Service healthcare practitioners who provide 
services to persons described in subsection (a) or (b). Such non-
Service healthcare practitioners may be regarded as employees of the 
Federal Government for purposes of section 1346(b) and chapter 171 of 
title 28, United States Code (relating to Federal tort claims) only 
with respect to acts or omissions which occur in the course of 
providing services to eligible persons as a part of the conditions 
under which such hospital privileges are extended.
    (e) Definition.--In this section, the term ``eligible Indian'' 
means any Indian who is eligible for health services provided by the 
Service without regard to the provisions of this section.

SEC. 151. DEFINITIONS.

    For purposes of this chapter, the definitions contained in section 
4 of the Indian Health Care Improvement Act shall apply.

SEC. 152. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 to carry out 
this chapter.

                        Subtitle E--Territories

SEC. 161. FUNDING FOR TERRITORIES.

    (a) Temporary Elimination of Spending Cap.--Section 1108 of the 
Social Security Act (42 U.S.C. 1308) is amended--
            (1) in subsection (f), by striking ``subsection (g)'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following:
    ``(h) Temporary Elimination of Caps.--With respect to each of 
fiscal years 2004 through 2007, the Secretary shall make payments under 
title XIX to Puerto Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa without regard to the limitations 
on the amount of such payments imposed under subsections (f) and 
(g).''.
    (b) Temporary Increase in FMAP.--The first sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) is amended by 
inserting ``(except that, only with respect to fiscal years 2004 
through 2007 and only for purposes of expenditures under this title, 
such percentage shall be 77 percent)'' after ``50 per centum''.

           Subtitle F--Migrant Workers and Farmworkers Health

SEC. 171. DEMONSTRATION PROJECT REGARDING CONTINUITY OF COVERAGE OF 
              MIGRANT WORKERS AND FARMWORKERS UNDER MEDICAID AND CHIP.

    (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.

               Subtitle G--Expanded Access to Health Care

SEC. 181. NATIONAL COMMISSION FOR EXPANDED ACCESS TO HEALTH CARE.

    (a) Establishment.--There is established a commission to be known 
as the National Commission for Expanded Access to Health Care (referred 
to in this section as the ``Commission'').
    (b) Appointment of Members.--
            (1) In general.--Not later than 45 days after the date of 
        enactment of this Act--
                    (A) the majority and minority leaders of the Senate 
                and the Speaker and minority leader of the House of 
                Representatives shall each appoint 7 members of the 
                Commission; and
                    (B) the Secretary of Health and Human Services (in 
                this section referred to as the ``Secretary'') shall 
                appoint 1 member of the Commission.
            (2) Criteria.--Members of the Commission shall include 
        representatives of the following:
                    (A) Consumers of health insurance.
                    (B) Health care professionals.
                    (C) State and territorial officials.
                    (D) Health economists.
                    (E) Health care providers.
                    (F) Experts on health insurance.
                    (G) Experts on expanding health care to individuals 
                who are uninsured.
                    (H) Experts on the elimination of racial and ethnic 
                health disparities.
                    (I) Experts on health care in the United States 
                territories.
            (3) Chairperson.--At the first meeting of the Commission, 
        the Commission shall select a Chairperson from among its 
        members.
    (c) Meetings.--
            (1) In general.--After the initial meeting of the 
        Commission, which shall be called by the Secretary, the 
        Commission shall meet at the call of the Chairperson.
            (2) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (3) Supermajority voting requirement.--To approve a report 
        required under paragraph (1), (2), or (3) of subsection (e), at 
        least 60 percent of the membership of the Commission must vote 
        in favor of such a report.
    (d) Duties.--The Commission shall--
            (1) assess the effectiveness of programs designed to expand 
        health care coverage or make health care coverage affordable to 
        uninsured individuals by identifying the accomplishments and 
        needed improvements of each program;
            (2) make recommendations regarding the benefits and cost-
        sharing that should be included in health care coverage for 
        various groups, taking into account--
                    (A) the special health care needs of children and 
                individuals with disabilities;
                    (B) the different ability of various populations to 
                pay out-of-pocket costs for services;
                    (C) incentives for efficiency and cost-containment;
                    (D) racial and ethnic disparities in health status 
                and health care;
                    (E) incremental changes to the United States health 
                care delivery system and changes to achieve fundamental 
                restructuring of the system;
                    (F) populations who are traditionally more 
                difficult to cover, including immigrants and homeless 
                persons;
                    (G) preventive care, diagnostic services, disease 
                management services, and other factors;
                    (H) quality improvement initiatives among health 
                institutions serving disadvantaged patient populations; 
                and
                    (I) the feasibility of and barriers to the 
                development of a comprehensive system of health care;
            (3) recommend mechanisms to expand health care coverage to 
        uninsured individuals;
            (4) recommend automatic enrollment and retention procedures 
        and other measures to increase health care coverage among those 
eligible for assistance; and
            (5) analyze the size, effectiveness, and efficiency of 
        current tax and other subsidies for health care coverage and 
        recommend improvements.
    (e) Reports.--
            (1) Annual reports.--The Commission shall submit annual 
        reports to the President and the appropriate committees of 
        Congress addressing the matters identified in subsection (d).
            (2) Biennial report.--The Commission shall submit biennial 
        reports to the President and the appropriate committees of 
        Congress containing--
                    (A) recommendations concerning essential benefits 
                and maximum out-of-pocket cost-sharing for--
                            (i) the general population; and
                            (ii) individuals with limited ability to 
                        pay; and
                    (B) proposed legislative language to implement such 
                recommendations.
            (3) Commission report.--Not later than January 15, 2007, 
        the Commission shall submit a report to the President and the 
        appropriate committees of Congress, which shall include--
                    (A) recommendations on policies to provide health 
                care coverage to uninsured individuals;
                    (B) recommendations on changes to policies enacted 
                under this Act; and
                    (C) proposed legislative language to implement such 
                recommendations.
    (f) Administration.--
            (1) Powers.--
                    (A) Hearings.--The Commission may hold such 
                hearings, sit and act at such times and places, take 
                such testimony, and receive such evidence as the 
                Commission considers advisable to carry out this 
                section.
                    (B) Information from federal agencies.--The 
                Commission may secure directly from any Federal 
                department or agency such information as the Commission 
                considers necessary to carry out this section. Upon 
                request of the Chairperson of the Commission, the head 
                of such department or agency shall furnish such 
                information to the Commission.
                    (C) Postal services.--The Commission may use the 
                United States mails in the same manner and under the 
                same conditions as other departments and agencies of 
                the Federal Government.
                    (D) Gifts.--The Commission may accept, use, and 
                dispose of donations of services or property.
            (2) Compensation.--
                    (A) In general.--Each member of the Commission who 
                is not an officer or employee of the Federal Government 
                shall be compensated at a rate equal to the daily 
                equivalent of the annual rate of basic pay prescribed 
                for level IV of the Executive Schedule under section 
                5315 of title 5, United States Code, for each day 
                (including travel time) during which such member is 
                engaged in the performance of duties of the Commission. 
                All members of the Commission who are officers or 
                employees of the United States shall serve without 
                compensation in addition to that received for their 
                services as officers or employees of the United States.
                    (B) Travel expenses.--The members of the Commission 
                shall be allowed travel expenses, as authorized by the 
                Chairperson of the Commission, including per diem in 
                lieu of subsistence, at rates authorized for employees 
                of agencies under subchapter I of chapter 57 of title 
                5, United States Code, while away from their homes or 
                regular places of business in the performance of 
                services for the Commission.
            (3) Staff.--
                    (A) In general.--The Chairperson of the Commission 
                may appoint an executive director such other staff as 
                may be necessary to enable the Commission to perform 
                its duties. The employment of an executive director 
                shall be subject to confirmation by the Commission.
                    (B) Staff compensation.--The Chairperson of the 
                Commission may fix the compensation of personnel 
                without regard to chapter 51 and subchapter III of 
                chapter 53 of title 5, United States Code, relating to 
                classification of positions and General Schedule pay 
                rates, except that the rate of pay for personnel may 
                not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
                    (C) Detail of government employees.--Any Federal 
                Government employee may be detailed to the Commission 
                without reimbursement, and such detail shall be without 
                interruption or loss of civil service status or 
                privilege.
                    (D) Procurement of temporary and intermittent 
                services.--The Chairperson of the Commission may 
                procure temporary and intermittent services under 
                section 3109(b) of title 5, United States Code, at 
                rates for individuals which do not exceed the daily 
                equivalent of the annual rate of basic pay prescribed 
                for level V of the Executive Schedule under section 
                5316 of such title.
    (g) Termination.--Except with respect to activities in connection 
with the ongoing biennial report required under subsection (e)(2), the 
Commission shall terminate 90 days after the date on which the 
Commission submits the report required under subsection (e)(3).
    (h) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for fiscal year 2005 and each subsequent fiscal year.

     TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTHCARE

SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

                     ``TITLE XXIX--MINORITY HEALTH

``SEC. 2900. DEFINITIONS.

    ``In this title, the definitions contained in section 801 of the 
Healthcare Equality and Accountability Act shall apply.

   ``Subtitle A--Culturally and Linguistically Appropriate Healthcare

``SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS WITH LIMITED 
              ENGLISH PROFICIENCY.

    ``(a) Purpose.--As provided in Executive Order 13166, it is the 
purpose of this section--
            ``(1) to improve access to Federally conducted and 
        Federally assisted programs and activities for individuals who 
        are limited in their English proficiency;
            ``(2) to require each Federal agency to examine the 
        services it provides and develop and implement a system by 
which limited English proficient individuals can enjoy meaningful 
access to those services consistent with, and without substantially 
burdening, the fundamental mission of the agency;
            ``(3) to require each Federal agency to ensure that 
        recipients of Federal financial assistance provide meaningful 
        access to their limited English proficient applicants and 
        beneficiaries;
            ``(4) to ensure that recipients of Federal financial 
        assistance take reasonable steps, consistent with the 
        guidelines set forth in the Limited English Proficient Guidance 
        of the Department of Justice (as issued on June 12, 2002), to 
        ensure meaningful access to their programs and activities by 
        limited English proficient individuals; and
            ``(5) to ensure compliance with title VI of the Civil 
        Rights Act of 1964 and that healthcare providers and 
        organizations do not discriminate in the provision of services.
    ``(b) Federally Conducted Programs and Activities.--
            ``(1) In general.--Not later than 120 days after the date 
        of enactment of this Act, each Federal agency that carries out 
        health care-related activities shall prepare a plan to improve 
        access to the federally conducted health care-related programs 
        and activities of the agency by limited English proficient 
        individuals.
            ``(2) Plan requirement.--Each plan under paragraph (1) 
        shall be consistent with the standards set forth in section 204 
        of the Healthcare Equality and Accountability Act, and shall 
        include the steps the agency will take to ensure that limited 
        English proficient individuals have access to the agency's 
        health care-related programs and activities. Each agency shall 
        send a copy of such plan to the Department of Justice, which 
        shall serve as the central repository of the agencies' plans.
    ``(c) Federally Assisted Programs and Activities.--
            ``(1) In general.--Not later than 120 days after the date 
        of enactment of this Act, each Federal agency providing health 
        care-related Federal financial assistance shall ensure that the 
        guidance for recipients of Federal financial assistance 
        developed by the agency to ensure compliance with title VI of 
        the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) is 
        specifically tailored to the recipients of such assistance and 
        is consistent with the standards described in section 204 of 
        the Healthcare Equality and Accountability Act. Each agency 
        shall send a copy of such guidance to the Department of Justice 
        which shall serve as the central repository of the agencies' 
        plans. After approval by the Department of Justice, each agency 
        shall publish its guidance document in the Federal Register for 
        public comment.
            ``(2) Requirements.--The agency-specific guidance developed 
        under paragraph (1) shall--
                    ``(A) detail how the general standards established 
                under section 204 of the Healthcare Equality and 
                Accountability Act will be applied to the agency's 
                recipients; and
                    ``(B) take into account the types of health care 
                services provided by the recipients, the individuals 
                served by the recipients, and other factors set out in 
                such standards.
            ``(3) Existing guidances.--A Federal agency that has 
        developed a guidance for purposes of title VI of the Civil 
        Rights Act of 1964 that the Department of Justice determines is 
        consistent with the standards described in section 204 of the 
        Healthcare Equality and Accountability Act shall examine such 
        existing guidance, as well as the programs and activities to 
        which such guidance applies, to determine if modification of 
        such guidance is necessary to comply with this subsection.
            ``(4) Consultation.--Each Federal agency shall consult with 
        the Department of Justice in establishing the guidances under 
        this subsection.
    ``(d) Consultations.--
            ``(1) In general.--In carrying out this section, each 
        Federal agency that carriers out health care-related activities 
        shall ensure that stakeholders, such as limited English 
        proficient individuals and their representative organizations, 
        recipients of Federal assistance, and other appropriate 
        individuals or entities, have an adequate and comparable 
        opportunity to provide input with respect to the actions of the 
        agency.
            ``(2) Evaluation of needs.--Each Federal agency described 
        in paragraph (1) shall evaluate the particular needs of the 
        limited English proficient individuals served by the agency, 
        and by a recipient of assistance provided by the agency, and 
        the burdens of compliance with the agency guidance and its 
        recipients of the requirements of this section.

``SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES IN HEALTHCARE.

    ``Recipients of Federal financial assistance from the Secretary 
shall, to the extent reasonable and practicable after applying the 4-
factor analysis described in title V of the Guidance to Federal 
Financial Assistance Recipients Regarding Title VI Prohibition Against 
National Origin Discrimination Affecting Limited-English Proficient 
Persons (June 12, 2002)--
            ``(1) implement strategies to recruit, retain, and promote 
        individuals at all levels of the organization to maintain a 
        diverse staff and leadership that can provide culturally and 
        linguistically appropriate healthcare to patient populations of 
        the service area of the organization;
            ``(2) ensure that staff at all levels and across all 
        disciplines of the organization receive ongoing education and 
        training in culturally and linguistically appropriate service 
        delivery;
            ``(3) offer and provide language assistance services, 
        including bilingual staff and interpreter services, at no cost 
        to each patient with limited English proficiency at all points 
        of contact, in a timely manner during all hours of operation;
            ``(4) notify patients of their right to receive language 
        assistance services in their primary language;
            ``(5) ensure the competence of language assistance provided 
        to limited English proficient patients by interpreters and 
        bilingual staff, and ensure that family and friends are not 
        used to provide interpretation services--
                    ``(A) except in case of emergency; or
                    ``(B) except on request of the patient, who has 
                been informed in his or her preferred language of the 
                availability of free interpretation services;
            ``(6) make available easily understood patient-related 
        materials including information or notices about termination of 
        benefits and post signage in the languages of the commonly 
        encountered groups or groups represented in the service area of 
        the organization;
            ``(7) develop and implement clear goals, policies, 
        operational plans, and management accountability and oversight 
        mechanisms to provide culturally and linguistically appropriate 
        services;
            ``(8) conduct initial and ongoing organizational self-
        assessments of culturally and linguistically appropriate 
        services-related activities and integrate cultural and 
        linguistic competence-related measures into the internal 
        audits, performance improvement programs, patient satisfaction 
        assessments, and outcomes-based evaluations of the 
        organization;
            ``(9) ensure that, consistent with the privacy protections 
        provided for under the regulations promulgated under section 
        264(c) of the Health Insurance Portability and Accountability 
        Act of 1996 (42 U.S.C. 1320d-2 note)--
                    ``(A) data on the individual patient's race, 
                ethnicity, and primary language are collected in health 
                records, integrated into the organization's management 
                information systems, and periodically updated; and
                    ``(B) if the patient is a minor or is 
                incapacitated, the primary language of the parent or 
                legal guardian is collected;
            ``(10) maintain a current demographic, cultural, and 
        epidemiological profile of the community as well as a needs 
        assessment to accurately plan for and implement services that 
        respond to the cultural and linguistic characteristics of the 
        service area of the organization;
            ``(11) develop participatory, collaborative partnerships 
        with communities and utilize a variety of formal and informal 
        mechanisms to facilitate community and patient involvement in 
        designing and implementing culturally and linguistically 
        appropriate services-related activities;
            ``(12) ensure that conflict and grievance resolution 
        processes are culturally and linguistically sensitive and 
        capable of identifying, preventing, and resolving cross-
        cultural conflicts or complaints by patients;
            ``(13) regularly make available to the public information 
        about their progress and successful innovations in implementing 
        the standards under this section and provide public notice in 
        their communities about the availability of this information; 
        and
            ``(14) regularly make available to the head of each Federal 
        entity from which Federal funds are received, information about 
        their progress and successful innovations in implementing the 
        standards under this section as required by the head of such 
        entity.

``SEC. 2903. CENTER FOR CULTURAL AND LINGUISTIC COMPETENCE IN 
              HEALTHCARE.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Office of Minority Health, shall establish and support a center to 
be known as the `Center for Cultural and Linguistic Competence in 
Healthcare' (referred to in this section as the `Center') to carry out 
the following activities:
            ``(1) Remote medical interpretation.--The Center shall 
        provide remote medical interpretation, directly or through 
        contract, at no cost to healthcare providers. Methods of 
        interpretation may include remote, simultaneous or consecutive 
        interpreting through telephonic systems, video conferencing, 
        and other methods determined appropriate by the Secretary for 
        patients with limited English proficiency. The quality of such 
        interpretation shall be monitored and reported publicly. 
        Nothing in this paragraph shall be construed to limit the 
        ability of healthcare providers or organizations to provide 
        medical interpretation services directly and obtain 
        reimbursement for such services as provided for under the 
        medicare, medicaid or SCHIP programs under titles XVIII, XIX, 
        or XXI of the Social Security Act.
            ``(2) Translation of written material.--The Center shall 
        provide, directly or through contract, for the translation of 
        written materials for healthcare providers and healthcare 
        organizations (as defined in section 2902(b)) at no cost to 
        such providers and organizations. Materials may be submitted 
        for translation into non-English languages. Translation 
        services shall be provided in a timely and reasonable manner. 
        The quality of such translation shall be monitored and reported 
        publicly.
            ``(3) Model language assistance programs.--The Center shall 
        provide for the collection and dissemination of information on 
        current model language assistance programs and strategies to 
        improve language access to healthcare for individuals with 
        limited English proficiency, including case studies using de-
        identified patient information, program summaries, and program 
        evaluations.
            ``(4) Medical interpretation guidelines.--
                    ``(A) In general.--The Center shall convene a 
                working group to develop quality guidelines and 
                standards for the training of medical interpreters and 
                translators. Such group shall include--
                            ``(i) representatives from the Office of 
                        Minority Health, the National Center on 
                        Minority Health and Health Disparities, the 
                        Agency for Healthcare Research and Quality, the 
                        Centers for Medicare and Medicaid Services, the 
                        Office for Civil Rights of the Department of 
                        Health and Human Services, and other Federal 
                        agencies determined appropriate by the 
                        Secretary; and
                            ``(ii) representatives of communities with 
                        a significant proportion of limited English 
                        proficient individuals, professional 
                        interpreter associations, medical 
                        interpretation service providers, and other 
                        public or private organizations determined 
                        appropriate by the Secretary.
                    ``(B) Publication.--Not later than 18 months after 
                the date of enactment of this Act, the Center shall 
                publish guidelines and standards developed under this 
                paragraph in the Federal Register.
            ``(5) Internet health clearinghouse.--The Center shall 
        develop and maintain an Internet clearinghouse to reduce 
        medical errors and healthcare costs caused by communication 
        with individuals with limited English proficiency or low 
        functional health literacy and reduce or eliminate the 
        duplication of effort to translate materials by--
                    ``(A) developing and making available templates for 
                standard documents that are necessary for patients and 
                consumers to access and make educated decisions about 
                their healthcare, including--
                            ``(i) administrative and legal documents 
                        such as informed consent, advanced directives, 
                        and waivers of rights;
                            ``(ii) clinical information such as how to 
                        take medications, how to prevent transmission 
                        of a contagious disease, and other prevention 
                        and treatment instructions; and
                            ``(iii) patient education and outreach 
                        materials such as immunization notices, health 
                        warnings, or screening notices;
                    ``(B) ensuring that the documents are posted in 
                English and non-English languages and are culturally 
                appropriate;
                    ``(C) allowing public review of the documents 
                before dissemination in order to ensure that the 
                documents are understandable and culturally appropriate 
                for the target populations;
                    ``(D) allowing healthcare providers to customize 
                the documents for their use;
                    ``(E) facilitating access to these documents;
                    ``(F) providing technical assistance with respect 
                to the access and use of such information; and
                    ``(G) carrying out any other activities the 
                Secretary determines to be useful to fulfill the 
                purposes of the Clearinghouse.
            ``(6) Provision of information.--The Center shall provide 
        information relating to culturally and linguistically competent 
        healthcare for minority populations residing in the United 
        States to all healthcare providers and healthcare organizations 
        at no cost. Such information shall include--
                    ``(A) tenets of culturally and linguistically 
                competent care;
                    ``(B) cultural and linguistic competence self-
                assessment tools;
                    ``(C) cultural and linguistic competence training 
                tools;
                    ``(D) strategic plans to increase cultural and 
                linguistic competence in different types of healthcare 
                organizations; and
                    ``(E) resources for cultural competence information 
                for educators, practitioners and researchers.
    ``(b) Director.--The Center shall be headed by a Director to be 
appointed by the Director of the Office of Minority Health who shall 
report to the Director of the Office of Minority Health.
    ``(c) Availability of Language Access.--The Director shall 
collaborate with the Administrator of the Centers for Medicare and 
Medicaid Services and the Administrator of the Health Resources and 
Services Administration, to notify healthcare providers and healthcare 
organizations about the availability of language access services by the 
Center.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2904. INNOVATIONS IN LANGUAGE ACCESS GRANTS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Centers for Medicare and Medicaid Services, the Administrator of 
the Health Resources and Services Administration, and the Director of 
the Office of Minority Health, shall award grants to eligible entities 
to enable such entities to design, implement, and evaluate innovative, 
cost-effective programs to improve linguistic access to healthcare for 
individuals with limited English proficiency.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a city, county, Indian tribe, State, territory, 
        community-based nonprofit organization, health center or 
        community clinic, university, college, or other entity 
        designated by the Secretary; and
            ``(2) prepare and submit to the Secretary an application, 
        at such time, in such manner, and accompanied by such 
        additional information as the Secretary may require.
    ``(c) Use of Funds.--An entity shall use funds received under a 
grant under this section to--
            ``(1) develop, implement, and evaluate models of providing 
        real-time interpretation services through in-person 
        interpretation, communications, and computer technology, 
        including the Internet, teleconferencing, or video 
        conferencing;
            ``(2) develop short-term medical interpretation training 
        courses and incentives for bilingual healthcare staff who are 
        asked to interpret in the workplace;
            ``(3) develop formal training programs for individuals 
        interested in becoming dedicated healthcare interpreters;
            ``(4) provide language training courses for healthcare 
        staff;
            ``(5) provide basic healthcare-related English language 
        instruction for limited English proficient individuals; and
            ``(6) develop other language assistance services as 
        determined appropriate by the Secretary.
    ``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to entities that have developed 
partnerships with organizations or agencies with experience in language 
access services.
    ``(e) Evaluation.--An entity that receives a grant under this 
section shall submit to the Secretary an evaluation that describes the 
activities carried out with funds received under the grant, and how 
such activities improved access to healthcare services and the quality 
of healthcare for individuals with limited English proficiency. Such 
evaluation shall be collected and disseminated through the Center for 
Linguistic and Cultural Competence in Healthcare established under 
section 2903.
    ``(f) Grantee Convention.--The Secretary, acting through the 
Director of the Center for Linguistic and Cultural Competence in 
Healthcare, shall at the end of the grant cycle convene grantees under 
this section to share findings and develop and disseminate model 
programs and practices.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2905. RESEARCH ON LANGUAGE ACCESS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Agency for Healthcare Research and Quality, shall expand research 
concerning--
            ``(1) the barriers to healthcare services that are faced by 
        limited English proficient individuals;
            ``(2) the impact of language barriers on the quality of 
        healthcare and the health status of limited English proficient 
        individuals and populations;
            ``(3) healthcare provider attitudes, knowledge, and 
        awareness of the barriers described in paragraphs (1) and (2); 
        and
            ``(4) the means by which oral or written language 
        interpretation services are provided to limited English 
        proficient individuals and whether such services are effective 
        in improving the quality of care.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2906. TOLL-FREE TELEPHONE NUMBER.

    ``The Secretary shall provide, through a toll-free number, for a 
means by which limited English proficient individuals who are seeking 
information about, or assistance with, Federal healthcare programs who 
phone such toll-free number are transferred (without charge) to 
appropriate translators for the provision of such information or 
assistance.''.

SEC. 203. STANDARDS FOR LANGUAGE ACCESS SERVICES.

    Not later than 120 days after the date of enactment of this Act, 
the head of each Federal agency that carries out health care-related 
activities shall develop and adopt a guidance on language services for 
those with limited English proficiency who attempt to have access to or 
participate in such activities that provides at the minimum the factors 
and principles set forth in the Department of Justice guidance 
published on June 12, 2002.

SEC. 204. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID AND 
              STATE CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) Demonstration Project Promoting Access for Medicare 
Beneficiaries With Limited English Proficiency.--
            (1) In General.--The Secretary shall conduct a 
        demonstration project (in this section referred to as the 
        `project') to demonstrate the impact on costs and health 
        outcomes of providing reimbursement for interpreter services to 
        certain medicare beneficiaries who are limited English 
        proficient in urban and rural areas.
            (2) Scope.--The Secretary shall carry out the project in 
        not less than 30 States through contracts with up to--
                    (A) ten health plans (under part C of title XVIII 
                of the Social Security Act);
                    (B) ten small providers; and
                    (C) ten hospitals.
            (3) Duration.--Each contract entered into under the project 
        shall extend over a period of not longer than 2 years.
            (4) Report.--Upon completion of the project, the Secretary 
        shall submit a report to Congress on the project which shall 
        include recommendations regarding the extension of such project 
        to the entire medicare program.
            (5) Evaluation.--The Director of the Agency for Healthcare 
        Research and Quality shall award grants to public and private 
        nonprofit entities for the evaluation of the project. Such 
        evaluations shall focus on access, utilization, efficiency, 
        cost-effectiveness, patient satisfaction, and select health 
        outcomes.
    (b) 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 culturally and 
                linguistically appropriate services, including oral 
                interpretation, translations of written materials, and 
                other cultural and linguistic services for individuals 
                with limited English proficiency and disabilities who 
                apply for, or receive, medical assistance under the 
                State plan (including any waiver granted to the State 
                plan); plus''.
    (c) SCHIP.--Section 2105(a)(1) of the Social Security Act (42 
U.S.C.1397ee(a)), as amended by section 515, 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) by redesignating clause (iv) as clause (v); and
                    (C) by inserting after clause (iii) the following:
                            ``(iv) for expenditures attributable to the 
                        provision of culturally and linguistically 
                        appropriate services, including oral 
                        interpretation, translations of written 
                        materials, and other language services for 
                        individuals with limited English proficiency 
                        and disabilities who apply for, or receive, 
                        child health assistance under the plan; and''.
    (d) Effective Date.--The amendments made by this section take 
effect on October 1, 2005.

SEC. 205. INCREASING UNDERSTANDING OF HEALTH LITERACY.

    (a) In General.--The Secretary, acting through the Director of the 
Agency for Healthcare Research and Quality and the Administrator of the 
Health Resources and Services Administration, shall award grants to 
eligible entities to improve healthcare for patient populations that 
have low functional health literacy.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be a hospital, health center or clinic, health plan, or 
        other health entity; and
            (2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    (c) Use of Funds.--
            (1) Agency for Healthcare Research and Quality.--Grants 
        awarded under subsection (a) through the Agency for Healthcare 
        Research and Quality shall be used--
                    (A) to define and increase the understanding of 
                health literacy;
                    (B) to investigate the correlation between low 
                health literacy and health and healthcare;
                    (C) to clarify which aspects of health literacy 
                have an effect on health outcomes; and
                    (D) for any other activity determined appropriate 
                by the Director of the Agency.
            (2) Health Resources and Services Administration.--Grants 
        awarded under subsection (a) through the Health Resources and 
        Services Administration shall be used to conduct demonstration 
        projects for interventions for patients with low health 
        literacy that may include--
                    (A) the development of new disease management 
                programs for patients with low health literacy;
                    (B) the tailoring of existing disease management 
                programs for patients with low health literacy;
                    (C) the translation of written health materials for 
                patients with low health literacy;
                    (D) the identification, implementation, and testing 
                of low health literacy screening tools;
                    (E) the conduct of educational campaigns for 
                patients and providers about low health literacy; and
                    (F) other activities determined appropriate by the 
                Administrator of the Health Resources and Services 
                Administration.
    (d) Definitions.--In this section, the term ``low health literacy'' 
means the inability of an individual to obtain, process, and understand 
basic health information and services needed to make appropriate health 
decisions.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND 
              LINGUISTICALLY APPROPRIATE HEALTHCARE SERVICES.

    Not later than 1 year after the date of enactment of this Act and 
annually thereafter, the Secretary of Health and Human Services shall 
enter into a contract with the Institute of Medicine for the 
preparation and publication of a report that describes federal efforts 
to ensure that all individuals have meaningful access to culturally and 
linguistically appropriate healthcare services. Such report shall 
include--
            (1) a description and evaluation of the activities carried 
        out under this title; and
            (2) a description of best practices, model programs, 
        guidelines, and other effective strategies for providing access 
        to culturally and linguistically appropriate healthcare 
        services.

SEC. 207. GENERAL ACCOUNTING OFFICE REPORT ON IMPACT OF LANGUAGE ACCESS 
              SERVICES.

    Not later than 3 years after the date of enactment of this Act, the 
Comptroller General of the United States shall examine, and prepare and 
publish a report on, the impact of language access services on the 
health and healthcare of limited English proficient populations. Such 
report shall include--
            (1) recommendations on the development and implementation 
        of policies and practices by healthcare organizations and 
        providers for limited English proficient patient populations;
            (2) a description of the effect of providing language 
        access services on quality of healthcare and access to care; 
        and
            (3) a description of the costs associated with or savings 
        related to provision of language access services.

                 TITLE III--HEALTH WORKFORCE DIVERSITY

SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

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

                   ``Subtitle B--Workforce Diversity

``SEC. 2911. REPORT ON WORKFORCE DIVERSITY.

    ``(a) In General.--Not later than July 1, 2006, and biannually 
thereafter, the Secretary, acting through the director of each entity 
within the Department of Health and Human Services, shall 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 health workforce diversity.
    ``(b) Requirement.--The report under subsection (a) shall contain 
the following information:
            ``(1) A description of any grant support that is provided 
        by each entity for workforce diversity initiatives with the 
        following information--
                    ``(A) the number of grants made;
                    ``(B) the purpose of the grants;
                    ``(C) the populations served through the grants;
                    ``(D) the organizations and institutions receiving 
                the grants; and
                    ``(E) the tracking efforts that were used to follow 
                the progress of participants.
            ``(2) A description of the entity's plan to achieve 
        workforce diversity goals that includes, to the extent relevant 
        to such entity--
                    ``(A) the number of underrepresented minority 
                health professionals that will be needed in various 
                disciplines over the next 10 years to achieve 
                population parity;
                    ``(B) the level of funding needed to fully expand 
                and adequately support health professions pipeline 
                programs;
                    ``(C) the impact such programs have had on the 
                admissions practices and policies of health professions 
                schools;
                    ``(D) the management strategy necessary to 
                effectively administer and institutionalize health 
                profession pipeline programs; and
                    ``(E) the impact that the Government Performance 
                and Results Act (GPRA) has had on evaluating the 
                performance of grantees and whether the GPRA is the 
                best assessment tool for programs under titles VII and 
                VIII.
            ``(3) A description of measurable objectives of each entity 
        relating to workforce diversity initiatives.
    ``(c) Public Availability.--The report under subsection (a) shall 
be made available for public review and comment.

``SEC. 2912. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions within the Health Resources and Services 
Administration, shall award a grant to an entity determined appropriate 
by the Secretary for the establishment of a national working group on 
workforce diversity.
    ``(b) Representation.--In establishing the national working group 
under subsection (a), the grantee shall ensure that the group has 
representation from the following entities:
            ``(1) The Health Resources and Services Administration.
            ``(2) The Department of Health and Human Services Data 
        Council.
            ``(3) The Bureau of Labor Statistics of the Department of 
        Labor.
            ``(4) The Public Health Practice Program Office--Office of 
        Workforce Policy and Planning.
            ``(5) The National Center on Minority Health and Health 
        Disparities.
            ``(6) The Agency for Healthcare Research and Quality.
            ``(7) The Institute of Medicine Study Committee for the 
        2004 workforce diversity report.
            ``(8) The Indian Health Service.
            ``(9) Academic institutions.
            ``(10) Consumer organizations.
            ``(11) Health professional associations, including those 
        that represent underrepresented minority populations.
            ``(12) Researchers in the area of health workforce.
            ``(13) Health workforce accreditation entities.
            ``(14) Private foundations that have sponsored workforce 
        diversity initiatives.
            ``(15) Not less than 5 health professions students 
        representing various health profession fields and levels of 
        training.
    ``(c) Activities.--The working group established under subsection 
(a) shall convene at least twice each year to complete the following 
activities:
            ``(1) Review current public and private health workforce 
        diversity initiatives.
            ``(2) Identify successful health workforce diversity 
        programs and practices.
            ``(3) Examine challenges relating to the development and 
        implementation of health workforce diversity initiatives.
            ``(4) Draft a national strategic work plan for health 
        workforce diversity, including recommendations for public and 
        private sector initiatives.
            ``(5) Develop a framework and methods for the evaluation of 
        current and future health workforce diversity initiatives.
            ``(6) Develop recommended standards for workforce diversity 
        that could be applicable to all health professions programs and 
        programs funded under this Act.
            ``(7) Develop curriculum guidelines for diversity training.
            ``(8) Develop a strategy for the inclusion of community 
        members on admissions committees for health profession schools.
            ``(9) Other activities determined appropriate by the 
        Secretary.
    ``(d) Annual Report.--Not later than 1 year after the establishment 
of the working group under subsection (a), and annually thereafter, the 
working group shall prepare and make available to the general public 
for comment, an annual report on the activities of the working group. 
Such report shall include the recommendations of the working group for 
improving health workforce diversity.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2913. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Office of 
Minority Health, and in collaboration with the Bureau of Health 
Professions within the Health Resources and Services Administration, 
shall establish a technical clearinghouse on health workforce diversity 
within the Office of Minority Health and coordinate current and future 
clearinghouses.
    ``(b) Information and Services.--The clearinghouse established 
under subsection (a) shall offer the following information and 
services:
            ``(1) Information on the importance of health workforce 
        diversity.
            ``(2) Statistical information relating to underrepresented 
        minority representation in health and allied health professions 
        and occupations.
            ``(3) Model health workforce diversity practices and 
        programs.
            ``(4) Admissions policies that promote health workforce 
        diversity and are in compliance with Federal and State laws.
            ``(5) Lists of scholarship, loan repayment, and loan 
        cancellation grants as well as fellowship information for 
        underserved populations for health professions schools.
            ``(6) Foundation and other large organizational initiatives 
        relating to health workforce diversity.
    ``(c) Consultation.--In carrying out this section, the Secretary 
shall consult with non-Federal entities which may include minority 
health professional associations to ensure the adequacy and accuracy of 
information.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2914. EVALUATION OF WORKFORCE DIVERSITY INITIATIVES.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions within the Health Resources and Services 
Administration, shall award grants to eligible entities for the conduct 
of an evaluation of current health workforce diversity initiatives 
funded by the Department of Health and Human Services.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a city, county, Indian tribe, State, territory, 
        community-based nonprofit organization, health center, 
        university, college, or other entity determined appropriate by 
        the Secretary;
            ``(2) with respect to an entity that is not an academic 
        medical center, university, or private research institution, 
        carry out activities under the grant in partnership with an 
        academic medical center, university, or private research 
        institution; and
            ``(3) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts awarded under a grant under subsection 
(a) shall be used to support the following evaluation activities:
            ``(1) Determinations of measures of health workforce 
        diversity success.
            ``(2) The short- and long-term tracking of participants in 
        health workforce diversity pipeline programs funded by the 
        Department of Health and Human Services.
            ``(3) Assessments of partnerships formed through activities 
        to increase health workforce diversity.
            ``(4) Assessments of barriers to health workforce 
        diversity.
            ``(5) Assessments of policy changes at the Federal, State, 
        and local levels.
            ``(6) Assessments of coordination within and between 
        Federal agencies and other institutions.
            ``(7) Other activities determined appropriate by the 
        Secretary and the Working Group established under section 2912.
    ``(d) Report.--Not later than 1 year after the date of enactment of 
this title, the Bureau of Health Professions within the Health 
Resources and Services Administration shall prepare and make available 
for public comment a report that summarizes the findings made by 
entities under grants under this section.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2915. DATA COLLECTION AND REPORTING BY HEALTH PROFESSIONAL 
              SCHOOLS.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions of the Health Resources and Services Administration 
and the Office of Minority Health, shall establish an aggregated 
database on health professional students.
    ``(b) Requirement To Collect Data.--Each health professional school 
(including medical, dental, and nursing schools) and allied health 
profession school and program that receives Federal funds shall collect 
race, ethnicity, and language proficiency data concerning those 
students enrolled at such schools or in such programs. In collecting 
such data, a school or program shall--
            ``(1) at a minimum, use the categories for race and 
        ethnicity described in the 1997 Office of Management and Budget 
        Standards for Maintaining, Collecting, and Presenting Federal 
        Data on Race and Ethnicity and available language standards; 
        and
            ``(2) if practicable, collect data on additional population 
        groups if such data can be aggregated into the minimum race and 
        ethnicity data categories.
    ``(c) Use of Data.--Data on race, ethnicity, and primary language 
collected under this section shall be reported to the database 
established under subsection (a) on an annual basis. Such data shall be 
available for public use.
    ``(d) Privacy.--The Secretary shall ensure that all data collected 
under this section is protected from inappropriate internal and 
external use by any entity that collects, stores, or receives the data 
and that such data is collected without personally identifiable 
information.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2916. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to eligible entities that demonstrate a commitment to health workforce 
diversity.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an educational institution or entity that 
        historically produces or trains meaningful numbers of 
        underrepresented minority health professionals, including--
                    ``(A) Historically Black Colleges and Universities;
                    ``(B) Hispanic-Serving Health Professions Schools;
                    ``(C) Hispanic-Serving Institutions;
                    ``(D) Tribal Colleges and Universities;
                    ``(E) Asian American and Pacific Islander-serving 
                institutions;
                    ``(F) institutions that have programs to recruit 
                and retain underrepresented minority health 
                professionals, in which a significant number of the 
                enrolled participants are underrepresented minorities;
                    ``(G) health professional associations, which may 
                include underrepresented minority health professional 
                associations; and
                    ``(H) institutions--
                            ``(i) located in communities with 
                        predominantly underrepresented minority 
                        populations;
                            ``(ii) with whom partnerships have been 
                        formed for the purpose of increasing workforce 
                        diversity; and
                            ``(iii) in which at least 20 percent of the 
                        enrolled participants are underrepresented 
                        minorities; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant under 
subsection (a) shall be used to expand existing workforce diversity 
programs, implement new workforce diversity programs, or evaluate 
existing or new workforce diversity programs. Such programs shall 
enhance diversity by considering minority status as part of an 
individualized consideration of qualifications. Possible activities may 
include--
            ``(1) educational outreach programs relating to 
        opportunities in the health professions;
            ``(2) scholarship, fellowship, grant, loan repayment, and 
        loan cancellation programs;
            ``(3) post-baccalaureate programs;
            ``(4) academic enrichment programs, particularly targeting 
        those who would not be competitive for health professions 
        schools;
            ``(5) kindergarten through 12th grade and other health 
        pipeline programs;
            ``(6) mentoring programs;
            ``(7) internship or rotation programs involving hospitals, 
        health systems, health plans and other health entities;
            ``(8) community partnership development for purposes 
        relating to workforce diversity; or
            ``(9) leadership training.
    ``(d) Reports.--Not later than 1 year after receiving a grant under 
this section, and annually for the term of the grant, a grantee shall 
submit to the Secretary a report that summarizes and evaluates all 
activities conducted under the grant.
    ``(e) Definition.--In this section, the term `Asian American and 
Pacific Islander-serving institutions' means institutions--
            ``(1) that are eligible institutions under section 312(b) 
        of the Higher Education Act of 1965; and
            ``(2) that, at the time of their application, have an 
        enrollment of undergraduate students that is made up of at 
        least 10 percent Asian American and Pacific Islander students.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2917. CAREER DEVELOPMENT FOR SCIENTISTS AND RESEARCHERS.

    ``(a) In General.--The Secretary, acting through the Director of 
the National Institutes of Health, the Director of the Centers for 
Disease Control and Prevention, the Commissioner of the Food and Drug 
Administration, and the Director of the Agency for Healthcare Research 
and Quality, shall award grants that expand existing opportunities for 
scientists and researchers and promote the inclusion of 
underrepresented minorities in the health professions.
    ``(b) Research Funding.--The head of each entity within the 
Department of Health and Human Services shall establish or expand 
existing programs to provide research funding to scientists and 
researchers in-training. Under such programs, the head of each such 
entity shall give priority in allocating research funding to support 
health research in traditionally underserved communities, including 
underrepresented minority communities, and research classified as 
community or participatory.
    ``(c) Data Collection.--The head of each entity within the 
Department of Health and Human Services shall collect data on the 
number (expressed as an absolute number and a percentage) of 
underrepresented minority and nonminority applicants who receive and 
are denied agency funding at every stage of review. Such data shall be 
reported annually to the Secretary and the appropriate committees of 
Congress.
    ``(d) Student Loan Reimbursement.--The Secretary shall establish a 
student loan reimbursement program to provide student loan 
reimbursement assistance to researchers who focus on minority health 
issues or minority racial and ethnic disparities in health. The 
Secretary shall promulgate regulations to define the scope and 
procedures for the program under this subsection.
    ``(e) Student Loan Cancellation.--The Secretary shall establish a 
student loan cancellation program to provide student loan cancellation 
assistance to researchers who focus on minority health issues or 
minority racial and ethnic disparities in health. Students 
participating in the program shall make a minimum 5-year commitment to 
work at an accredited health profession school. The Secretary shall 
promulgate additional regulations to define the scope and procedures 
for the program under this subsection.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2918. CAREER SUPPORT FOR NON-RESEARCH HEALTH PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, the Administrator of 
the Substance Abuse and Mental Health Services Administration, the 
Administrator of the Health Resources and Services Administration, and 
the Administrator of the Centers for Medicare and Medicaid Services 
shall establish a program to award grants to eligible individuals for 
career support in non-research-related healthcare.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an individual shall--
            ``(1) be a student in a health professions school, a 
        graduate of such a school who is working in a health 
        profession, or a faculty member of such a school; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--An individual shall use amounts received under 
a grant under this section to--
            ``(1) support the individual's health activities or 
        projects that involve underserved communities, including racial 
        and ethnic minority communities;
            ``(2) support health-related career advancement activities; 
        and
            ``(3) to pay, or as reimbursement for payments of, student 
        loans for individuals who are health professionals and are 
        focused on health issues affecting underserved communities, 
        including racial and ethnic minority communities.
    ``(d) Definition.--In this section, the term `career in non-
research-related healthcare' means employment or intended employment in 
the field of public health, health policy, health management, health 
administration, medicine, nursing, pharmacy, allied health, community 
health, or other fields determined appropriate by the Secretary, other 
than in a position that involves research.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2919. RESEARCH ON THE EFFECT OF WORKFORCE DIVERSITY ON QUALITY.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Director of the Office 
of Minority Health and the Director of the National Center on Minority 
Health and Health Disparities, shall award grants to eligible entities 
to expand research on the link between health workforce diversity and 
quality healthcare.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a clinical, public health, or health services 
        research entity or other entity determined appropriate by the 
        Director; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant awarded under 
subsection (a) shall be used to support research that investigates the 
effect of health workforce diversity on--
            ``(1) language access;
            ``(2) cultural competence;
            ``(3) patient satisfaction;
            ``(4) timeliness of care;
            ``(5) safety of care;
            ``(6) effectiveness of care;
            ``(7) efficiency of care;
            ``(8) patient outcomes;
            ``(9) community engagement;
            ``(10) resource allocation;
            ``(11) organizational structure; or
            ``(12) other topics determined appropriate by the Director.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give individualized consideration to all relevant 
aspects of the applicant's background. Consideration of prior research 
experience involving the health of underserved communities shall be 
such a factor.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2920. HEALTH DISPARITIES EDUCATION PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the National 
Center on Minority Health and Health Disparities and in collaboration 
with the Office of Minority Health, the Office for Civil Rights, the 
Centers for Disease Control and Prevention, the Centers for Medicare 
and Medicaid Services, the Health Resources and Services 
Administration, and other appropriate public and private entities, 
shall establish and coordinate a health and healthcare disparities 
education program to support, develop, and implement educational 
initiatives and outreach strategies that inform healthcare 
professionals and the public about the existence of and methods to 
reduce racial and ethnic disparities in health and healthcare.
    ``(b) Activities.--The Secretary, through the education program 
established under subsection (a) shall, through the use of public 
awareness and outreach campaigns targeting the general public and the 
medical community at large--
            ``(1) disseminate scientific evidence for the existence and 
        extent of racial and ethnic disparities in healthcare, 
        including disparities that are not otherwise attributable to 
        known factors such as access to care, patient preferences, or 
        appropriateness of intervention, as described in the 2002 
        Institute of Medicine Report, Unequal Treatment;
            ``(2) disseminate new research findings to healthcare 
        providers and patients to assist them in understanding, 
        reducing, and eliminating health and healthcare disparities;
            ``(3) disseminate information about the impact of 
        linguistic and cultural barriers on healthcare quality and the 
        obligation of health providers who receive Federal financial 
        assistance to ensure that people with limited English 
        proficiency have access to language access services;
            ``(4) disseminate information about the importance and 
        legality of racial, ethnic, and primary language data 
        collection, analysis, and reporting;
            ``(5) design and implement specific educational initiatives 
        to health care providers relating to health and health care 
        disparities;
            ``(6) assess the impact of the programs established under 
        this section in raising awareness of health and healthcare 
        disparities and providing information on available resources.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2920A. CULTURAL COMPETENCE TRAINING FOR HEALTHCARE 
              PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, the Director of 
the Office of Minority Health, and the Director of the National Center 
for Minority Health and Health Disparities, shall award grants to 
eligible entities to test, implement, and evaluate models of cultural 
competence training for healthcare providers in coordination with the 
initiative under section 2920A(a).
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an academic medical center, a health center or 
        clinic, a hospital, a health plan, or a health system;
            ``(2) partner with a minority serving institution, minority 
        professional association, or community-based organization 
        representing minority populations, in addition to a research 
        institution to carry out activities under this grant; and
            ``(3) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

SEC. 302. HEALTH CAREERS OPPORTUNITY PROGRAM.

    (a) Purpose.--It is the purpose of this section to diversify the 
healthcare workforce by increasing the number of individuals from 
disadvantaged backgrounds in the health and allied health professions 
by enhancing the academic skills of students from disadvantaged 
backgrounds and supporting them in successfully competing, 
entering, and graduating from health professions training programs.
    (b) Authorization of Appropriations.--Section 740(c) of the Public 
Health Service Act (42 U.S.C. 293d(c)) is amended by striking 
``$29,400,000'' and all that follows through ``2002'' and inserting 
``$50,000,000 for fiscal year 2005, and such sums as may be necessary 
for each of fiscal years 2006 through 2010''.

SEC. 303. PROGRAM OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION FOR 
              UNDERREPRESENTED MINORITIES.

    (a) Purpose.--It is the purpose of this section to diversify the 
healthcare workforce by supporting programs of excellence in designated 
health professions schools that demonstrate a commitment to 
underrepresented minority populations with a focus on minority health 
issues, cultural and linguistic competence, and eliminating health 
disparities.
    (b) Authorization of Appropriation.--Section 737(h)(1) of the 
Public Health Service Act (42 U.S.C. 293(h)(1)) is amended to read as 
follows:
            ``(1) Authorization of appropriations.--For the purpose of 
        making grants under subsection (a), there are authorized to be 
        appropriated $50,000,000 for fiscal year 2005, and such sums as 
        may be necessary for each of the fiscal years 2006 through 
        2010.''.

SEC. 304. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.

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

``SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to Hispanic-serving health professions schools for the purpose of 
carrying out programs to recruit Hispanic individuals to enroll in and 
graduate from such schools, which may include providing scholarships 
and other financial assistance as appropriate.
    ``(b) Eligibility.--In subsection (a), the term `Hispanic-serving 
health professions school' means an entity that--
            ``(1) is a school or program under section 799B;
            ``(2) has an enrollment of full-time equivalent students 
        that is made up of 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.''.

SEC. 305. HEALTH PROFESSIONS STUDENT LOAN FUND; AUTHORIZATIONS OF 
              APPROPRIATIONS REGARDING STUDENTS FROM DISADVANTAGED 
              BACKGROUNDS.

    Section 724(f)(1) of the Public Health Service Act (42 U.S.C. 
292t(f)(1)) is amended by striking ``$8,000,000'' and all that follows 
and inserting ``$35,000,000 for fiscal year 2005, and such sums as may 
be necessary for each of the fiscal years 2006 through 2010.''.

SEC. 306. NATIONAL HEALTH SERVICE CORPS; RECRUITMENT AND FELLOWSHIPS 
              FOR INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.

    (a) In General.--Section 331(b) of the Public Health Service Act 
(42 U.S.C. 254d(b)) is amended by adding at the end the following:
    ``(3) The Secretary shall ensure that the individuals with respect 
to whom activities under paragraphs (1) and (2) are carried out include 
individuals from disadvantaged backgrounds, including activities 
carried out to provide health professions students with information on 
the Scholarship and Repayment Programs.''.
    (b) Assignment of Corps Personnel.--Section 333(a) of the Public 
Health Service Act (42 U.S.C. 254f(a)) is amended by adding at the end 
the following:
    ``(4) In assigning Corps personnel under this section, the 
Secretary shall give preference to applicants who request assignment to 
a federally qualified health center (as defined in section 
1905(l)(2)(B) of the Social Security Act) or to a provider organization 
that has a majority of patients who are minorities or individuals from 
low-income families (families with a family income that is less than 
200 percent of the Official Poverty Line).''.

SEC. 307. LOAN REPAYMENT PROGRAM OF CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    Section 317F(c) of the Public Health Service Act (42 U.S.C. 247b-
7(c)) is amended--
            (1) by striking ``and'' after ``1994,''; and
            (2) by inserting before the period the following: 
        ``$750,000 for fiscal year 2005, and such sums as may be 
        necessary for each of the fiscal years 2006 through 2010.''.

SEC. 308. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS AT SCHOOLS 
              OF PUBLIC HEALTH AND SCHOOLS OF ALLIED HEALTH.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.), as amended by section 304, is further amended by adding at 
the end the following:

``SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS.

    ``(a) Cooperative Agreements.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, in 
consultation with the Director of the Centers for Disease Control and 
Prevention, the Director of the Agency for Healthcare Research and 
Quality, and the Director of the Office of Minority Health, shall award 
cooperative agreements to schools of public health and schools of 
allied health to design and implement online degree programs.
    ``(b) Priority.--In awarding cooperative agreements under this 
section, the Secretary shall give priority to any school of public 
health or school of allied health that is located in a medically 
underserved community.
    ``(c) Requirements.--Awardees must design and implement an online 
degree program, that meet the following restrictions:
            ``(1) Enrollment of individuals who have obtained a 
        secondary school diploma or its recognized equivalent.
            ``(2) Maintaining a significant enrollment of 
        underrepresented minority or disadvantaged students.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

SEC. 309. MID-CAREER HEALTH PROFESSIONS SCHOLARSHIP PROGRAM.

    Part B of title VII of the Public Health Service Act (as amended by 
section 308) is further amended by adding at the end the following:

``SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLARSHIP PROGRAM.

    ``(a) In General.--The Secretary may make grants to eligible 
schools for awarding scholarships to eligible individuals to attend the 
school involved, for the purpose of enabling the individuals to make a 
career change from a non-health profession to a health profession.
    ``(b) Expenses.--Amounts awarded as a scholarship under this 
section may be expended only for tuition expenses, other reasonable 
educational expenses, and reasonable living expenses incurred in the 
attendance of the school involved.
    ``(c) Definitions.--In this section:
            ``(1) Eligible school.--The term `eligible school' means a 
        school of medicine, osteopathic medicine, dentistry, nursing 
        (as defined in section 801), pharmacy, podiatric medicine, 
        optometry, veterinary medicine, public health, chiropractic, or 
        allied health, a school offering a graduate program in 
        behavioral and mental health practice, or an entity providing 
        programs for the training of physician assistants.
            ``(2) Eligible individual.--The term `eligible individual' 
        means an individual who has obtained a secondary school diploma 
        or its recognized equivalent.
    ``(d) Priority.--In providing scholarships to eligible individuals, 
eligible schools shall give to individuals from disadvantaged 
backgrounds.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

SEC. 310. NATIONAL REPORT ON THE PREPAREDNESS OF HEALTH PROFESSIONALS 
              TO CARE FOR DIVERSE POPULATIONS.

    The Secretary of Health and Human Services shall include in the 
report prepared under section 1707(c) of the Public Health Service Act 
(as added by section 603 of this Act), information relating to the 
preparedness of health professionals to care for racially and 
ethnically diverse populations. Such information, which shall be 
collected by the Bureau of Health Professions, shall include--
            (1) with respect to health professions education, the 
        number and percentage of hours of classroom discussion relating 
        to minority health issues, including cultural competence;
            (2) a description of the coursework involved in such 
        education;
            (3) a description of the results of an evaluation of the 
        preparedness of students in such education;
            (4) a description of the types of exposure that students 
        have during their education to minority patient populations; 
        and
            (5) a description of model programs and practices.

SEC. 311. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.

    Subtitle B of title XXIX of the Public Health Service Act, as 
amended by section 301, is further amended by adding at the end the 
following:

``SEC. 2920B. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.

    ``(a) In General.--The Administrator of the Health Resources and 
Services Administration and Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the Office of 
Minority Health, shall award grants to eligible entities to increase 
awareness among post-primary and post-secondary students of career 
opportunities in the health professions.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a clinical, public health or health services 
        organization, community-based or non-profit entity, or other 
        entity determined appropriate by the Director of the Centers 
        for Disease Control and Prevention;
            ``(2) serve a health professional shortage area, as 
        determined by the Secretary;
            ``(3) work with students, including those from racial and 
        ethnic minority backgrounds, that have expressed an interest in 
        the health professions; and
            ``(4) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Grant awards under subsection (a) shall be 
used to support internships that will increase awareness among students 
of non-research based and career opportunities in the following health 
professions:
            ``(1) Medicine.
            ``(2) Nursing.
            ``(3) Public Health.
            ``(4) Pharmacy.
            ``(5) Health Administration and Management.
            ``(6) Health Policy.
            ``(7) Psychology.
            ``(8) Dentistry.
            ``(9) International Health.
            ``(10) Social Work.
            ``(11) Allied Health.
            ``(12) Other professions deemed appropriate by the Director 
        of the Centers for Disease Control and Prevention.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Centers for Disease Control and Prevention shall give 
priority to those entities that--
            ``(1) serve a high proportion of individuals from 
        disadvantaged backgrounds;
            ``(2) have experience in health disparity elimination 
        programs;
            ``(3) facilitate the entry of disadvantaged individuals 
        into institutions of higher education; and
            ``(4) provide counseling or other services designed to 
        assist disadvantaged individuals in successfully completing 
        their education at the post-secondary level.
    ``(f) Stipends.--The Secretary may approve stipends under this 
section for individuals for any period of education in student-
enhancement programs (other than regular courses) at health professions 
schools, programs, or entities, except that such a stipend may not be 
provided to an individual for more than 6 months, and such a stipend 
may not exceed $20 per day (notwithstanding any other provision of law 
regarding the amount of stipends).
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2920C. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the Office of 
Minority Health, shall award scholarships to postsecondary students who 
seek a career in public health.
    ``(b) Eligibility.--To be eligible to receive a scholarship under 
subsection (a) an individual shall--
            ``(1) have experience in public health research or public 
        health practice, or other health professions as determined 
        appropriate by the Director of the Centers for Disease Control 
        and Prevention;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) have expressed an interest in public health;
            ``(4) demonstrate promise for becoming a leader in public 
        health;
            ``(5) secure admission to a 4-year institution of higher 
        education;
            ``(6) comply with subsection (f); and
            ``(7) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become public health professionals.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give priority to those students that--
            ``(1) are from disadvantaged backgrounds;
            ``(2) have secured admissions to a minority serving 
        institution; and
            ``(3) have identified a health professional as a mentor at 
        their school or institution and an academic advisor to assist 
        in the completion of their baccalaureate degree.
    ``(e) Scholarships.--The Secretary may approve payment of 
scholarships under this section for such individuals for any period of 
education in student undergraduate tenure, except that such a 
scholarship may not be provided to an individual for more than 4 years, 
and such scholarships may not exceed $10,000 per academic year 
(notwithstanding any other provision of law regarding the amount of 
scholarship).
    ``(f) Requirements.--To be eligible to receive assistance under 
this section an individual shall--
            ``(1) have at minimum a grade point average of 2.75 at the 
        time of entry to an entity described in subsection (d)(2) and 
        maintain such 2.75 average or above throughout their tenure at 
        such institutions;
            ``(2) receive academic instruction that prepares the 
        individual to enter the field of public health;
            ``(3) gain experience in public health through working at 
        non-profit, community-based health facilities or at Federal, 
        State, or local governmental healthcare institutions; and
            ``(4) meet at minimum twice a month with the identified 
        health professions mentor.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2920D. PATSY MINK HEALTH AND GENDER RESEARCH FELLOWSHIP PROGRAM.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the Office of 
Minority Health, the Administrator of the Substance Abuse and Mental 
Health Services Administration, and the Director of the Indian Health 
Services, shall award research fellowships to post-baccalaureate 
students to conduct research that will examine gender and health 
disparities and to pursue a career in the health professions.
    ``(b) Eligibility.--To be eligible to receive a fellowship under 
subsection (a) an individual shall--
            ``(1) have experience in health research or public health 
        practice;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) have expressed an interest in the health professions;
            ``(4) demonstrate promise for becoming a leader in the 
        field of women's health;
            ``(5) secure admission to a health professions school or 
        graduate program with an emphasis in gender studies;
            ``(6) comply with subsection (f); and
            ``(7) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become researchers and advance the research base on the intersection 
between gender and health.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Centers for Disease Control and Prevention shall give 
priority to those applicants that--
            ``(1) are from disadvantaged backgrounds; and
            ``(2) have identified a mentor and academic advisor who 
        will assist in the completion of their graduate or professional 
        degree and have secured a research assistant position with a 
        researcher working in the area of gender and health.
    ``(e) Fellowships.--The Director of the Centers for Disease Control 
and Prevention may approve fellowships for individuals under this 
section for any period of education in the student's graduate or health 
profession tenure, except that such a fellowship may not be provided to 
an individual for more than 3 years, and such a fellowship may not 
exceed $18,000 per academic year (notwithstanding any other provision 
of law regarding the amount of fellowship).
    ``(f) Requirements.--To be eligible to receive assistance under 
this section, an individual shall--
            ``(1) maintain a minimum a grade point average of 2.75 at 
        the time of entry to an entity described in subsection (b)(5) 
        and maintain a grade point average of 3.25 or above throughout 
        their tenure at such institution;
            ``(2) undergo academic instruction to assist in completion 
        of the health professions or graduate degree; and
            ``(3) attend twice-monthly meetings with an academic 
        advisor throughout the tenure of the fellowship.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2920E. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP 
              PROGRAM.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Director of the Office 
of Minority Health, shall award research fellowships to college 
students or recent graduates to advance their understanding of 
international health.
    ``(b) Eligibility.--To be eligible to receive a fellowship under 
subsection (a) an individual shall--
            ``(1) have educational experience in the field of 
        international health;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) demonstrate promise for becoming a leader in the 
        field of international health;
            ``(4) be a college senior or recent graduate of a four year 
        higher education institution;
            ``(5) comply with subsection (f); and
            ``(6) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become health professionals and to advance their knowledge about 
international issues relating to healthcare access and quality.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give priority to those applicants that--
            ``(1) are from a disadvantaged background; and
            ``(2) have identified a mentor at a health professions 
        school or institution, an academic advisor to assist in the 
        completion of their graduate or professional degree, and an 
        advisor from an international health Non-Governmental 
        Organization, Private Volunteer Organization, or other 
        international institution or program that focuses on 
increasing healthcare access and quality for residents in developing 
countries.
    ``(e) Fellowships.--The Secretary shall approve fellowships for 
college seniors or recent graduates, except that such a fellowship may 
not be provided to an individual for more than 6 months, may not be 
awarded to a graduate that has not been enrolled in school for more 
than 1 year, and may not exceed $4,000 per academic year 
(notwithstanding any other provision of law regarding the amount of 
fellowship).
    ``(f) Requirements.--To be eligible to receive assistance under 
this section, an individual shall--
            ``(1) maintain a minimum grade point average of 2.75 at the 
        time of application; and
            ``(2) undergo academic instruction in global health, and 
        issues relating to access and quality of healthcare;
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2920F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR PROGRAM.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, the Director of the Centers for Medicaid and 
Medicare, and the Administrator for Health Resources and Services 
Administration, in collaboration with the Director of the Office of 
Minority Health, shall award grants to eligible entities to expose 
entering graduate students to the health professions.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a clinical, public health or health services 
        organization, community-based or non-profit entity, or other 
        entity determined appropriate by the Director of the Agency for 
        Healthcare Research and Quality;
            ``(2) serve in a health professional shortage area as 
        determined by the Secretary;
            ``(3) work with students obtaining a degree in the health 
        professions; and
            ``(4) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant awarded under 
subsection (a) shall be used to support opportunities that expose 
students to non-research based health professions, including--
            ``(1) public health policy;
            ``(2) healthcare and pharmaceutical policy;
            ``(3) healthcare administration and management;
            ``(4) health economics; and
            ``(5) other professions determined appropriate by the 
        Director of the Agency for Healthcare Research and Quality.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Agency for Healthcare Research and Quality shall give 
priority to those entities that--
            ``(1) have experience with health disparity elimination 
        programs;
            ``(2) facilitate training in the fields described in 
        subsection (c); and
            ``(3) provide counseling or other services designed to 
        assist such individuals in successfully completing their 
        education at the post-secondary level.
    ``(e) Stipends.--The Secretary may approve the payment of stipends 
for individuals under this section for any period of education in 
student-enhancement programs (other than regular courses) at health 
professions schools or entities, except that such a stipend may not be 
provided to an individual for more than 2 months, and such a stipend 
may not exceed $100 per day (notwithstanding any other provision of law 
regarding the amount of stipends).
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

      TITLE IV--REDUCING DISEASE AND DISEASE-RELATED COMPLICATIONS

   Subtitle A--Eliminating Disparities in Prevention, Detection, and 
                          Treatment of Disease

                     CHAPTER 1--GENERAL PROVISIONS

SEC. 401. GUIDELINES FOR DISEASE SCREENING FOR MINORITY PATIENTS.

    (a) In General.--The Secretary, acting through the Director of the 
Agency for Healthcare Research and Quality, shall convene a series of 
meetings to develop guidelines for disease screening for minority 
patient populations which have a higher than average risk for many 
chronic diseases and cancers.
    (b) Participants.--In convening meetings under subsection (a), the 
Secretary shall ensure that meeting participants include 
representatives of--
            (1) professional societies and associations;
            (2) minority health organizations;
            (3) healthcare researchers and providers, including those 
        with expertise in minority health;
            (4) Federal health agencies, including the Office of 
        Minority Health and the National Institutes of Health; and
            (5) other experts determined appropriate by the Secretary.
    (c) Diseases.--Screening guidelines for minority populations shall 
be developed under subsection (a) for--
            (1) hypertension;
            (2) hypercholesterolemia;
            (3) diabetes;
            (4) cardiovascular disease;
            (5) prostate cancer;
            (6) breast cancer;
            (7) colon cancer;
            (8) kidney disease;
            (9) glaucoma; and
            (10) other diseases determined appropriate by the 
        Secretary.
    (d) Dissemination.--Not later than 24 months after the date of 
enactment of this title, the Secretary shall publish and disseminate to 
healthcare provider organizations the guidelines developed under 
subsection (a).
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, sums as may be necessary for 
each of fiscal years 2005 through 2010.

SEC. 402. PREVENTIVE HEALTH SERVICES BLOCK GRANTS, USE OF ALLOTMENTS.

    Section 1904(a)(1) of the Public Health Service Act (42 U.S.C. 
300w-3(a)(1)) is amended--
            (1) in subparagraph (G)--
                    (A) by striking ``through (F)'' and inserting 
                ``through (G)''; and
                    (B) by redesignating such subparagraph as 
                subparagraph (H); and
            (2) by inserting after subparagraph (F), the following:
            ``(G) Community outreach and education programs and other 
        activities designed to address and prevent minority health 
        conditions (as defined in section 485E(c)(2)).''.

SEC. 403. PROGRAM FOR INCREASING IMMUNIZATION RATES FOR ADULTS AND 
              ADOLESCENTS; COLLECTION OF ADDITIONAL IMMUNIZATION DATA.

    (a) Activities of Centers for Disease Control and Prevention.--
Section 317(j) of the Public Health Service Act (42 U.S.C. 247b(j)) is 
amended by adding at the end the following paragraphs:
    ``(3)(A) For the purpose of carrying out activities toward 
increasing immunization rates for adults and adolescents through the 
immunization program under this subsection, and for the purpose of 
carrying out subsection (k)(2), there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal years 2004 through 
2010. Such authorization is in addition to amounts available under 
paragraphs (1) and (2) for such purposes.
    ``(B) In expending amounts appropriated under subparagraph (A), the 
Secretary shall give priority to adults and adolescents who are 
medically underserved and are at risk for vaccine-preventable diseases, 
including as appropriate populations identified through projects under 
subsection (k)(2)(E).
    ``(C) The purposes for which amounts appropriated under 
subparagraph (A) are available include (with respect to immunizations 
for adults and adolescents) payment of the costs of storing vaccines, 
outreach activities to inform individuals of the availability of the 
immunizations, and other program expenses necessary for the 
establishment or operation of immunization programs carried out or 
supported by States or other public entities pursuant to this 
subsection.
    ``(4) The Secretary shall annually submit to the Congress a report 
that--
            ``(A) evaluates the extent to which the immunization system 
        in the United States has been effective in providing for 
        adequate immunization rates for adults and adolescents, taking 
        into account the applicable year 2010 health objectives 
        established by the Secretary regarding the health status of the 
        people of the United States; and
            ``(B) describes any issues identified by the Secretary that 
        may affect such rates.
    ``(5) In carrying out this subsection and paragraphs (1) and (2) of 
subsection (k), the Secretary shall consider recommendations regarding 
immunizations that are made in reports issued by the Institute of 
Medicine.''.
    (b) Research, Demonstrations, and Education.--Section 317(k) of the 
Public Health Service Act (42 U.S.C. 247b(k)) is amended--
            (1) by redesignating paragraphs (2) through (4) as 
        paragraphs (3) through (5), respectively; and
            (2) by inserting after paragraph (1) the following 
        paragraph:
            ``(2) The Secretary, directly and through grants under 
        paragraph (1), shall provide for a program of research, 
        demonstration projects, and education in accordance with the 
        following:
                    ``(A) The Secretary shall coordinate with public 
                and private entities (including nonprofit private 
                entities), and develop and disseminate guidelines, 
                toward the goal of ensuring that immunizations are 
                routinely offered to adults and adolescents by public 
                and private health care providers.
                    ``(B) The Secretary shall cooperate with public and 
                private entities to obtain information for the annual 
                evaluations required in subsection (j)(4)(A).
                    ``(C) The Secretary shall (relative to fiscal year 
                2001) increase the extent to which the Secretary 
                collects data on the incidence, prevalence, and 
                circumstances of diseases and adverse events that are 
                experienced by adults and adolescents and may be 
                associated with immunizations, including collecting 
                data in cooperation with commercial laboratories.
                    ``(D) The Secretary shall ensure that the entities 
                with which the Secretary cooperates for purposes of 
                subparagraphs (A) through (C) include managed care 
                organizations, community based organizations that 
                provide health services, and other health care 
                providers.
                    ``(E) The Secretary shall provide for projects to 
                identify racial and ethnic minority groups and other 
                health disparity populations for which immunization 
                rates for adults and adolescents are below such rates 
                for the general population, and to determine the 
                factors underlying such disparities.''.

SEC. 404. INNOVATIVE CHRONIC DISEASE MANAGEMENT PROGRAMS.

    (a) In General.--The Secretary, acting in coordination with the 
Administrator of the Centers for Medicare and Medicaid Services, the 
Administrator of the Health Resources and Services Administration, the 
Director of the National Institutes of Health, the Director of the 
Centers for Disease Control and Prevention, and the Director of the 
Office of Minority Health, shall award grants to eligible entities for 
the identification, implementation, and evaluation of programs for 
patients with chronic disease.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be a health center or clinic, public health department, 
        health plan, hospital, health system, community-based or non-
        profit organization, or other health entity determined 
        appropriate by the Secretary; and
            (2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    (c) Use of Funds.--An entity shall use amounts received under a 
grant under subsection (a) to identify, implement, and evaluate chronic 
disease management programs that are tailored for racially and 
ethnically diverse populations. In carrying out such activities, an 
entity shall focus on--
            (1) self-management training;
            (2) patient empowerment;
            (3) group visits;
            (4) community health workers;
            (5) case management;
            (6) work- and school-based interventions;
            (7) home visitation; or
            (8) other activities determined appropriate by the 
        Secretary.
    (d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2004 through 2010.

SEC. 405. GRANTS FOR RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH.

    (a) Purpose.--It is the purpose of this section to provide for the 
awarding of grants to assist communities in mobilizing and organizing 
resources in support of effective and sustainable programs that will 
reduce or eliminate disparities in health and healthcare experienced by 
racial and ethnic minority individuals.
    (b) Authority To Award Grants.--The Secretary, acting through the 
Centers for Disease Control and Prevention and the Office of Minority 
Health, shall award planning, implementation, and evaluation grants to 
eligible entities to assist in designing, implementing, and evaluating 
culturally and linguistically appropriate, science-based, and 
community-driven strategies to eliminate racial and ethnic health and 
healthcare disparities.
    (c) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            (1) represent a coalition--
                    (A) whose principal purpose is to develop and 
                implement interventions to reduce or eliminate a health 
                or healthcare disparity in a targeted racial or ethnic 
                minority group in the community served by the 
                coalition; and
                    (B) that includes--
                            (i) at least 3 members selected from 
                        among--
                                    (I) public health departments;
                                    (II) community-based organizations;
                                    (III) university and/or research 
                                organizations;
                                    (IV) Indian tribal organizations or 
                                national Indian organizations;
                                    (V) Papa Ola Lokahi; and
                                    (VI) interested public or private 
                                sector healthcare providers or 
                                organizations;
                            (ii) at least 1 member that is from a 
                        community-based organization that represents 
                        the targeted racial or ethnic minority group; 
                        and
                            (iii) at least 1 member that is a National 
                        Center for Minority Health and Health 
                        Disparities Center of Excellence (unless such a 
                        Center does not exist within the community 
                        involved, declines or refuses to participate, 
                        or the coalition demonstrates to the Secretary 
                        that such participation would not further the 
                        goals of the program or would be unduly 
                        burdensome); and
            (2) submit to the Secretary an application, at such time, 
        in such manner, and containing such information as the 
        Secretary may require, including--
                    (A) a description of the targeted racial or ethnic 
                population in the community to be served under the 
                grant;
                    (B) a description of at least 1 health disparity 
                that exists in the racial or ethnic targeted 
                population; and
                    (C) a demonstration of the proven record of 
                accomplishment of the coalition members in serving and 
                working with the targeted community.
    (d) Planning Grants.--
            (1) In general.--The Secretary shall award grants to 
        eligible entities described in subsection (c) to support the 
        planning and development of culturally and linguistically 
        appropriate programs that utilize science-based and community-
        driven strategies to reduce or eliminate a health or healthcare 
        disparity in the targeted population. Such grants may be used 
        to--
                    (A) expand the coalition that is represented by the 
                entity through the identification of additional 
                partners, particularly among the targeted community, 
                and establish linkages with national and State public 
                and private partners;
                    (B) establish community working groups;
                    (C) conduct a needs assessment for the targeted 
                population in the area of the health disparity using 
                input from the targeted community;
                    (D) participate in workshops sponsored by the 
                Office of Minority Health or the Centers for Disease 
                Control and Prevention for technical assistance, 
                planning, evaluation, and other programmatic issues;
                    (E) identify promising intervention strategies; and
                    (F) develop a plan with the input of the targeted 
                community that includes strategies for--
                            (i) implementing intervention strategies 
                        that have the most promising potential for 
                        reducing the health disparity in the target 
                        population;
                            (ii) identifying other sources of revenue 
                        and integrating current and proposed funding 
                        sources to ensure long-term sustainability of 
                        the program; and
                            (iii) evaluating the program, including 
                        collecting data and measuring progress toward 
                        reducing or eliminating the health disparity in 
                        the targeted population that takes into account 
                        the evaluation model developed by the Centers 
                        for Disease Control and Prevention in 
                        collaboration with the Office of Minority 
                        Health.
            (2) Duration.--The period during which payments may be made 
        under a grant under paragraph (1) shall not exceed 1 year, 
        except where the Secretary determines that extraordinary 
        circumstances exist as described in section 340(c)(3) of the 
        Public Health Service Act.
    (e) Implementation Grants.--
            (1) In general.--The Secretary shall award grants to 
        eligible entities that have received a planning grant under 
        subsection (d) to enable such entity to--
                    (A) implement a plan to address the selected health 
                disparity for the target population, in an effective 
                and timely manner;
                    (B) collect data appropriate for monitoring and 
                evaluating the program carried out under the grant;
                    (C) analyze and interpret data, or collaborate with 
                academic or other appropriate institutions, for such 
                analysis and collection;
                    (D) participate in conferences and workshops for 
                the purpose of informing and educating others regarding 
                the experiences and lessons learned from the project;
                    (E) collaborate with appropriate partners to 
                publish the results of the project for the benefit of 
                the public health community;
                    (F) establish mechanisms with other public or 
                private groups to maintain financial support for the 
                program after the grant terminates; and
                    (G) maintain relationships with local partners and 
                continue to develop new relationships with State and 
                national partners.
            (2) Duration.--The period during which payments may be made 
        under a grant under paragraph (1) shall not exceed 4 years. 
        Such payments shall be subject to annual approval by the 
        Secretary and to the availability of appropriations for the 
        fiscal year involved.
    (f) Evaluation Grants.--
            (1) In general.--The Secretary shall award grants to 
        eligible entities that have received an implementation grant 
        under subsection (e) that require additional assistance for the 
        purpose of rigorous data analysis, program evaluation 
        (including process and outcome measures), or dissemination of 
        findings.
            (2) Priority.--In awarding grants under this subsection, 
        the Secretary shall give priority to--
                    (A) entities that in previous funding cycles--
                            (i) have received a planning grant under 
                        subsection (d); and
                            (ii) implemented activities of the type 
                        described in subsection (e)(1);
                    (B) entities that fulfilled the goals of their 
                planning grant under subsection (d) in an especially 
                timely manner;
                    (C) entities that incorporate best practices or 
                build on successful models in their action plan, 
                including the use of community health workers; and
                    (D) entities that would enable the Secretary to 
                provide for an equitable distribution of such grants 
                among the 5 categories for race and ethnicity described 
                in the 1997 Office of Management and Budget Standards 
                for Maintaining, Collecting, and Presenting Federal 
                Data on Race and Ethnicity.
    (g) Maintenance of Effort.--The Secretary may not award a grant to 
an eligible entity under this section unless the entity agrees that, 
with respect to the costs to be incurred by the entity in carrying out 
the activities for which the grant was awarded, the entity (and each of 
the participating partners in the coalition represented by the entity) 
will maintain its expenditures of non-Federal funds for such activities 
at a level that is not less than the level of such expenditures during 
the fiscal year immediately preceding the first fiscal year for which 
the grant is awarded.
    (h) Technical Assistance.--The Secretary may, either directly or by 
grant or contract, provide any entity that receives a grant under this 
section with technical and other nonfinancial assistance necessary to 
meet the requirements of this section.
    (i) Administrative Burdens.--The Secretary shall make every effort 
to minimize duplicative or unnecessary administrative burdens on 
grantees in the process of applying for grants under subsection (d), 
(e), or (f).
    (j) Report.--Not later than September 30, 2007, the Secretary shall 
publish a report that describes the extent to which the activities 
funded under this section have been successful in reducing and 
eliminating disparities in health and healthcare in targeted 
populations, and provides examples of best practices or model programs 
funded under this section.
    (k) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section 
for each of fiscal years 2005 through 2010.

SEC. 406. IOM STUDY REQUEST.

    (a) In General.--The Secretary of Health and Human Services shall 
request that the Institute of Medicine conduct, or contract with 
another entity to conduct, a study to investigate promising strategies 
for improving minority health and reducing and eliminating racial and 
ethnic disparities in health and healthcare.
    (b) Content.--The study under subsection (a) shall--
            (1) identify key stakeholders for intervention in the 
        public and private sector;
            (2) identify the barriers to eliminating racial and ethnic 
        disparities in health and healthcare;
            (3) explore approaches for addressing disparities in health 
        and healthcare using a quality improvement framework;
            (4) suggest an evaluation and research agenda that will 
        advance effective strategies for reducing and eliminating 
        racial and ethnic disparities in health and healthcare; and
            (5) assess the capacity of the Department of Health and 
        Human Services, as currently structured, to implement and 
        evaluate promising strategies to improve minority health and 
        reduce and eliminate racial and ethnic disparities in health 
        and healthcare.
    (c) Agenda.--The agenda described in subsection (b)(4) shall 
include a focus on the following:
            (1) Observational studies of race-discordant and race-
        concordant physician-patient clinical encounters.
            (2) Studies of the behaviors and expressed attitudes toward 
        race and ethnicity during education and training of health 
        professionals.
            (3) Expansion of prospective studies of disparities in 
        care, combining clinical data with qualitative interviews with 
        patients and providers.
            (4) Studies of the natural history of social categorization 
        in medical education and practice.
            (5) Studies of the effectiveness of standard clinical 
        guidelines in reducing disparities across disease categories.
            (6) Exploration of health system characteristics that may 
        contribute to or mitigate disparities in health care.
            (7) Evaluation of cultural competency programs and their 
        impact on the attitudes, knowledge, skills, and behaviors of 
        healthcare providers.
            (8) Expansion of community-participatory research with a 
        focus on such topics as increasing trust and patient 
        empowerment.
            (9) Studies on appropriate indicators of socio-economic 
        status, and methods for incorporating such indicators in 
        patient records.
            (10) Interventional studies designed to eliminate 
        disparities.
    (d) Report.--Not later than 24 months after the date of enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
the appropriate committees of Congress a report containing the results 
of the study conducted under subsection (a).
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 and 2006.

SEC. 407. STRATEGIC PLAN.

    (a) In General.--The Secretary, acting through the Administrator of 
the Substance Abuse and Mental Health Services Administration, shall 
formulate a strategic plan for implementing the 2001 report by the 
Surgeon General of the Public Health Service entitled `Mental Health: 
Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report 
of the Surgeon General' and the 2003 report by the President's New 
Freedom Commission on Mental Health entitled `Achieving the Promise: 
Transforming Mental Health Care in America'.
    (b) Submission.--Not later than 6 months after the date of the 
enactment of this title, the Secretary shall submit to the Congress the 
strategic plan formulated under this section.

                    CHAPTER 2--ENVIRONMENTAL JUSTICE

SEC. 410. SHORT TITLE; PURPOSES.

    (a) Short Title.--This chapter may be cited as the ``Environmental 
Justice Act of 2003''.
    (b) Purposes.--The purposes of this chapter are--
            (1) to ensure that all Federal health agencies develop 
        practices that promote environmental justice;
            (2) to provide minority, low-income, and Native American 
        communities greater access to public information and 
        opportunity for participation in decisionmaking affecting human 
        health and the environment; and
            (3) to mitigate the inequitable distribution of the burdens 
        and benefits of Federal programs having significant impact on 
        human health and the environment.

SEC. 411. DEFINITIONS.

     For purposes of this chapter:
            (1) Environmental justice.--
                    (A) In general.--The term ``environmental justice'' 
                means the fair treatment of people of all races, 
                cultures, and socioeconomic groups with respect to the 
                development, adoption, implementation, and enforcement 
                of laws, regulations, and policies affecting the 
                environment.
                    (B) Fair treatment.--The term ``fair treatment'' 
                means policies and practices that will minimize the 
likelihood that a minority, low-income, or Native American community 
will bear a disproportionate share of the adverse environmental 
consequences, or be denied reasonable access to the environmental 
benefits, resulting from implementation of a Federal program or policy.
            (2) Federal agency.--The term ``Federal agency'' means--
                    (A) each Federal entity represented on the Working 
                Group;
                    (B) any other entity that conducts any Federal 
                program or activity that substantially affects human 
                health or the environment; and
                    (C) each Federal agency that implements any 
                program, policy, or activity applicable to Native 
                Americans.
            (3) Working group.--The term ``Working Group'' means the 
        interagency working group established by section 413.
            (4) Advisory committee.--The term ``the Advisory 
        Committee'' means the advisory committee established by section 
        415.

SEC. 412. ENVIRONMENTAL JUSTICE RESPONSIBILITIES OF FEDERAL AGENCIES.

    (a) Environmental Justice Mission.--To the greatest extent 
practicable, the head of each Federal agency shall make achieving 
environmental justice part of its mission by identifying and 
addressing, as appropriate, disproportionately high and adverse human 
health or environmental effects of its programs, policies, and 
activities on minority and low-income populations in the United States 
and its territories and possessions, including the District of 
Columbia, the Commonwealth of Puerto Rico, Virgin Islands, Guam, and 
the Commonwealth of the Mariana Islands.
    (b) Nondiscrimination.--Each Federal agency shall conduct its 
programs, policies, and activities in a manner that ensures that such 
programs, policies, and activities do not have the effect of excluding 
any person or group from participation in, denying any person or group 
the benefits of, or subjecting any person or group to discrimination 
under, such programs, policies, and activities, because of race, color, 
national origin, or income.

SEC. 413. INTERAGENCY ENVIRONMENTAL JUSTICE WORKING GROUP.

    (a) Creation and Composition.--There is hereby established the 
Interagency Working Group on Environmental Justice, comprising the 
heads of the following executive agencies and offices, or their 
designees:
            (1) The Department of Defense.
            (2) The Department of Health and Human Services.
            (3) The Department of Housing and Urban Development.
            (4) The Department of Homeland Security.
            (5) The Department of Labor.
            (6) The Department of Agriculture.
            (7) The Department of Transportation.
            (8) The Department of Justice;
            (9) The Department of the Interior.
            (10) The Department of Commerce.
            (11) The Department of Energy.
            (12) The Environmental Protection Agency.
            (13) The Office of Management and Budget.
            (14) Any other official of the United States that the 
        President may designate.
    (b) Functions.--The Working Group shall--
            (1) provide guidance to Federal agencies on criteria for 
        identifying disproportionately high and adverse human health or 
        environmental effects on minority, low-income, and Native 
        American populations;
            (2) coordinate with, provide guidance to, and serve as a 
        clearinghouse for, each Federal agency as it develops or 
        revises an environmental justice strategy as required by this 
        chapter, in order to ensure that the administration, 
        interpretation and enforcement of programs, activities, and 
        policies are undertaken in a consistent manner;
            (3) assist in coordinating research by, and stimulating 
        cooperation among, the Environmental Protection Agency, the 
        Department of Health and Human Services, the Department of 
        Housing and Urban Development, and other Federal agencies 
        conducting research or other activities in accordance with 
        section 7;
            (4) assist in coordinating data collection, maintenance, 
        and analysis required by this chapter;
            (5) examine existing data and studies on environmental 
        justice;
            (6) hold public meetings and otherwise solicit public 
        participation and consider complaints as required under 
        subsection (c);
            (7) develop interagency model projects on environmental 
        justice that evidence cooperation among Federal agencies; and
            (8) in coordination with the Department of the Interior and 
        after consultation with tribal leaders, coordinate steps to be 
        taken pursuant to this chapter that affect or involve 
        federally-recognized Indian Tribes.
    (c) Public Participation.--The Working Group shall--
            (1) hold public meetings and otherwise solicit public 
        participation, as appropriate, for the purpose of fact-finding 
        with regard to implementation of this chapter, and prepare for 
        public review a summary of the comments and recommendations 
        provided; and
            (2) receive, consider, and in appropriate instances conduct 
        inquiries concerning complaints regarding environmental justice 
        and the implementation of this chapter by Federal agencies.
    (d) Annual Reports.--
            (1) In general.--Each fiscal year following enactment of 
        this Act, the Working Group shall submit to the President, 
        through the Office of the Deputy Assistant to the President for 
        Environmental Policy and the Office of the Assistant to the 
        President for Domestic Policy, a report that describes the 
        implementation of this chapter, including, but not limited to, 
        a report of the final environmental justice strategies 
        described in section 6 of this chapter and annual progress made 
        in implementing those strategies.
            (2) Copy of report.--The President shall transmit to the 
        Speaker of the House of Representatives and the President of 
        the Senate a copy of each report submitted to the President 
        pursuant to paragraph (1).
    (e) Conforming Change.--The Interagency Working Group on 
Environmental Justice established under Executive Order No. 12898, 
dated February 11, 1994, is abolished.

SEC. 414. FEDERAL AGENCY STRATEGIES.

    (a) Agency-Wide Strategies.--Each Federal agency shall develop an 
agency-wide environmental justice strategy that identifies and 
addresses disproportionally high and adverse human health or 
environmental effects or disproportionally low benefits of its 
programs, policies, and activities with respect to minority, low-
income, and Native American populations.
    (b) Revisions.--Each strategy developed pursuant to subsection (a) 
shall identify programs, policies, planning, and public participation 
processes, rulemaking, and enforcement activities related to human 
health or the environment that should be revised to--
            (1) promote enforcement of all health and environmental 
        statutes in areas with minority, low-income, or Native American 
        populations;
            (2) ensure greater public participation;
            (3) improve research and data collection relating to the 
        health of and environment of minority, low-income, and Native 
        American populations; and
            (4) identify differential patterns of use of natural 
        resources among minority, low-income, and Native American 
        populations.
    (c) Timetables.--Each strategy developed pursuant to subsection (a) 
shall include, where appropriate, a timetable for undertaking revisions 
identified pursuant to subsection (b).

SEC. 415. FEDERAL ENVIRONMENTAL JUSTICE ADVISORY COMMITTEE.

    (a) Establishment.--There is established a committee to be known as 
the ``Federal Environmental Justice Advisory Committee''.
    (b) Duties.--The Advisory Committee shall provide independent 
advice and recommendations to the Environmental Protection Agency and 
the Working Group on areas relating to environmental justice, which may 
include any of the following:
            (1) Advice on Federal agencies' framework development for 
        integrating socioeconomic programs into strategic planning, 
        annual planning, and management accountability for achieving 
        environmental justice results agency-wide.
            (2) Advice on measuring and evaluating agencies' progress, 
        quality, and adequacy in planning, developing, and implementing 
        environmental justice strategies, projects, and programs.
            (3) Advice on agencies' existing and future information 
        management systems, technologies, and data collection, and the 
        conduct of analyses that support and strengthen environmental 
        justice programs in administrative and scientific areas.
            (4) Advice to help develop, facilitate, and conduct reviews 
        of the direction, criteria, scope, and adequacy of the Federal 
        agencies' scientific research and demonstration projects 
        relating to environmental justice.
            (5) Advice for improving how the Environmental Protection 
        Agency and others participate, cooperate, and communicate 
        within that agency and between other Federal agencies, State or 
        local governments, federally recognized Tribes, environmental 
        justice leaders, interest groups, and the public.
            (6) Advice regarding the Environmental Protection Agency's 
        administration of grant programs relating to environmental 
        justice assistance (not to include the review or 
        recommendations of individual grant proposals or awards).
            (7) Advice regarding agencies' awareness, education, 
        training, and other outreach activities involving environmental 
        justice.
    (c) Advisory Committee.--The Advisory Committee shall be considered 
an advisory committee within the meaning of the Federal Advisory 
Committee Act (5 U.S.C. App.).
    (d) Membership.--
            (1) In general.--The Advisory Committee shall be composed 
        of 21 members to be appointed in accordance with paragraph (2). 
        Members shall include representatives of--
                    (A) community-based groups;
                    (B) industry and business;
                    (C) academic and educational institutions;
                    (D) minority health organizations;
                    (E) State and local governments, federally 
                recognized tribes, and indigenous groups; and
                    (F) nongovernmental and environmental groups.
            (2) Appointments.--Of the members of the Advisory 
        Committee--
                    (A) five members shall be appointed by the majority 
                leader of the Senate;
                    (B) five members shall be appointed by the minority 
                leader of the Senate;
                    (C) five members shall be appointed by the Speaker 
                of the House of Representatives;
                    (D) five members shall be appointed by the minority 
                leader of the House of Representatives; and
                    (E) one member to be appointed by the President.
    (e) Meetings.--The Advisory Committee shall meet at least twice 
annually. Meetings shall occur as needed and approved by the Director 
of the Office of Environmental Justice of the Environmental Protection 
Agency, who shall serve as the officer required to be appointed under 
section 10(e) of the Federal Advisory Committee Act (5 U.S.C. App.) 
with respect to the Committee (in this subsection referred to as the 
``Designated Federal Officer''). The Administrator of the Environmental 
Protection Agency may pay travel and per diem expenses of members of 
the Advisory Committee when determined necessary and appropriate. The 
Designated Federal Officer or a designee of such Officer shall be 
present at all meetings, and each meeting will be conducted in 
accordance with an agenda approved in advance by such Officer. The 
Designated Federal Officer may adjourn any meeting when the Designated 
Federal Officer determines it is in the public interest to do so. As 
required by the Federal Advisory Committee Act, meetings of the 
Advisory Committee shall be open to the public unless the President 
determines that a meeting or a portion of a meeting may be closed to 
the public in accordance with subsection (c) of section 552b of title 
5, United States Code. Unless a meeting or portion thereof is closed to 
the public, the Designated Federal Officer shall provide an opportunity 
for interested persons to file comments before or after such meeting or 
to make statements to the extent that time permits.
    (f) Duration.--The Advisory Committee shall remain in existence 
until otherwise provided by law.

SEC. 416. HUMAN HEALTH AND ENVIRONMENTAL RESEARCH, DATA COLLECTION AND 
              ANALYSIS.

    (a) Disproportionate Impact.--To the extent permitted by other 
applicable law, including section 552a of title 5, United States Code, 
popularly known as the Privacy Act of 1974, the Administrator of the 
Environmental Protection Agency, or the head of such other Federal 
agency as the President may direct, shall collect, maintain, and 
analyze information assessing and comparing environmental and human 
health risks borne by populations identified by race, national origin, 
or income. To the extent practical and appropriate, Federal agencies 
shall use this information to determine whether their programs, 
policies, and activities have disproportionally high and adverse human 
health or environmental effects on, or disproportionally low benefits 
for, minority, low-income, and Native American populations.
    (b) Information Related to Non-Federal Facilities.--In connection 
with the development and implementation of agency strategies in section 
4, the Administrator of the Environmental Protection Agency, or the 
head of such other Federal agency as the President may direct, shall 
collect, maintain, and analyze information on the race, national 
origin, and income level, and other readily accessible and appropriate 
information, for areas surrounding facilities or sites expected to have 
a substantial environmental, human health, or economic effect on the 
surrounding populations, if such facilities or sites become the subject 
of a substantial Federal environmental administrative or judicial 
action.
    (c) Impact From Federal Facilities.--The Administrator of the 
Environmental Protection Agency, or the head of such other Federal 
agency as the President may direct, shall collect, maintain, and 
analyze information on the race, national origin, and income level, and 
other readily accessible and appropriate information, for areas 
surrounding Federal facilities that are--
            (1) subject to the reporting requirements under the 
        Emergency Planning and Community Right-to-Know Act (42 U.S.C. 
        11001 et seq.) as mandated in Executive Order No. 12856; and
            (2) expected to have a substantial environmental, human 
        health, or economic effect on surrounding populations.
    (d) Information Sharing.--
            (1) In general.--In carrying out the responsibilities in 
        this section, each Federal agency, to the extent practicable 
        and appropriate, shall share information and eliminate 
        unnecessary duplication of efforts through the use of existing 
        data systems and cooperative agreements among Federal agencies 
        and with State, local, and tribal governments.
            (2) Public availability.--Except as prohibited by other 
        applicable law, information collected or maintained pursuant to 
        this section shall be made available to the public.
    (e) Public Comment.--Federal agencies shall provide minority, low-
income, and Native American populations the opportunity to participate 
in the development, design, and conduct of activities undertaken 
pursuant to this section.

                        CHAPTER 3--BORDER HEALTH

SEC. 421. SHORT TITLE.

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

SEC. 422. DEFINITIONS.

    In this chapter:
            (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. 423. BORDER HEALTH 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, community 
health center, or community clinic 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 education and 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) workforce training and development;
                    (K) community health workers or promotoras;
                    (L) health care infrastructure problems in the 
                border area (including planning and construction 
                grants);
                    (M) health disparities in the border area;
                    (N) environmental health; 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 
2005, and such sums as may be necessary for each succeeding fiscal 
year.

SEC. 424. 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 2005 and such sums as may be necessary for 
each succeeding fiscal year.''.

 CHAPTER 4--PATIENT NAVIGATOR, OUTREACH, AND CHRONIC DISEASE PREVENTION

SEC. 425. SHORT TITLE.

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

SEC. 426. 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 Alaska Natives, and rural 
        health clinics and qualified nonprofit entities that partner 
        with one or more centers providing healthcare 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 
                        healthcare services within the healthcare 
                        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, 
        about the services of the model program under the grant. Such 
        activities shall include facilitating access to appropriate 
        healthcare services and patient navigators within the 
        healthcare 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 
        healthcare 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, about 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 Alaska Natives, and rural 
        health clinics and qualified nonprofit entities that partner 
        with one or more centers providing healthcare 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' healthcare 
                        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 healthcare 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 healthcare 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 healthcare 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 in which 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 healthcare 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 healthcare 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 2005 through 2010.
                    ``(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 2005 through 2010.
                    ``(C) Bureau of primary healthcare.--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 2005 through 
                2010.
                    ``(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 2005 through 
                2010.
                    ``(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. 427. 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 the following 
section:

``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 
                        healthcare services within the healthcare 
                        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 healthcare 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 
        healthcare 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) 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 
        healthcare services and patient navigators within the 
healthcare 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' healthcare 
                        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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 2005 
        through 2010.
            ``(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 2005 
        through 2010.
            ``(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. 428. 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 healthcare 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 
                        healthcare services within the healthcare 
                        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 
        healthcare services and patient navigators within the 
healthcare 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 
        healthcare 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 healthcare 
        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' healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 2005 through 2010.
                    (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 2005 through 2010.
                    (C) Bureau of primary health 13 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 2005 through 
                2010.
                    (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 2005 through 
                2010.
                    (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.

                  CHAPTER 5--COMMUNITY HEALTH WORKERS

SEC. 431. SHORT TITLE.

    This chapter may be cited as the ``Community Health Workers Act of 
2003''.

SEC. 432. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN.

    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. 399O. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN.

    ``(a) Grants Authorized.--The Secretary, in collaboration with the 
Director of the Centers for Disease Control and Prevention and other 
Federal officials determined appropriate by the Secretary, is 
authorized to award grants to States or local or tribal units, to 
promote positive health behaviors for women in target populations, 
especially racial and ethnic minority women in medically underserved 
communities.
    ``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may 
be used to support community health workers--
            ``(1) to educate, guide, and provide outreach in a 
        community setting regarding health problems prevalent among 
        women and especially among racial and ethnic minority women;
            ``(2) to educate, guide, and provide experiential learning 
        opportunities that target behavioral risk factors;
            ``(3) to educate and guide regarding effective strategies 
        to promote positive health behaviors within the family;
            ``(4) to educate and provide outreach regarding enrollment 
        in health insurance including the State Children's Health 
        Insurance Program under title XXI of the Social Security Act, 
        medicare under title XVIII of such Act and medicaid under title 
        XIX of such Act;
            ``(5) to promote community wellness and awareness; and
            ``(6) to educate and refer target populations to 
        appropriate health care agencies and community-based programs 
        and organizations in order to increase access to quality health 
        care services, including preventive health services.
    ``(c) Application.--
            ``(1) In general.--Each State or local or tribal unit 
        (including federally recognized tribes and Alaska native 
        villages) that desires to receive a grant under subsection (a) 
        shall submit an application to the Secretary, at such time, in 
        such manner, and accompanied by such additional information as 
        the Secretary may require.
            ``(2) Contents.--Each application submitted pursuant to 
        paragraph (1) shall--
                    ``(A) describe the activities for which assistance 
                under this section is sought;
                    ``(B) contain an assurance that with respect to 
                each community health worker program receiving funds 
                under the grant awarded, such program provides training 
                and supervision to community health workers to enable 
                such workers to provide authorized program services;
                    ``(C) contain an assurance that the applicant will 
                evaluate the effectiveness of community health worker 
                programs receiving funds under the grant;
                    ``(D) contain an assurance that each community 
                health worker program receiving funds under the grant 
                will provide services in the cultural context most 
                appropriate for the individuals served by the program;
                    ``(E) contain a plan to document and disseminate 
                project description and results to other States and 
                organizations as identified by the Secretary; and
                    ``(F) describe plans to enhance the capacity of 
                individuals to utilize health services and health-
                related social services under Federal, State, and local 
                programs by--
                            ``(i) assisting individuals in establishing 
                        eligibility under the programs and in receiving 
                        the services or other benefits of the programs; 
                        and
                            ``(ii) providing other services as the 
                        Secretary determines to be appropriate, that 
                        may include transportation and translation 
                        services.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to those applicants--
            ``(1) who propose to target geographic areas--
                    ``(A) with a high percentage of residents who are 
                eligible for health insurance but are uninsured or 
                underinsured;
                    ``(B) with a high percentage of families for whom 
                English is not their primary language; and
                    ``(C) that encompass the United States-Mexico 
                border region;
            ``(2) with experience in providing health or health-related 
        social services to individuals who are underserved with respect 
        to such services; and
            ``(3) with documented community activity and experience 
        with community health workers.
    ``(e) Collaboration With Academic Institutions.--The Secretary 
shall encourage community health worker programs receiving funds under 
this section to collaborate with academic institutions. Nothing in this 
section shall be construed to require such collaboration.
    ``(f) Quality Assurance and Cost-Effectiveness.--The Secretary 
shall establish guidelines for assuring the quality of the training and 
supervision of community health workers under the programs funded under 
this section and for assuring the cost-effectiveness of such programs.
    ``(g) Monitoring.--The Secretary shall monitor community health 
worker programs identified in approved applications and shall determine 
whether such programs are in compliance with the guidelines established 
under subsection (e).
    ``(h) Technical Assistance.--The Secretary may provide technical 
assistance to community health worker programs identified in approved 
applications with respect to planning, developing, and operating 
programs under the grant.
    ``(i) Report to Congress.--
            ``(1) In general.--Not later than 4 years after the date on 
        which the Secretary first awards grants under subsection (a), 
        the Secretary shall submit to Congress a report regarding the 
        grant project.
            ``(2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    ``(A) A description of the programs for which grant 
                funds were used.
                    ``(B) The number of individuals served.
                    ``(C) An evaluation of--
                            ``(i) the effectiveness of these programs;
                            ``(ii) the cost of these programs; and
                            ``(iii) the impact of the project on the 
                        health outcomes of the community residents.
                    ``(D) Recommendations for sustaining the community 
                health worker programs developed or assisted under this 
                section.
                    ``(E) Recommendations regarding training to enhance 
                career opportunities for community health workers.
    ``(j) Definitions.--In this section:
            ``(1) Community health worker.--The term `community health 
        worker' means an individual who promotes health or nutrition 
        within the community in which the individual resides--
                    ``(A) by serving as a liaison between communities 
                and health care agencies;
                    ``(B) by providing guidance and social assistance 
                to community residents;
                    ``(C) by enhancing community residents' ability to 
                effectively communicate with health care providers;
                    ``(D) by providing culturally and linguistically 
                appropriate health or nutrition education;
                    ``(E) by advocating for individual and community 
                health or nutrition needs; and
                    ``(F) by providing referral and followup services.
            ``(2) Community setting.--The term `community setting' 
        means a home or a community organization located in the 
        neighborhood in which a participant resides.
            ``(3) Medically underserved community.--The term `medically 
        underserved community' means a community identified by a 
        State--
                    ``(A) that has a substantial number of individuals 
                who are members of a medically underserved population, 
                as defined by section 330(b)(3); and
                    ``(B) a significant portion of which is a health 
                professional shortage area as designated under section 
                332.
            ``(4) Support.--The term `support' means the provision of 
        training, supervision, and materials needed to effectively 
        deliver the services described in subsection (b), reimbursement 
        for services, and other benefits.
            ``(5) Target population.--The term `target population' 
        means women of reproductive age, regardless of their current 
        childbearing status.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

                  CHAPTER 6--HEALTH EMPOWERMENT ZONES

SEC. 440. HEALTH EMPOWERMENT ZONES.

    (a) Health Empowerment Zone Programs.--
            (1) Grants.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and the Director of the Office of Minority 
        Health, and in cooperation with the Director of the Office of 
        Community Services and the Director of the National Center for 
        Minority Health and Health Disparities, shall make grants to 
        partnerships of private and public entities to establish health 
        empowerment zone programs in communities that 
        disproportionately experience disparities in health status and 
        healthcare for the purpose described in paragraph (2).
            (2) Use of funds.--
                    (A) In general.--Subject to subparagraph (B), the 
                purpose of a health empowerment zone program under this 
                section shall be to assist individuals, businesses, 
                schools, minority health associations, non-profit 
                organizations, community-based organizations, 
                hospitals, healthcare clinics, foundations, and other 
                entities in communities that disproportionately 
                experience disparities in health status and healthcare 
                which are seeking--
                            (i) to improve the health or environment of 
                        minority individuals in the community and to 
                        reduce disparities in health status and 
                        healthcare by assisting individuals in 
                        accessing Federal programs; and
                            (ii) to coordinate the efforts of 
                        governmental and private entities regarding the 
                        elimination of racial and ethnic disparities in 
                        health status and healthcare.
                    (B) Medicare and medicaid.--A health empowerment 
                zone program under this section shall not provide any 
                assistance (other than referral and follow-up services) 
                that is duplicative of programs under title XVIII or 
                XIX of the Social Security Act (42 U.S.C. 1395 and 1396 
                et seq.).
            (3) Distribution.--The Secretary shall make at least 1 
        grant under this section to a partnership for a health 
        empowerment zone program in communities that disproportionately 
        experience disparities in health status and healthcare that is 
        located in a territory or possession of the United States.
            (4) Application.--To obtain a grant under this section, a 
        partnership shall submit to the Secretary an application in 
        such form and in such manner as the Secretary may require. An 
        application under this paragraph shall--
                    (A) demonstrate that the communities to be served 
                by the health empowerment zone program are those that 
                disproportionately experience disparities in health 
                status and healthcare;
                    (B) set forth a strategic plan for accomplishing 
                the purpose described in paragraph (2), by--
                            (i) describing the coordinated health, 
                        economic, human, community, and physical 
                        development plan and related activities 
                        proposed for the community;
                            (ii) describing the extent to which local 
                        institutions and organizations have contributed 
                        and will contribute to the planning process and 
                        implementation;
                            (iii) identifying the projected amount of 
                        Federal, State, local, and private resources 
                        that will be available in the area and the 
                        private and public partnerships to be used 
                        (including any participation by or cooperation 
                        with universities, colleges, foundations, non-
                        profit organizations, medical centers, 
                        hospitals, health clinics, school districts, or 
                        other private and public entities);
                            (iv) identifying the funding requested 
                        under any Federal program in support of the 
                        proposed activities;
                            (v) identifying benchmarks for measuring 
                        the success of carrying out the strategic plan;
                            (vi) demonstrating the ability to reach and 
                        service the targeted underserved minority 
                        community populations in a culturally 
                        appropriate and linguistically responsive 
                        manner; and
                            (vii) demonstrating a capacity and 
                        infrastructure to provide long-term community 
                        response that is culturally appropriate and 
                        linguistically responsive to communities that 
                        disproportionately experience disparities in 
                        health and healthcare; and
                    (C) include such other information as the Secretary 
                may require.
            (5) Preference.--In awarding grants under this subsection, 
        the Secretary shall give preference to proposals from 
        indigenous community entities that have an expertise in 
        providing culturally appropriate and linguistically responsive 
        services to communities that disproportionately experience 
        disparities in health and health care.
    (b) Federal Assistance for Health Empowerment Zone Grant 
Programs.--The Secretary, the Administrator of the Small Business 
Administration, the Secretary of Agriculture, the Secretary of 
Education, the Secretary of Labor, and the Secretary of Housing and 
Urban Development shall each--
            (1) where appropriate, provide entity-specific technical 
        assistance and evidence-based strategies to communities that 
        disproportionately experience disparities in health status and 
        healthcare to further the purposes served by a health 
        empowerment zone program established with a grant under 
        subsection (a);
            (2) identify all programs administered by the Department of 
        Health and Human Services, Small Business Administration, 
        Department of Agriculture, Department of Education, Department 
        of Labor, and the Department of Housing and Urban Development, 
        respectively, that may be used to further the purpose of a 
        health empowerment zone program established with a grant under 
        subsection (a); and
            (3) in administering any program identified under paragraph 
        (2), consider the appropriateness of giving priority to any 
        individual or entity located in communities that 
        disproportionately experience disparities in health status and 
        healthcare served by a health empowerment zone program 
        established with a grant under subsection (a), if such priority 
        would further the purpose of the health empowerment zone 
        program.
    (c) Health Empowerment Zone Coordinating Committee.--
            (1) Establishment.--For each health empowerment zone 
        program established with a grant under subsection (a), the 
        Secretary acting through the Director of Office of Minority 
        Health and the Administrator of the Health Resources and 
        Services Administration shall establish a health empowerment 
        zone coordinating committee.
            (2) Duties.--Each coordinating committee established, in 
        coordination with the Director of the Office of Minority Health 
        and the Administrator of the Health Resources and Services 
        Administration, shall provide technical assistance and 
        evidence-based strategies to the grant recipient involved, 
        including providing guidance on research, strategies, health 
        outcomes, program goals, management, implementation, 
        monitoring, assessment, and evaluation processes.
            (3) Membership.--
                    (A) Appointment.--The Director of the Office of 
                Minority Health and the Administrator of the Health 
                Resources and Services Administration, in consultation 
                with the respective grant recipient shall appoint the 
                members of each coordinating committee.
                    (B) Composition.--The Director of the Office of 
                Minority Health, and the Administrator of the Health 
                Resources and Services Administration shall ensure that 
                each coordinating committee established--
                            (i) has not more than 20 members;
                            (ii) includes individuals from communities 
                        that disproportionately experience disparities 
                        in health status and healthcare;
                            (iii) includes community leaders and 
                        leaders of community-based organizations;
                            (iv) includes representatives of academia 
                        and lay and professional organizations and 
                        associations including those having expertise 
                        in medicine, technical, social and behavioral 
                        science, health policy, advocacy, cultural and 
                        linguistic competency, research management, and 
                        organization; and
                            (v) represents a reasonable cross-section 
                        of knowledge, views, and application of 
                        expertise on societal, ethical, behavioral, 
                        educational, policy, legal, cultural, 
                        linguistic, and workforce issues related to 
                        eliminating disparities in health and 
                        healthcare.
                    (C) Individual qualifications.--The Director of the 
                Office of Minority Health and the Administrator of the 
                Health Resources and Services Administration may not 
                appoint an individual to serve on a coordinating 
                committee unless the individual meets the following 
                qualifications:
                            (i) The individual is not employed by the 
                        Federal Government.
                            (ii) The individual has appropriate 
                        experience, including experience in the areas 
                        of community development, cultural and 
                        linguistic competency, reducing and eliminating 
                        racial and ethnic disparities in health and 
                        health care, or minority health.
                    (D) Selection.--In selecting individuals to serve 
                on a coordinating committee, the Director of Office of 
                Minority Health and the Administrator Health Resources 
                and Services Administration shall give due 
                consideration to the recommendations of the Congress, 
                industry leaders, the scientific community (including 
                the Institute of Medicine), academia, community based 
                non-profit organizations, minority health and related 
                organizations, the education community, State and local 
                governments, and other appropriate organizations.
                    (E) Chairperson.--The Director of the Office of 
                Minority Health and the Administrator of the Health 
                Resources and Services Administration, in consultation 
                with the members of the coordinating committee 
                involved, shall designate a chairperson of the 
                coordinating committee, who shall serve for a term of 3 
                years and who may be reappointed at the expiration of 
                each such term.
                    (F) Terms.--Each member of a coordinating committee 
                shall be appointed for a term of 1 to 3 years in 
                overlapping staggered terms, as determined by the 
                Director of the Office of Minority Health and the 
                Administrator of the Health Resources and Services 
                Administration at the time of appointment, and may be 
                reappointed at the expiration of each such term.
                    (G) Vacancies.--A vacancy on a coordinating 
                committee shall be filled in the same manner in which 
                the original appointment was made.
                    (H) Compensation.--Each member of a coordinating 
                committee shall be compensated at a rate equal to the 
                daily equivalent of the annual rate of basic pay for 
                level IV of the Executive Schedule for each day 
                (including travel time) during which such member is 
                engaged in the performance of the duties of the 
                coordinating committee.
                    (I) Travel expenses.--Each member of a coordinating 
                committee shall receive travel expenses, including per 
                diem in lieu of subsistence, in accordance with 
                applicable provisions under subchapter I of chapter 57 
                of title 5, United States Code.
            (4) Meetings.--A coordinating committee shall meet 3 to 5 
        times each year, at the call of the coordinating committee's 
        chairperson and in consultation with the Director of Office of 
        Minority Health and the Administrator Health Resources and 
        Services Administration.
            (5) Report.--Each coordinating committee shall transmit to 
        the Congress an annual report that, with respect to the health 
        empowerment zone program involved, includes the following:
                    (A) A review of the program's effectiveness in 
                achieving stated goals and outcomes.
                    (B) A review of the program's management and the 
                coordination of the entities involved.
                    (C) A review of the activities in the program's 
                portfolio and components.
                    (D) An identification of policy issues raised by 
                the program.
                    (E) An assessment of the program's capacity, 
                infrastructure, and number of underserved minority 
                communities reached.
                    (F) Recommendations for new program goals, research 
                areas, enhanced approaches, partnerships, coordination 
                and management mechanisms, and projects to be 
                established to achieve the program's stated goals, to 
                improve outcomes, monitoring, and evaluation.
                    (G) A review of the degree of minority entity 
                participation in the program, and an identification of 
                a strategy to increase such participation.
                    (H) Any other reviews or recommendations determined 
                to be appropriate by the coordinating committee.
    (d) Report.--The Director of the Office of Minority Health and the 
Administrator of the Health Resources and Services Administration shall 
submit a joint annual report to the appropriate committees of Congress 
on the results of the implementation of programs under this section.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

    Subtitle B--Targeting Diseases and Conditions with Particularly 
                            Disparate Impact

                      CHAPTER 1--CANCER REDUCTION

SEC. 441. CANCER REDUCTION.

    (a) Preventive Health Measures With Respect to Breast and Cervical 
Cancer.--
            (1) In general.--Section 1510(a) of the Public Health 
        Service Act (42 U.S.C. 300n-5(a)) is amended by striking 
        ``2003'' and inserting ``2008''.
            (2) Supplemental grants for additional preventive health 
        services.--Section 1509(d)(1) of the Public Health Service Act 
        (42 U.S.C. 300n-4a(d)(1)) is amended by striking ``2003'' and 
        inserting ``2008''.
    (b) Treatment and Prevention.--Title XXIX of the Public Health 
Service Act, as amended by section 302, is further amended by adding at 
the end the following:

    ``Subtitle C--Reducing Disease and Disease-Related Complications

                     ``CHAPTER 1--CANCER REDUCTION

``SEC. 2921. CANCER PREVENTION AND TREATMENT FOR UNDERSERVED MINORITY 
              OR OTHER POPULATIONS.

    ``(a) Grants.--The Secretary may make grants to qualifying health 
centers, non-profit organizations, and public institutions for the 
development, expansion, or operation of programs that, for individuals 
otherwise served by such centers, provide--
            ``(1) information and education on cancer prevention;
            ``(2) screenings for cancer;
            ``(3) counseling on cancer, including counseling upon a 
        diagnosis of cancer; and
            ``(4) treatment for cancer.
    ``(b) Qualifying Health Centers and Public Institutions.--For 
purposes of this section:
            ``(1) Qualifying health centers.--The term `qualifying 
        health center' includes community health centers, migrant 
        health centers, health centers for the homeless, health centers 
        for residents of public housing, and community clinics.
            ``(2) Qualifying public institutions.--The term `qualifying 
        public institutions' means an entity that meets the 
        requirements of section 2971(b)(1).
    ``(c) Preference in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to applicants 
that--
            ``(1) have service populations that include a significant 
        number of low-income minority individuals who are at-risk for 
        cancer;
            ``(2) will, through programs under subsection (b)--
                    ``(A) emphasize early detection of and 
                comprehensive treatment for cancer;
                    ``(B) provide comprehensive treatment services for 
                cancer in its earliest stages; and
                    ``(C) carry out subparagraphs (A) and (B) for two 
                or more types of cancer; and
            ``(3) in order to provide treatment for cancer, have 
        established or will establish referral arrangements with 
        entities that provide screenings for low-income individuals.
    ``(d) Appropriate Cultural Context.--As a condition for the receipt 
of a grant under subsection (a), the applicant shall agree that, in the 
program carried out with the grant, services will be provided in the 
languages most appropriate for, and with consideration for the cultural 
background of, the individuals for whom the services are provided.
    ``(e) Outreach Services.--As a condition for the receipt of a grant 
under subsection (a), the applicant shall agree to provide outreach 
activities to inform the public of the services of the program, and to 
provide information on cancer; and
    ``(f) Application for Grant.--A grant may be made under subsection 
(a) 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.
    ``(g) Designation of Type of Cancer.--In making a grant under 
subsection (a), the Secretary shall designate the type or types of 
cancer with respect to which the grant is being made.
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2005 through 2010.''.

                     CHAPTER 2--HIV/AIDS REDUCTION

SEC. 442. HIV/AIDS REDUCTION.

    Subtitle C of title XXIX of the Public Health Service Act, as added 
by section 441, is amended by adding at the end the following:

                    ``CHAPTER 2--HIV/AIDS REDUCTION

``SEC. 2922. HIV/AIDS REDUCTION IN THE MINORITY COMMUNITY.

    ``(a) Expanded Funding.--The Secretary, in collaboration with the 
Director of the Office of Minority Health, the Director of the Centers 
for Disease Control and Prevention, the Administrator of the Health 
Resources and Services Administration, and the Administrator of the 
Substance Abuse and Mental Health Administration, shall provide funds 
and carry out activities to expand the Minority HIV/AIDS Initiative.
    ``(b) Use of Funds.--The additional funds made available under this 
section may be used, through the Minority HIV/AIDS Initiative, to 
support the following activities:
            ``(1) The provision of technical assistance and 
        infrastructure support to reduce HIV/AIDS in minority 
        populations.
            ``(2) To increase minority populations' access to HIV/AIDS 
        prevention and care services.
            ``(3) To build stronger community programs and partnerships 
        to address HIV prevention and the healthcare needs of specific 
        minority racial and ethnic populations.
    ``(c) Priority Interventions.--Within the minority populations 
referred to in subsection (b), priority in conducting intervention 
services shall be given to--
            ``(1) women;
            ``(2) youth;
            ``(3) men who engage in homosexual activity;
            ``(4) persons who engage in intravenous drug abuse;
            ``(5) homeless individuals; and
            ``(6) individuals incarcerated or in the penal system.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $610,000,000 
for fiscal year 2005, and such sums as may be necessary for each of the 
fiscal years 2006 through 2010.''.

                 CHAPTER 3--INFANT MORTALITY REDUCTION

SEC. 443. INFANT MORTALITY REDUCTION.

    Subtitle C of title XXIX of the Public Health Service Act, as 
amended by section 442, is further amended by adding at the end the 
following:

                ``CHAPTER 3--INFANT MORTALITY REDUCTION

``SEC. 2923. INFANT MORTALITY REDUCTION.

    ``(a) Back to Sleep Campaign.--
            ``(1) In general.--The Secretary shall support 
        collaborations through the National Institute of Child Health 
        and Human Development.
            ``(2) Use of funds.--Collaborations funded under paragraph 
        (1) shall be directed towards the goal of reducing the 
        incidence of Sudden Infant Death Syndrome in minority 
        communities, particularly the African American and American 
        Indian and Native Alaskan communities, through increased 
        education on the importance of back sleeping for infants. Such 
        increased education shall include child care centers and other 
        secondary child caregivers.
    ``(b) Guidelines for Child Care Licensure.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the National Institute of Child Health and Human 
        Development, shall convene a working group to develop health 
        guidelines relating to infant mortality reduction for use by 
        child care licensing entities, including State, territorial, 
        tribal, and local governments.
            ``(2) Focus.--The guidelines developed under paragraph (1) 
        shall focus specifically on appropriate actions to reduce the 
        incidence of Sudden Infant Death Syndrome in child care 
        settings.
            ``(3) Report.--Not later than 1 year after the date of 
        enactment of this title, the Secretary shall submit to the 
        appropriate committees of Congress and the States a report that 
        describes the guidelines developed under this subsection.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

       CHAPTER 4--FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS

SEC. 444. FETAL ALCOHOL SYNDROME.

    Subtitle C of title XXIX of the Public Health Service Act, as 
amended added by section 443, is further amended by adding at the end 
the following:

      ``CHAPTER 4--FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS

``SEC. 2924. FETAL ALCOHOL SYNDROME.

    ``(a) Surveillance and Identification Research.--The Secretary 
shall direct the National Center for Birth Defects and Developmental 
Disabilities (referred to in this section as the `Center') to--
            ``(1) develop a uniform surveillance case definition for 
        Fetal Alcohol Syndrome (referred to in this section as `FAS') 
        and a uniform surveillance definition for Alcohol Related 
        Neurodevelopmental Disorder (referred to in this section as 
        `ARND');
            ``(2) develop a comprehensive screening process for FAS and 
        ARND to include all age groups; and
            ``(3) disseminate the screening process developed under 
        paragraph (2) to--
                    ``(A) hospitals, outpatient programs, and other 
                healthcare providers;
                    ``(B) incarceration and detainment facilities;
                    ``(C) primary and secondary schools;
                    ``(D) social work and child welfare offices;
                    ``(E) State offices and others providing services 
                to individuals with disabilities; and
                    ``(F) others determined appropriate by the 
                Secretary.
    ``(b) Clinical Characterization of FAS and Related Diseases.--The 
Secretary shall direct the National Institute of Alcohol Abuse and 
Alcoholism to--
            ``(1) research methods to quantify the central nervous 
        system impairments associated with fetal alcohol exposure and 
        to develop clinical diagnostic tools for the intellectual and 
        behavioral problems associated with FAS and related diseases;
            ``(2) develop a neurocognitive phenotype for FAS and ARND; 
        and
            ``(3) include all relevant scientific and clinical 
        characterizations of FAS and related diseases in relevant 
        diagnostic codes.
    ``(c) Community-Based and Support Services Coordination Grants.--
The Secretary shall award grants to States, Indian tribes and tribal 
organizations, and nongovernmental organizations for the establishment 
of--
            ``(1) pilot projects to identify and implement best 
        practices for--
                    ``(A) educating children with fetal alcohol 
                spectrum disorders, including--
                            ``(i) activities and programs designed 
                        specifically for the identification, treatment, 
                        and education of such children; and
                            ``(ii) curricula development and 
                        credentialing of teachers, administrators, and 
                        social workers who implement such programs;
                    ``(B) educating judges, attorneys, child advocates, 
                law enforcement officers, prison wardens, alternative 
                incarceration administrators, and incarceration 
                officials on how to treat and support individuals 
                suffering from a fetal alcohol spectrum disorder within 
                the criminal justice system, including--
                            ``(i) programs designed specifically for 
                        the identification, treatment, and education of 
                        those with a fetal alcohol spectrum disorder; 
                        and
                            ``(ii) curricula development and 
                        credentialing within justice system for 
                        individuals who implement such programs; and
                    ``(C) educating adoption or foster care agency 
                officials about available and necessary services for 
                children with fetal alcohol spectrum disorders, 
                including--
                            ``(i) programs designed specifically for 
                        the identification, treatment, and education of 
                        those with a fetal alcohol spectrum disorder; 
                        and
                            ``(ii) education and training for potential 
                        parents of an adopted child with a fetal 
                        alcohol spectrum disorder;
            ``(2) nationally coordinated systems that integrate 
        transitional services for those affected by prenatal alcohol 
        exposure such as housing assistance, vocational training and 
        placement, and medication monitoring by--
                    ``(A) providing training and support to family 
                services programs, children's mental health programs, 
                and other local efforts;
                    ``(B) recruiting and training mentors for teenagers 
                with a fetal alcohol spectrum disorder; and
                    ``(C) maintaining a clearinghouse including all 
                relevant neurobehavioral information needed for 
                supporting individuals with a fetal alcohol spectrum 
                disorder; and
            ``(3) programs to disseminate and coordinate fetal alcohol 
        spectrum disorder awareness and identification efforts by 
        community health centers, including--
                    ``(A) education of health professionals regarding 
                available support services; and
                    ``(B) implementation of a tracking system targeting 
                the rates of fetal alcohol spectrum disorders among 
                individuals from certain racial, ethnic, and economic 
                backgrounds.
    ``(d) Application.--To be eligible to receive a grant under 
subsection (d), an entity shall submit to the Secretary an application 
in such form, in such manner, and containing such agreements, 
assurances, and information as the Secretary determines to be necessary 
to carry out this section.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

              CHAPTER 5--DIABETES PREVENTION AND TREATMENT

SEC 445. MONITORING THE QUALITY OF AND DISPARITIES IN DIABETES CARE.

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

``SEC. 904. AREAS OF SPECIAL EMPHASIS.

    ``The Secretary, acting through the Director, shall incorporate 
within the annual quality report required under section 913(b)(2) and 
the annual disparities report required under section 903(a)(6), 
scientific evidence and information appropriate for monitoring the 
quality and safety of diabetes care and identifying, understanding, and 
reducing disparities in care.''.

SEC. 446. DIABETES PREVENTION, TREATMENT, AND CONTROL.

    (a) Determination.--The Secretary, in consultation with Indian 
tribes and tribal organizations, shall determine--
            (1) by tribe, tribal organization, and service unit of the 
        Service, the prevalence of, and the types of complications 
        resulting from, diabetes among Indians; and
            (2) based on paragraph (1), the measures (including patient 
        education) each service unit should take to reduce the 
        prevalence of, and prevent, treat, and control the 
        complications resulting from, diabetes among Indian tribes 
        within that service unit.
    (b) Screening.--The Secretary shall screen each Indian who receives 
services from the Service for diabetes and for conditions which 
indicate a high risk that the individual will become diabetic. Such 
screening may be done by an Indian tribe or tribal organization 
operating healthcare programs or facilities with funds from the Service 
under the Indian Self-Determination and Education Assistance Act.
    (c) Continued Funding.--The Secretary shall continue to fund, 
through fiscal year 2015, each effective model diabetes project in 
existence on the date of the enactment of this Act and such other 
diabetes programs operated by the Secretary or by Indian tribes and 
tribal organizations and any additional programs added to meet existing 
diabetes needs. Indian tribes and tribal organizations shall receive 
recurring funding for the diabetes programs which they operate pursuant 
to this section. Model diabetes projects shall consult, on a regular 
basis, with tribes and tribal organizations in their regions regarding 
diabetes needs and provide technical expertise as needed.
    (d) Dialysis Programs.--The Secretary shall provide funding through 
the Service, Indian tribes and tribal organizations to establish 
dialysis programs, including funds to purchase dialysis equipment and 
provide necessary staffing.
    (e) Other Activities.--The Secretary shall, to the extent funding 
is available--
            (1) in each area office of the Service, consult with Indian 
        tribes and tribal organizations regarding programs for the 
        prevention, treatment, and control of diabetes;
            (2) establish in each area office of the Service a registry 
        of patients with diabetes to track the prevalence of diabetes 
        and the complications from diabetes in that area; and
            (3) ensure that data collected in each area office 
        regarding diabetes and related complications among Indians is 
        disseminated to tribes, tribal organizations, and all other 
        area offices.
    (f) Definitions.--For purposes of this section, the definitions 
contained in section 4 of the Indian Health Care Improvement Act shall 
apply.

SEC. 447. GENETICS OF DIABETES.

    Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) 
is amended by inserting after section 430 the following:

``SEC. 430A. GENETICS OF DIABETES.

    ``The Diabetes Mellitus Interagency Coordinating Committee, in 
collaboration with the Directors of the National Human Genome Research 
Institute, the National Institute of Diabetes and Digestive and Kidney 
Diseases, and the National Institute of Environmental Health Sciences, 
and other voluntary organizations and interested parties, shall--
            ``(1) coordinate and assist efforts of the Type 1 Diabetes 
        Genetics Consortium, which will collect and share valuable DNA 
        information from type 1 diabetes patients from studies around 
        the world; and
            ``(2) provide continued coordination and support for the 
        consortia of laboratories investigating the genomics of 
        diabetes.''.

SEC. 448. RESEARCH AND TRAINING ON DIABETES IN UNDERSERVED AND MINORITY 
              POPULATIONS.

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

``SEC. 434B. RESEARCH ON DIABETES IN UNDERSERVED AND MINORITY 
              POPULATIONS.

    ``(a) In General.--The Director of the Institute, in coordination 
with the Director of the National Center on Minority Health and Health 
Disparities, the Director of the Office of Minority Health, and other 
appropriate institutes and centers, shall expand, intensify, and 
coordinate research programs on pre-diabetes, type 1 diabetes and type 
2 diabetes in underserved populations and minority groups.
    ``(b) Research.--The research described in subsection (a) shall 
include research on--
            ``(1) behavior, including diet and physical activity and 
        other aspects of behavior;
            ``(2) environmental factors related to type 2 diabetes that 
        are unique to, more serious, or more prevalent, among 
        underserved or high-risk populations;
            ``(3) research on the prevention of complications, which 
        are unique to, more serious, or more prevalent among 
        minorities, as well as research on how to effectively translate 
        the findings of clinical trials and research to improve methods 
        for self-management and health-care delivery; and
            ``(4) genetic studies of diabetes, consistent with research 
        conducted under section 430A.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated for purposes of carrying out this section, such sums as 
may be necessary for each of fiscal years 2005 through 2010.''.
    (b) Division Directors.--Section 428(b)(1) of the Public Health 
Service Act (42 U.S.C. 285c-2(b)(1)) is amended by inserting 
``(including research training of members of minority populations in 
order to facilitate their conduct of diabetes-related research in 
underserved populations and minority groups)'' after ``research 
programs''.

SEC. 449. AUTHORIZATION OF APPROPRIATIONS.

    Subpart 3 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285c et seq.) (as amended by section 448(a)) is amended by 
adding at the end the following:

``SEC. 434C. AUTHORIZATION OF APPROPRIATIONS.

    ``For the purpose of carrying out this subpart with respect to the 
programs of the National Institute of Diabetes and Digestive and Kidney 
Diseases, other than section 434B, there are authorized to be 
appropriated such sums as may be necessary for each of fiscal years 
2005 through 2010.''.

SEC. 450. MODEL COMMUNITY DIABETES AND CHRONIC DISEASE CARE AND 
              PREVENTION AMONG PACIFIC ISLANDERS AND NATIVE HAWAIIANS.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 432, is further amended by adding 
at the end the following:

``SEC. 399P. MODEL COMMUNITY DIABETES AND CHRONIC DISEASE CARE AND 
              PREVENTION AMONG PACIFIC ISLANDERS AND NATIVE HAWAIIANS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, may award grants and 
enter into cooperative agreements and contracts with eligible entities 
to establish a model community demonstration project to provide 
training and support for community-based prevention and control 
programs targeting diabetes, hypertension, cardiovascular disease, and 
other related health problems in American Samoa, the Commonwealth of 
the Northern Mariana Islands, Guam, the Federated States of Micronesia, 
Hawaii, the Republic of the Marshall Islands, and the Republic of 
Palau.
    ``(b) Eligible Entity Defined.--In this section the term `eligible 
entity' means any organization described in section 501(c)(3) of the 
Internal Revenue Code of 1986 and exempt from tax under section 501(a) 
of such Code.
    ``(c) Priority.--The Secretary shall give priority for grants, 
agreements, and contracts under this section to eligible entities that 
have previously administered culturally appropriate Centers for Disease 
Control and Prevention programs intended to prevent and control 
diabetes in the areas described in subsection (a).
    ``(d) Regulations.--The Secretary is authorized to promulgate such 
regulations as may be necessary to carry out this section.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for fiscal years 2005 through 2010.''.

SEC. 451. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

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

``SEC. 317H. DIABETES IN CHILDREN AND YOUTH.

    ``(a) Surveillance on Type 1 Diabetes.--The Secretary, acting 
through the Director of the Centers for Disease Control and Prevention 
and in consultation with the Director of the National Institutes of 
Health, shall develop a sentinel system to collect data on type 1 
diabetes, including the incidence and prevalence of type 1 diabetes and 
shall establish a national database for such data.
    ``(b) Type 2 Diabetes in Youth.--The Secretary shall implement a 
national public health effort to address type 2 diabetes in youth, 
including--
            ``(1) enhancing surveillance systems and expanding research 
        to better assess the prevalence and incidence of type 2 
        diabetes in youth and determine the extent to which type 2 
        diabetes is incorrectly diagnosed as type 1 diabetes among 
        children;
            ``(2) standardizing and improving methods to assist in 
        diagnosis, treatment, and prevention of diabetes including 
        developing less invasive ways to monitor blood glucose to 
        prevent hypoglycemia such as nonmydriatic retinal imaging and 
        improving existing glucometers that measure blood glucose; and
            ``(3) developing methods to identify obstacles facing 
        children in traditionally underserved populations to obtain 
        care to prevent or treat type 2 diabetes.
    ``(c) Long-Term Epidemiological Studies on Diabetes in Children.--
The Secretary, acting through the Director of the Centers for Disease 
Control and Prevention and the Director of the National Institute of 
Diabetes and Digestive and Kidney Diseases, shall conduct or support 
long-term epidemiology studies in children with diabetes or at risk for 
diabetes. Such studies shall investigate the causes and characteristics 
of the disease and its complications.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

      CHAPTER 6--HEART DISEASE AND STROKE PREVENTION AND TREATMENT

SEC. 455. SYSTEMS FOR HEART DISEASE AND STROKE.

    Title XXIX of the Public Health Service Act, as amended by section 
443, is further amended by adding at the end the following:

           ``Subtitle D--Systems for Heart Disease and Stroke

                       ``CHAPTER 1--HEART DISEASE

``SEC. 2941. HEART DISEASE.

    ``(a) In General.--The Secretary, acting through the National 
Heart, Lung and Blood Institute and the Centers for Disease Control, 
shall award competitive grants to eligible entities to provide for 
community-based interventions to encourage healthy lifestyles to reduce 
morbidity and mortality from heart disease.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a community-based or non-profit organization, 
        academic medical institution, hospital, health center, health 
        plan, health department, or other health-related entity 
        determined appropriate by the Secretary; and
            ``(2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to--
            ``(1) carry out interventions that address primary 
        prevention of heart disease in the minority community, 
        including educational outreach efforts concerning risk factors 
        for, and the prevention of, heart disease;
            ``(2) carry out activities to facilitate healthy lifestyles 
        in minority populations through--
                    ``(A) behavioral change interventions to increase 
                physical activity and improve nutrition;
                    ``(B) the increased use of community facilities and 
                public spaces for exercise;
                    ``(C) school, after-school, or intramural physical 
                activity or sports programs for children and youth;
                    ``(D) employment-based interventions to increase 
                physical activity or nutrition; or
            ``(3) expand or evaluate existing programs of the type 
        described in paragraphs (1) and (2).
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

                 ``CHAPTER 2--STROKE EDUCATION CAMPAIGN

``SEC. 2945. STROKE EDUCATION CAMPAIGN.

    ``(a) In General.--The Secretary shall carry out a national 
education and information campaign to promote stroke prevention and 
increase the number of stroke patients who seek immediate treatment. In 
implementing such education and information campaign, the Secretary 
shall avoid duplicating existing stroke education efforts by other 
Federal Government agencies and may consult with national and local 
associations that are dedicated to increasing the public awareness of 
stroke, consumers of stroke awareness products, and providers of stroke 
care.
    ``(b) Use of Funds.--The Secretary may use amounts appropriated to 
carry out the campaign described in subsection (a)--
            ``(1) to make public service announcements about the 
        warning signs of stroke and the importance of treating stroke 
        as a medical emergency;
            ``(2) to provide education regarding ways to prevent stroke 
        and the effectiveness of stroke treatment;
            ``(3) to purchase media time and space;
            ``(4) to pay for advertising production costs;
            ``(5) to test and evaluate advertising and educational 
        materials for effectiveness, especially among groups at high 
        risk for stroke, including women, older adults, and African-
        Americans;
            ``(6) to develop alternative campaigns that are targeted to 
        unique communities, including rural and urban communities, and 
        States with a particularly high incidence of stroke;
            ``(7) to measure public awareness prior to the start of the 
        campaign on a national level and in targeted communities to 
        provide baseline data that will be used to evaluate the 
        effectiveness of the public awareness efforts; and
            ``(8) to carry out other activities that the Secretary 
        determines will promote prevention practices among the general 
        public and increase the number of stroke patients who seek 
        immediate care.
    ``(c) Consultations.--In carrying out this section, the Secretary 
shall consult with medical, surgical, rehabilitation, and nursing 
specialty groups, hospital associations, voluntary health 
organizations, emergency medical services, State directors, and 
associations, experts in the use of telecommunication technology to 
provide stroke care, national disability, minority health professional 
organizations and consumer organizations representing individuals with 
disabilities and chronic illnesses, concerned advocates, and other 
interested parties.
    ``(d) Stroke.--In this section, the term `stroke' means a `brain 
attack' in which blood flow to the brain is interrupted or in which a 
blood vessel or aneurysm in the brain breaks or ruptures.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out subsection (b), such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

              CHAPTER 7--OBESITY AND OVERWEIGHT REDUCTION

SEC. 461. OVERWEIGHT AND OBESITY PREVENTION AND TREATMENT.

    (a) In General.--The Secretary, in collaboration with the Director 
of the Centers for Disease Control and Prevention, the Administrator of 
the National Center for Minority Health and Health Disparities, and the 
Administrator of the Health Resources and Services Administration, 
shall establish grant programs for the purpose of preventing and 
treating overweight and obesity in underserved minority populations.
    (b) Definitions.--In this section, with respect to an individual:
            (1) Obesity.--The term ``obesity'' means a Body Mass Index 
        greater than or equal to 30.0 kg/m<SUP>2</SUP>.
            (2) Overweight.--The term ``overweight'' means a Body Mass 
        Index of 25 to 29.9 kg/m<SUP>2</SUP>.
    (c) Centers for Disease Control and Prevention.--The Director of 
the Centers for Disease Control and Prevention shall expand overweight 
and obesity reduction activities that include the following:
            (1) Surveillance in minority racial and ethnic populations.
            (2) Communication strategies, including the use of social 
        marketing for minority populations, about the dangers of 
        obesity.
            (3) Creation of partnerships with State health departments 
        in developing obesity prevention and treatment interventions.
            (4) Development of work-based wellness programs to 
        encourage adoption of healthy lifestyles by employees.
    (d) National Center for Minority Health and Health Disparities.--
The Director of the Centers for Disease Control and Prevention shall 
establish and implement a grant program to support research in the 
following areas:
            (1) Behavioral and environmental causes of overweight and 
        obesity in minority populations.
            (2) Prevention and treatment interventions for overweight 
        and obesity, tailored for minority populations.
            (3) Disparities in the prevalence of overweight and obesity 
        among racial and ethnic minority groups.
            (4) Development and dissemination of best practice 
        guidelines for treatment of overweight and obesity, tailored 
for gender and age groups within minority populations.
            (5) Data collection and reporting relating to overweight 
        and obesity in minority populations.
    (e) Health Resources and Services Administration.--The 
Administrator of the Health Resources and Services Administration, in 
collaboration with the Director of the Office of Minority Health, the 
Secretary of Education, and the Secretary of Agriculture, shall 
establish and implement a school-based obesity prevention and treatment 
program that may include the following activities:
            (1) Projects to change the perception of overweight and 
        obesity of children from racially and ethnically diverse 
        backgrounds at all ages.
            (2) Culturally appropriate student education about healthy 
        eating habits, based on the Dietary Guidelines for Americans.
            (3) Student programs to increase knowledge, attitudes, 
        skills, behaviors, and confidence needed to be physically 
        active for life.
            (4) Student peer advisor programs to increase awareness and 
        model healthy lifestyles among fellow students.
            (5) Teacher education using scientifically evaluated 
        physical education and nutrition curricula tailored to minority 
        populations.
            (6) Family-focused initiatives to encourage the adoption of 
        strategies relating to healthy lifestyles for parents (or 
        guardians) and children.
            (7) The creation of partnerships with community, fitness, 
        or health organizations that will promote healthy eating and 
        physical activity among children.
            (8) Incentive programs to ensure the provision of healthful 
        foods and beverages on school campuses and at school events.
    (f) Evaluation.--A grantee under this section shall submit to the 
Secretary an evaluation, in collaboration with an academic health 
center or other qualified entity, that describes activities carried out 
with funds received under the grant and the effectiveness of such 
activities in preventing or treating overweight and obesity.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

       CHAPTER 8--TUBERCULOSIS CONTROL, PREVENTION, AND TREATMENT

SEC. 465. 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. 466. 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.
            ``(7) Capacity support to States and large cities for 
        strengthening tuberculosis programs.''; 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.
    ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2005 through 2010.''.

SEC. 467. 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, 2004.

                           CHAPTER 9--ASTHMA

SEC. 471. PROVISIONS REGARDING NATIONAL ASTHMA EDUCATION AND PREVENTION 
              PROGRAM OF NATIONAL HEART, LUNG, AND BLOOD INSTITUTE.

    In addition to any other authorization of appropriations that is 
available to the National Heart, Lung, and Blood Institute for the 
purpose of carrying out the National Asthma Education and Prevention 
Program, there is authorized to be appropriated to such Institute for 
such purpose such sums as may be necessary for each of fiscal years 
2005 through 2010. Amounts appropriated under the preceding sentence 
shall be expended to expand such Program.

SEC. 472. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    (a) Expansion of Public Health Surveillance Activities; Program for 
Providing Information and Education to Public.--The Secretary of Health 
and Human Services, acting through the Director of the Centers for 
Disease Control and Prevention, shall collaborate with the States to 
expand the scope of--
            (1) activities that are carried out to determine the 
        incidence and prevalence of asthma; and
            (2) activities that are carried out to prevent the health 
        consequences of asthma, including through the provision of 
        information and education to the public regarding asthma, which 
        may include the use of public service announcements through the 
        media and such other means as such Director determines to be 
        appropriate.
    (b) Compilation of Data.--The Secretary of Health and Human 
Services, acting through the Director of the Centers for Disease 
Control and Prevention and in consultation with the National Asthma 
Education Prevention Program Coordinating Committee, shall--
            (1) conduct local asthma surveillance activities to collect 
        data on the prevalence and severity of asthma and the quality 
        of asthma management, including--
                    (A) telephone surveys to collect sample household 
                data on the local burden of asthma; and
                    (B) health care facility specific surveillance to 
                collect asthma data on the prevalence and severity of 
                asthma, and on the quality of asthma care; and
            (2) compile and annually publish data on--
                    (A) the prevalence of children suffering from 
                asthma in each State; and
                    (B) the childhood mortality rate associated with 
                asthma nationally and in each State.
    (c) Additional Funding.--In addition to any other authorization of 
appropriations that is available to the Centers for Disease Control and 
Prevention for the purpose of carrying out this section, there is 
authorized to be appropriated to such Centers for such purpose such 
sums as may be necessary for each of fiscal years 2005 through 2010.

SEC. 473. GRANTS FOR COMMUNITY OUTREACH REGARDING ASTHMA INFORMATION, 
              EDUCATION, AND SERVICES.

    (a) In General.--The Secretary may make grants to nonprofit private 
entities for projects to carry out, in communities identified by 
entities applying for the grants, outreach activities to provide for 
residents of the communities the following:
            (1) Information and education on asthma.
            (2) Referrals to health programs of public and nonprofit 
        private entities that provide asthma-related services, 
        including such services for low-income individuals. The grant 
        may be expended to make arrangements to coordinate the 
        activities of such entities in order to establish and operate 
        networks or consortia regarding such referrals.
    (b) Preferences in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to applicants that 
will carry out projects under such subsection in communities that are 
disproportionately affected by asthma or underserved with respect to 
the activities described in such subsection and in which a significant 
number of low-income individuals reside.
    (c) Evaluations.--A condition for a grant under subsection (a) is 
that the applicant for the grant agree to provide for the evaluation of 
the projects carried out under such subsection by the applicant to 
determine the extent to which the projects have been effective in 
carrying out the activities referred to in such subsection.
    (d) Funding.--For the purpose of carrying out this section, there 
is authorized to be appropriated such sums as may be necessary for each 
of fiscal years 2005 through 2010.

SEC. 474. ACTION PLANS OF LOCAL EDUCATIONAL AGENCIES REGARDING ASTHMA.

    (a) In General.--
            (1)  School-based asthma activities.--The Secretary of 
        Education (in this section referred to as the ``Secretary''), 
        in consultation with the Director of the Centers for Disease 
        Control and Prevention and the Director of the National 
        Institutes of Health, may make grants to local educational 
        agencies for programs to carry out at elementary and secondary 
        schools specified in paragraph (2) asthma-related activities 
        for children who attend such schools.
            (2) Eligible schools.--The elementary and secondary schools 
        referred to in paragraph (1) are such schools that are located 
        in communities with a significant number of low-income or 
        underserved individuals (as defined by the Secretary).
    (b) Development of Programs.--Programs under subsection (a) shall 
include grants under which local education agencies and State public 
health officials collaborate to develop programs to improve the 
management of asthma in school settings.
    (c) Certain Guidelines.--Programs under subsection (a) shall be 
carried out in accordance with applicable guidelines or other 
recommendations of the National Institutes of Health (including the 
National Heart, Lung, and Blood Institute) and the Environmental 
Protection Agency.
    (d) Certain Activities.--Activities that may be carried out in 
programs under subsection (a) include the following:
            (1) Identifying and working directly with local hospitals, 
        community clinics, advocacy organizations, parent-teacher 
        associations, minority health organizations, and asthma 
        coalitions.
            (2) Identifying asthmatic children and training them and 
        their families in asthma self-management.
            (3) Purchasing asthma equipment.
            (4) Hiring school nurses.
            (5) Training teachers, nurses, coaches, and other school 
        personnel in asthma-symptom recognition and emergency 
        responses.
            (6) Simplifying procedures to improve students' safe access 
        to their asthma medications.
            (7) Such other asthma-related activities as the Secretary 
        determines to be appropriate.
    (e) Definitions.--For purposes of this section, the terms 
``elementary school'', ``local educational agency'', and ``secondary 
school'' have the meanings given such terms in the Elementary and 
Secondary Education Act of 1965.
    (f) Funding.--For the purpose of carrying out this section, there 
is authorized to be appropriated such sums as may be necessary for each 
of fiscal years 2005 through 2010.

                    CHAPTER 10--SICKLE CELL DISEASE

SEC. 481. DEMONSTRATION PROGRAM FOR THE DEVELOPMENT AND ESTABLISHMENT 
              OF SYSTEMIC MECHANISMS FOR THE PREVENTION AND TREATMENT 
              OF SICKLE CELL DISEASE.

    (a) Authority To Conduct Demonstration Program.--
            (1) In general.--The Administrator, through the Bureau of 
        Primary Health Care and the Maternal and Child Health Bureau, 
        shall conduct a demonstration program by making grants to up to 
        40 eligible entities for each fiscal year in which the program 
        is conducted under this section for the purpose of developing 
        and establishing systemic mechanisms to improve the prevention 
        and treatment of Sickle Cell Disease, including through--
                    (A) the coordination of service delivery for 
                individuals with Sickle Cell Disease;
                    (B) genetic counseling and testing;
                    (C) bundling of technical services related to the 
                prevention and treatment of Sickle Cell Disease;
                    (D) training of health professionals; and
                    (E) identifying and establishing other efforts 
                related to the expansion and coordination of education, 
                treatment, pain management, and continuity of care 
                programs for individuals with Sickle Cell Disease.
            (2) Grant award requirements.--
                    (A) Geographic diversity.--The Administrator shall, 
                to the extent practicable, award grants under this 
                section to eligible entities located in different 
                regions of the United States.
                    (B) Priority.--In awarding grants under this 
                section, the Administrator shall give priority to 
                awarding grants to eligible entities that are--
                            (i) Federally-qualified health centers that 
                        have a partnership or other arrangement with a 
                        comprehensive Sickle Cell Disease treatment 
                        center that does not receive funds from the 
                        National Institutes of Health; or
                            (ii) Federally-qualified health centers 
                        that intend to develop a partnership or other 
                        arrangement with a comprehensive Sickle Cell 
                        Disease treatment center that does not receive 
                        funds from the National Institutes of Health.
    (b) Additional Requirements.--An eligible entity awarded a grant 
under this section shall use funds made available under the grant to 
carry out, in addition to the activities described in subsection 
(a)(1), the following activities:
            (1) To facilitate and coordinate the delivery of education, 
        treatment, and continuity of care for individuals with Sickle 
        Cell Disease under--
                    (A) the entity's collaborative agreement with a 
                community-based Sickle Cell Disease organization or a 
                nonprofit entity that works with individuals who have 
                Sickle Cell Disease;
                    (B) the Sickle Cell Disease newborn screening 
                program for the State in which the entity is located; 
                and
                    (C) the maternal and child health program under 
                title V of the Social Security Act (42 U.S.C. 701 et 
                seq.) for the State in which the entity is located.
            (2) To train nursing and other health staff who specialize 
        in pediatrics, obstetrics, internal medicine, or family 
        practice to provide healthcare and genetic counseling for 
        individuals with the sickle cell trait.
            (3) To enter into a partnership with adult or pediatric 
        hematologists in the region and other regional experts in 
        Sickle Cell Disease at tertiary and academic health centers and 
        State and county health offices.
    (c) National Coordinating Center.--
            (1) Establishment.--The Administrator shall enter into a 
        contract with an entity to serve as the National Coordinating 
        Center for the demonstration program conducted under this 
        section.
            (2) Activities described.--The National Coordinating Center 
        shall--
                    (A) collect, coordinate, monitor, and distribute 
                data, best practices, and findings regarding the 
                activities funded under grants made to eligible 
                entities under the demonstration program;
                    (B) develop a model protocol for eligible entities 
                with respect to the prevention and treatment of Sickle 
                Cell Disease;
                    (C) develop educational materials regarding the 
                prevention and treatment of Sickle Cell Disease; and
                    (D) prepare and submit to Congress a final report 
                that includes recommendations regarding the 
                effectiveness of the demonstration program conducted 
                under this section and such direct outcome measures 
                as--
                            (i) the number and type of healthcare 
                        resources utilized (such as emergency room 
                        visits, hospital visits, length of stay, and 
                        physician visits for individuals with Sickle 
                        Cell Disease); and
                            (ii) the number of individuals that were 
                        tested and subsequently received genetic 
                        counseling for the sickle cell trait.
    (d) Application.--An eligible entity desiring a grant under this 
section shall submit an application to the Administrator at such time, 
in such manner, and containing such information as the Administrator 
may require.
    (e) Definitions.--In this section:
            (1) Administrator.--The term ``Administrator'' means the 
        Administrator of the Health Resources and Services 
        Administration.
            (2) Eligible entity.--The term ``eligible entity'' means a 
        Federally-qualified health center, a nonprofit hospital or 
        clinic, or a university health center that provides primary 
        healthcare, that--
                    (A) has a collaborative agreement with a community-
                based Sickle Cell Disease organization or a nonprofit 
                entity with experience in working with individuals who 
                have Sickle Cell Disease; and
                    (B) demonstrates to the Administrator that either 
                the Federally-qualified health center, the nonprofit 
                hospital or clinic, the university health center, the 
                organization or entity described in subparagraph (A), 
                or the experts described in subsection (b)(3), has at 
                least 5 years of experience in working with individuals 
                who have Sickle Cell Disease.
            (3) Federally-qualified health center.--The term 
        ``Federally-qualified health center'' has the meaning given 
        that term in section 1905(l)(2)(B) of the Social Security Act 
        (42 U.S.C. 1396d(l)(2)(B)).
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

         CHAPTER 11--AUTOIMMUNE DISEASE IN MINORITY POPULATIONS

SEC. 482. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE IN MINORITY 
              POPULATIONS.

    Part B of title IV of the Public Health Service Act is amended by 
inserting after section 409E (42 U.S.C. 284i) the following:

``SEC. 490E-1. RESEARCH FUNDING FOR AUTOIMMUNE DISEASE IN MINORITY 
              POPULATIONS.

    ``(a) Expansion and Intensification of Activities Regarding 
Autoimmune Diseases on Minorities.--With respect to the plan under 
section 409E(c)(1), the Coordinating Committee shall ensure that 
provisions of the plan developed under paragraph (2) of such subsection 
include provisions for the following:
            ``(1)(A) Basic research, epidemiological research, and 
        other appropriate research concerning the etiology and causes 
        of autoimmune diseases in all minorities, including genetic, 
        hormonal, and environmental factors.
            ``(B)(i) Giving priority under subparagraph (A) to research 
        regarding environmental factors.
            ``(ii) The coordination of (to the extent practicable and 
        appropriate), and providing additional support for, research 
        described in clause (i) that is conducted by public or 
        nonprofit private entities.
            ``(2)(A) The development of information and education 
        programs for patients, healthcare providers, and others as 
        appropriate on genetic, hormonal, and environmental risk 
        factors associated with autoimmune diseases in minorities, and 
        on the importance of the prevention or control of such risk 
        factors and timely referral with appropriate diagnosis and 
        treatment.
            ``(B) The inclusion in programs under subparagraph (A) of 
        information and education on the prevalence and nature of 
        autoimmune diseases, on risk factors, and on health-related 
        behaviors that can improve health status in minority 
        populations.
            ``(3) Outreach programs for purposes of paragraphs (1) and 
        (2) that--
                    ``(A) are directed toward minority individuals, 
                particularly those who are at-risk for autoimmune 
                diseases; and
                    ``(B) are carried out through community health 
                centers, community clinics, or other health centers 
                under section 330, through State, territory, or local 
                health departments, Indian tribes, or through primary 
                care physicians.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

  CHAPTER 12--PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED DISEASES

SEC. 485. PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED DISEASES.

    (a) In General.--Section 318(e)(1) of the Public Health Service Act 
(42 U.S.C. 247c(e)(1)) is amended by striking ``1998'' and inserting 
``2008''.
    (b) Preventable Cases of Infertility.--Section 318A of the Public 
Health Service Act (42 U.S.C. 247c-1) is amended--
            (1) in subsection (q), by striking ``1998'' and inserting 
        ``2010''; and
            (2) in subsection (r)(2), by striking ``1998'' and 
        inserting ``2010''.

                       CHAPTER 13--DENTAL DISEASE

SEC. 486. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES UNDER 
              MEDICAID AND SCHIP.

    Title V of the Social Security Act (42 U.S.C. 701 et seq.) is 
amended by adding at the end the following:

``SEC. 511. GRANTS TO IMPROVE THE PROVISION OF DENTAL SERVICES UNDER 
              MEDICAID AND SCHIP.

    ``(a) Authority To Make Grants.--In addition to any other payments 
made under this title to a State, the Secretary shall award grants to 
States that satisfy the requirements of subsection (b) to improve the 
provision of dental services to children who are enrolled in a State 
plan under title XIX or a State child health plan under title XXI (in 
this section, collectively referred to as the `State plans').
    ``(b) Requirements.--In order to be eligible for a grant under this 
section, a State shall provide the Secretary with the following 
assurances:
            ``(1) Improved service delivery.--The State shall have a 
        plan to improve the delivery of dental services to children, 
        including children with special health care needs, who are 
        enrolled in the State plans, including providing outreach and 
        administrative case management, improving collection and 
        reporting of claims data, and providing incentives, in addition 
        to raising reimbursement rates, to increase provider 
        participation.
            ``(2) Adequate payment rates.--The State has provided for 
        payment under the State plans for dental services for children 
        at levels consistent with the market-based rates and sufficient 
        enough to enlist providers to treat children in need of dental 
        services.
            ``(3) Ensured access.--The State shall ensure it will make 
        dental services available to children enrolled in the State 
        plans to the same extent as such services are available to the 
        general population of the State.
    ``(c) Use of Funds.--
            ``(1) In general.--Funds provided under this section may be 
        used to provide administrative resources (such as program 
        development, provider training, data collection and analysis, 
        and research-related tasks) to assist States in providing and 
        assessing services that include preventive and therapeutic 
        dental care regimens.
            ``(2) Limitation.--Funds provided under this section may 
        not be used for payment of direct dental, medical, or other 
        services or to obtain Federal matching funds under any Federal 
        program.
    ``(d) Application.--A State shall submit an application to the 
Secretary for a grant under this section in such form and manner and 
containing such information as the Secretary may require.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to make grants under this section, such sums as may be 
necessary for fiscal year 2005 and each fiscal year thereafter.
    ``(f) Application of Other Provisions of Title.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        other provisions of this title shall not apply to a grant made 
        under this section.
            ``(2) Exceptions.--The following provisions of this title 
        shall apply to a grant made under subsection (a) to the same 
        extent and in the same manner as such provisions apply to 
        allotments made under section 502(c):
                    ``(A) Section 504(b)(6) (relating to prohibition on 
                payments to excluded individuals and entities).
                    ``(B) Section 504(c) (relating to the use of funds 
                for the purchase of technical assistance).
                    ``(C) Section 504(d) (relating to a limitation on 
                administrative expenditures).
                    ``(D) Section 506 (relating to reports and audits), 
                but only to the extent determined by the Secretary to 
                be appropriate for grants made under this section.
                    ``(E) Section 507 (relating to penalties for false 
                statements).
                    ``(F) Section 508 (relating to nondiscrimination).
                    ``(G) Section 509 (relating to the administration 
                of the grant program).''.

SEC. 487. 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:
            ``(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.''.
                    (B) Conditions described.--Section 2105(c) of the 
                Social Security Act (42 U.S.C. 1397ee(c)) is amended by 
                adding at the end the following:
            ``(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 the highest income eligibility 
                        standard permitted under this title as of 
                        January 1, 2002;
                            ``(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 the Social Security Act (42 U.S.C. 
                1397bb(b)(1)(B)) is amended--
                            (i) in clause (i), by striking ``and'' at 
                        the end;
                            (ii) in clause (ii), by striking the period 
                        and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(iii) at State option, may not apply a 
                        waiting period in the case of a 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 the Social Security Act (42 U.S.C. 1396d) is amended--
                    (A) in subsection (b), in the fourth sentence, by 
                striking ``or subsection (u)(3)'' and inserting 
                ``(u)(3), or (u)(4)''; and
                    (B) in subsection (u)--
                            (i) by redesignating paragraph (4) as 
                        paragraph (5); and
                            (ii) by inserting after paragraph (3) the 
                        following:
            ``(4) 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 the Social Security Act (42 U.S.C. 1397gg(e)(1)) 
        is amended--
                    (A) by redesignating subparagraphs (B) through (D) 
                as subparagraphs (C) through (E), respectively; and
                    (B) by inserting after subparagraph (A) the 
                following:
                    ``(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.

SEC. 488. 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 insert 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));
                            ``(iv) a dental education program 
                        accredited by the Commission on Dental 
                        Accreditation; or
                            ``(v) a community-based program whose child 
                        service population is made up of at least 33 
                        percent of children who are eligible children, 
                        including at least 25 percent of such children 
                        being children with mental retardation or 
                        related developmental disabilities, unless 
                        specific documentation of a lack of need for 
                        access by this sub-population is established; 
                        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, including information concerning dental 
                provider capacity to serve individuals with 
                developmental disabilities.
            ``(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; or
                            ``(ii) not less than 25 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 such sums as may be necessary for each of 
fiscal years 2005 through 2010 to hire and retain dental healthcare 
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 65 percent of such amount to 
                make grants to eligible entities; and
                    ``(B) not more than 35 percent of such amount to 
                make grants to eligible individuals.''.

             CHAPTER 14--PREVENTION AND CONTROL OF INJURIES

SEC. 491. PREVENTION AND CONTROL OF INJURIES.

    (a) In General.--Section 394A of the Public Health Service Act (42 
U.S.C. 280b-3) is amended--
            (1) by striking ``and'' after ``1994,'';
            (2) by striking ``and'' after ``1998,''; and
            (3) by striking ``through 2005'' and all that follows and 
        inserting the following: ``through 2004, $300,000,000 for 
        fiscal year 2005, and such sums as may be necessary for each of 
        the fiscal years 2006 through 2010.''.
    (b) Demonstration Projects in Urban Areas.--Section 394A of the 
Public Health Service Act (42 U.S.C. 280b-3) is amended by adding at 
the end the following sentence: ``For the purpose of carrying out 
section 393(a)(6) in urban areas, there are authorized to be 
appropriated such sums as may be necessary for each of the fiscal years 
2005 through 2010, in addition to amounts available for such purpose 
pursuant to the preceding sentence.''.
    (c) Demonstration Projects Regarding Violence.--Section 393 of the 
Public Health Service Act (42 U.S.C. 280b-1a) is amended--
            (1) by redesignating subsection (b) as subsection (c); and
            (2) by inserting after subsection (a) the following 
        subsection:
    ``(b) Grants under subsection (a)(6) shall include grants to public 
or nonprofit private trauma centers for demonstration projects to 
reduce violence.''.

           CHAPTER 15--UTERINE FIBROID RESEARCH AND EDUCATION

SEC. 495. RESEARCH WITH RESPECT TO UTERINE FIBROIDS.

    (a) In General.--The Director of the National Institutes of Health 
(in this section referred to as the ``Director of NIH'') shall expand, 
intensify, and coordinate programs for the conduct and support of 
research with respect to uterine fibroids.
    (b) Administration.--
            (1) In general.--The Director of NIH shall carry out this 
        section through the appropriate institutes, offices, and 
        centers, including the National Institute of Child Health and 
        Human Development, the National Institute of Environmental 
        Health Sciences, the Office of Research on Women's Health, the 
        National Center on Minority Health and Health Disparities, and 
        any other agencies that the Director of NIH determines to be 
        appropriate.
            (2) Coordination of activities.--The Office of Research on 
        Women's Health shall coordinate activities under paragraph (1) 
        among the institutes, offices, and centers of the National 
        Institutes of Health.
    (c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2005 through 2010.

SEC. 496. INFORMATION AND EDUCATION WITH RESPECT TO UTERINE FIBROIDS.

    (a) Uterine Fibroids Public Education Program.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary''), acting 
        through the Director of the Centers for Disease Control and 
        Prevention, shall develop and disseminate to the public 
        information regarding uterine fibroids, including information 
        on--
                    (A) the incidence and prevalence of uterine 
                fibroids;
                    (B) the elevated risk for minority women; and
                    (C) the availability, as medically appropriate, of 
                a range of treatment options for symptomatic uterine 
                fibroids.
            (2) Dissemination.--The Secretary may disseminate 
        information under paragraph (1) directly, or through 
        arrangements with nonprofit organizations, consumer groups, 
        institutions of higher education (as defined in section 101 of 
        the Higher Education Act of 1965 (20 U.S.C. 1001)), Federal, 
        State, or local agencies, or the media.
            (3) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2005 through 2010.
    (b) Uterine Fibroids Information Program for Health Care 
Providers.--
            (1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, shall develop and disseminate to health care 
        providers information on uterine fibroids, including 
        information on the elevated risk for minority women and the 
        range of available options for the treatment of symptomatic 
        uterine fibroids.
            (2) Authorization of appropriations.--For the purpose of 
        carrying out this subsection, there are authorized to be 
        appropriated such sums as may be necessary for each of the 
        fiscal years 2005 through 2010.
    (c) Definition.--For purposes of this section, the term 
``minority'', with respect to women, means women who are members of 
racial or ethnic minority groups within the meaning of section 1707 of 
the Public Health Service Act (42 U.S.C. 300u-6).

                TITLE V--DATA COLLECTION AND REPORTING.

                     Subtitle A--General Provisions

SEC. 501. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    (a) Purpose.--It is the purpose of this section to promote data 
collection, analysis, and reporting by race, ethnicity, and primary 
language among federally supported health programs.
    (b) Amendment.--Title XXIX of the Public Health Service Act, as 
amended by section 463, is further amended by adding at the end the 
following:

              ``Subtitle E--Data Collection and Reporting

``SEC. 2951. DATA ON RACE, ETHNICITY AND PRIMARY LANGUAGE.

    ``(a) Requirements.--
            ``(1) In general.--Each health-related program operated by 
        or that receives funding or reimbursement, in whole or in part, 
        either directly or indirectly from the Department of Health and 
        Human Services shall--
                    ``(A) require the collection, by the agency or 
                program involved, of data on the race, ethnicity, and 
                primary language of each applicant for and recipient of 
health-related assistance under such program--
                            ``(i) using, at a minimum, the categories 
                        for race and ethnicity described in the 1997 
                        Office of Management and Budget Standards for 
                        Maintaining, Collecting, and Presenting Federal 
                        Data on Race and Ethnicity;
                            ``(ii) using the standards developed under 
                        subsection (e) for the collection of language 
                        data;
                            ``(iii) where practicable, collecting data 
                        for additional population groups if such groups 
                        can be aggregated into the minimum race and 
                        ethnicity categories; and
                            ``(iv) where practicable, through self-
                        report;
                    ``(B) with respect to the collection of the data 
                described in subparagraph (A) for applicants and 
                recipients who are minors or otherwise legally 
                incapacitated, require that--
                            ``(i) such data be collected from the 
                        parent or legal guardian of such an applicant 
                        or recipient; and
                            ``(ii) the preferred language of the parent 
                        or legal guardian of such an applicant or 
                        recipient be collected;
                    ``(C) systematically analyze such data using the 
                smallest appropriate units of analysis feasible to 
                detect racial and ethnic disparities in health and 
                healthcare and when appropriate, for men and women 
                separately, and report the results of such analysis to 
                the Secretary, the Director of the Office for Civil 
                Rights, the Committee on Health, Education, Labor, and 
                Pensions and the Committee on Finance of the Senate, 
                and the Committee on Energy and Commerce and the 
                Committee on Ways and Means of the House of 
                Representatives;
                    ``(D) provide such data to the Secretary on at 
                least an annual basis; and
                    ``(E) ensure that the provision of assistance to an 
                applicant or recipient of assistance is not denied or 
                otherwise adversely affected because of the failure of 
                the applicant or recipient to provide race, ethnicity, 
                and primary language data.
            ``(2) Rules of construction.--Nothing in this subsection 
        shall be construed to--
                    ``(A) permit the use of information collected under 
                this subsection in a manner that would adversely affect 
                any individual providing any such information; and
                    ``(B) require health care providers to collect 
                data.
    ``(b) Protection of Data.--The Secretary shall ensure (through the 
promulgation of regulations or otherwise) that all data collected 
pursuant to subsection (a) is protected--
            ``(1) under the same privacy protections as the Secretary 
        applies to other health data under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) 
        relating to the privacy of individually identifiable health 
        information and other protections; and
            ``(2) from all inappropriate internal use by any entity 
        that collects, stores, or receives the data, including use of 
        such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from other inappropriate 
        uses, as defined by the Secretary.
    ``(c) National Plan of the Data Council.--The Secretary shall 
develop and implement a national plan to improve the collection, 
analysis, and reporting of racial, ethnic, and primary language data at 
the Federal, State, territorial, Tribal, and local levels, including 
data to be collected under subsection (a). The Data Council of the 
Department of Health and Human Services, in consultation with the 
National Committee on Vital Health Statistics, the Office of Minority 
Health, and other appropriate public and private entities, shall make 
recommendations to the Secretary concerning the development, 
implementation, and revision of the national plan. Such plan shall 
include recommendations on how to--
            ``(1) implement subsection (a) while minimizing the cost 
        and administrative burdens of data collection and reporting;
            ``(2) expand awareness among Federal agencies, States, 
        territories, Indian tribes, health providers, health plans, 
        health insurance issuers, and the general public that data 
        collection, analysis, and reporting by race, ethnicity, and 
        primary language is legal and necessary to assure equity and 
        non-discrimination in the quality of healthcare services;
            ``(3) ensure that future patient record systems have data 
        code sets for racial, ethnic, and primary language identifiers 
        and that such identifiers can be retrieved from clinical 
        records, including records transmitted electronically;
            ``(4) improve health and healthcare data collection and 
        analysis for more population groups if such groups can be 
        aggregated into the minimum race and ethnicity categories, 
        including exploring the feasibility of enhancing collection 
        efforts in States for racial and ethnic groups that comprise a 
        significant proportion of the population of the State;
            ``(5) provide researchers with greater access to racial, 
        ethnic, and primary language data, subject to privacy and 
        confidentiality regulations; and
            ``(6) safeguard and prevent the misuse of data collected 
        under subsection (a).
    ``(d) Compliance With Standards.--Data collected under subsection 
(a) shall be obtained, maintained, and presented (including for 
reporting purposes) in accordance with the 1997 Office of Management 
and Budget Standards for Maintaining, Collecting, and Presenting 
Federal Data on Race and Ethnicity (at a minimum).
    ``(e) Language Collection Standards.--Not later than 1 year after 
the date of enactment of this title, the Director of the Office of 
Minority Health, in consultation with the Office for Civil Rights of 
the Department of Health and Human Services, shall develop and 
disseminate Standards for the Classification of Federal Data on 
Preferred Written and Spoken Language.
    ``(f) Technical Assistance for the Collection and Reporting of 
Data.--
            ``(1) In general.--The Secretary may, either directly or 
        through grant or contract, provide technical assistance to 
        enable a healthcare program or an entity operating under such 
        program to comply with the requirements of this section.
            ``(2) Types of assistance.--Assistance provided under this 
        subsection may include assistance to--
                    ``(A) enhance or upgrade computer technology that 
                will facilitate racial, ethnic, and primary language 
                data collection and analysis;
                    ``(B) improve methods for health data collection 
                and analysis including additional population groups 
                beyond the Office of Management and Budget categories 
                if such groups can be aggregated into the minimum race 
                and ethnicity categories;
                    ``(C) develop mechanisms for submitting collected 
                data subject to existing privacy and confidentiality 
                regulations; and
                    ``(D) develop educational programs to inform health 
                insurance issuers, health plans, health providers, 
                health-related agencies, and the general public that 
                data collection and reporting by race, ethnicity, and 
                preferred language are legal and essential for 
                eliminating health and healthcare disparities.
    ``(g) Analysis of Racial and Ethnic Data.--The Secretary, acting 
through the Director of the Agency for Healthcare Research and Quality 
and in coordination with the Administrator of the Centers for Medicare 
and Medicaid Services, shall provide technical assistance to agencies 
of the Department of Health and Human Services in meeting Federal 
standards for race, ethnicity, and primary language data collection and 
analysis of racial and ethnic disparities in health and healthcare in 
public programs by--
            ``(1) identifying appropriate quality assurance mechanisms 
        to monitor for health disparities;
            ``(2) specifying the clinical, diagnostic, or therapeutic 
        measures which should be monitored;
            ``(3) developing new quality measures relating to racial 
        and ethnic disparities in health and healthcare;
            ``(4) identifying the level at which data analysis should 
        be conducted; and
            ``(5) sharing data with external organizations for research 
        and quality improvement purposes.
    ``(h) National Conference.--
            ``(1) In general.--The Secretary shall sponsor a biennial 
        national conference on racial, ethnic, and primary language 
        data collection to enhance coordination, build partnerships, 
        and share best practices in racial, ethnic, and primary 
        language data collection, analysis, and reporting.
            ``(2) Reports.--Not later than 6 months after the date on 
        which a national conference has convened under paragraph (1), 
        the Secretary shall publish in the Federal Register and submit 
        to the Committee on Health, Education, Labor, and Pensions and 
        the Committee on Finance of the Senate and the Committee on 
        Energy and Commerce and the Committee on Ways and Means of the 
        House of Representatives a report concerning the proceedings 
        and findings of the conference.
    ``(i) Report.--Not later than 2 years after the date of enactment 
of this title, and biennially thereafter, the Secretary shall submit to 
the appropriate committees of Congress a report on the effectiveness of 
data collection, analysis, and reporting on race, ethnicity, and 
primary language under the programs and activities of the Department of 
Health and Human Services and under other Federal data collection 
systems with which the Department interacts to collect relevant data on 
race and ethnicity. The report shall evaluate the progress made in the 
Department with respect to the national plan under subsection (c) or 
subsequent revisions thereto.
    ``(j) Grants for Data Collection by Health Plans, Health Centers, 
and Hospitals.--
            ``(1) In general.--The Secretary, in consultation with the 
        Administrator of the Centers for Medicare and Medicaid 
        Services, is authorized to award grants for the conduct of 20 
        demonstration programs by health plans, health centers, or 
        hospitals to enhance their ability to collect, analyze, and 
        report the data required under subsection (a).
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1), a health plan or hospital shall--
                    ``(A) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require, including a plan to eliminate racial, ethnic, 
                and primary language disparities in health and 
                healthcare through one or more of the activities 
                described in paragraph (3); and
                    ``(B) provide assurances that the health plan or 
                hospital will use, at a minimum, the racial and ethnic 
                categories and the standards for collection described 
                in the 1997 Office of Management and Budget Standards 
                for Maintaining, Collecting, and Presenting Federal 
                Data on Race and Ethnicity and available standards for 
                language.
            ``(3) Activities.--A grantee shall use amounts received 
        under a grant under paragraph (1) to--
                    ``(A) collect, analyze, and report data by race, 
                ethnicity, and primary language for patients served by 
                the hospital (including emergency room patients and 
                patients served on an outpatient basis) or health 
                center, or, in the case of a private health plan, such 
                data for enrollees;
                    ``(B) enhance or upgrade computer technology that 
                will facilitate racial, ethnic, and primary language 
                data collection and analysis;
                    ``(C) provide analyses of racial and ethnic 
                disparities in health and healthcare, including 
                specific disease conditions, diagnostic and therapeutic 
                procedures, or outcomes;
                    ``(D) improve health data collection and analysis 
                for additional population groups beyond the Office of 
                Management and Budget categories if such groups can be 
                aggregated into the minimum race and ethnicity 
                categories;
                    ``(E) develop mechanisms for sharing collected data 
                subject to privacy and confidentiality regulations;
                    ``(F) develop educational programs to inform health 
                insurance issuers, health plans, health providers, 
                health-related agencies, patients, enrollees, and the 
                general public that data collection, analysis, and 
                reporting by race, ethnicity, and preferred language 
                are legal and essential for eliminating disparities in 
                health and healthcare; and
                    ``(G) develop quality assurance systems designed to 
                track disparities and quality improvement systems 
                designed to eliminate disparities.
    ``(l) Definition.--In this section, the term `health-related 
program' mean a program--
            ``(1) under the Social Security Act (42 U.S.C. 301 et seq.) 
        that pay for healthcare and services; and
            ``(2) under this Act that provide Federal financial 
        assistance for healthcare, biomedical research, health services 
        research, and programs designed to improve the public's health.
    ``(m) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2952. PROVISIONS RELATING TO NATIVE AMERICANS.

    ``(a) Epidemiology Centers.--
            ``(1) Establishment.--
                    ``(A) In general.--In addition to those centers 
                operating 1 day prior to the date of enactment of this 
                title, (including those centers for which funding is 
                currently being provided through funding agreements 
                under the Indian Self-Determination and Education 
                Assistance Act), the Secretary shall, not later than 
                180 days after such date of enactment, establish and 
                fund an epidemiology center in each service area which 
                does not have such a center to carry out the functions 
                described in subparagraph (B). Any centers established 
under the preceding sentence may be operated by Indian tribes or tribal 
organizations pursuant to funding agreements under the Indian Self-
Determination and Education Assistance Act, but funding under such 
agreements may not be divisible.
                    ``(B) Functions.--In consultation with and upon the 
                request of Indian tribes, tribal organizations and 
                urban Indian organizations, each area epidemiology 
                center established under this subsection shall, with 
                respect to such area shall--
                            ``(i) collect data related to the health 
                        status objective described in section 3(b) of 
                        the Indian Health Care Improvement Act, and 
                        monitor the progress that the Service, Indian 
                        tribes, tribal organizations, and urban Indian 
                        organizations have made in meeting such health 
                        status objective;
                            ``(ii) evaluate existing delivery systems, 
                        data systems, and other systems that impact the 
                        improvement of Indian health;
                            ``(iii) assist Indian tribes, tribal 
                        organizations, and urban Indian organizations 
                        in identifying their highest priority health 
                        status objectives and the services needed to 
                        achieve such objectives, based on 
                        epidemiological data;
                            ``(iv) make recommendations for the 
                        targeting of services needed by tribal, urban, 
                        and other Indian communities;
                            ``(v) make recommendations to improve 
                        healthcare delivery systems for Indians and 
                        urban Indians;
                            ``(vi) provide requested technical 
                        assistance to Indian tribes and urban Indian 
                        organizations in the development of local 
                        health service priorities and incidence and 
                        prevalence rates of disease and other illness 
                        in the community; and
                            ``(vii) provide disease surveillance and 
                        assist Indian tribes, tribal organizations, and 
                        urban Indian organizations to promote public 
                        health.
                    ``(C) Technical assistance.--The director of the 
                Centers for Disease Control and Prevention shall 
                provide technical assistance to the centers in carrying 
                out the requirements of this subsection.
            ``(2) Funding.--The Secretary may make funding available to 
        Indian tribes, tribal organizations, and eligible intertribal 
        consortia or urban Indian organizations to conduct 
        epidemiological studies of Indian communities.
    ``(b) Definitions.--For purposes of this section, the definitions 
contained in section 4 of the Indian Health Care Improvement Act shall 
apply.''.

SEC. 502. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL SECURITY 
              ADMINISTRATION.

    Part A of title XI of the Social Security Act (42 U.S.C. 1301 et 
seq.) is amended by adding at the end the following:

``SEC. 1150A. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL 
              SECURITY ADMINISTRATION.

    ``(a) Requirement.--The Commissioner of the Social Security 
Administration in consultation with the Administrator of the Centers 
for Medicare and Medicaid Services shall--
            ``(1) require the collection of data on the race, 
        ethnicity, and primary language of all applicants for social 
        security numbers, social security income, social security 
        disability, and medicare--
                    ``(A) using, at a minimum, the categories for race 
                and ethnicity described in the 1997 Office of 
                Management and Budget Standards for Maintaining, 
                Collecting, and Presenting Federal Data on Race and 
                Ethnicity and available language standards; and
                    ``(B) where practicable, collecting data for 
                additional population groups if such groups can be 
                aggregated into the minimum race and ethnicity 
                categories;
            ``(2) with respect to the collection of the data described 
        in paragraph (1) for applicants who are under 18 years of age 
        or otherwise legally incapacitated, require that--
                    ``(A) such data be collected from the parent or 
                legal guardian of such an applicant; and
                    ``(B) the primary language of the parent or legal 
                guardian of such an applicant or recipient be used;
            ``(3) require that such data be uniformly analyzed and 
        reported at least annually to the Commissioner of Social 
        Security;
            ``(4) be responsible for storing the data reported under 
        paragraph (3);
            ``(5) ensure transmission to the Centers for Medicare and 
        Medicaid Services and other Federal health agencies;
            ``(6) provide such data to the Secretary on at least an 
        annual basis; and
            ``(7) ensure that the provision of assistance to an 
        applicant is not denied or otherwise adversely affected because 
        of the failure of the applicant to provide race, ethnicity, and 
        primary language data.
    ``(b) Protection of Data.--The Commissioner of Social Security 
shall ensure (through the promulgation of regulations or otherwise) 
that all data collected pursuant subsection (a) is protected--
            ``(1) under the same privacy protections as the Secretary 
        applies to other health data under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) 
        relating to the privacy of individually identifiable health 
        information and other protections; and
            ``(2) from all inappropriate internal use by any entity 
        that collects, stores, or receives the data, including use of 
        such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from other inappropriate 
        uses, as defined by the Secretary.
    ``(c) National Education Program.--Not later than 18 months after 
the date of enactment of this section, the Secretary, acting through 
the Director of the Office of Minority Health and in collaboration with 
the Commissioner of the Social Security Administration, shall develop 
and implement a program to educate all populations about the purpose 
and uses of racial, ethnic, and primary language health data 
collection.
    ``(d) Rule of Construction.--Nothing in this section shall be 
construed to permit the use of information collected under this section 
in a manner that would adversely affect any individual providing any 
such information.
    ``(e) Technical Assistance.--The Secretary may, either directly or 
by grant or contract, provide technical assistance to enable any health 
entity to comply with the requirements of this section.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

SEC. 503. REVISION OF HIPAA CLAIMS STANDARDS.

    (a) In General.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services shall revise 
the regulations promulgated under part C of title XI of the Social 
Security Act (42 U.S.C. 1320d et seq.), as added by the Health 
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191), relating to the collection of data on race, ethnicity, and 
primary language in a health-related transaction to require--
            (1) the use, at a minimum, of the categories for race and 
        ethnicity described in the 1997 Office of Management and Budget 
        Standards for Maintaining, Collecting, and Presenting Federal 
        Data on Race and Ethnicity;
            (2) the establishment of a new data code set for primary 
        language; and
            (3) the designation of the racial, ethnic, and primary 
        language code sets as ``required'' for claims and enrollment 
        data.
    (b) Dissemination.--The Secretary of Health and Human Services 
shall disseminate the new standards developed under subsection (a) to 
all health entities that are subject to the regulations described in 
such subsection and provide technical assistance with respect to the 
collection of the data involved.
    (c) Compliance.--The Secretary of Health and Human Services shall 
require that health entities comply with the new standards developed 
under subsection (a) not later than 2 years after the final 
promulgation of such standards.

SEC. 504. NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n)) 
is amended--
            (1) in paragraph (1), by striking ``2003'' and inserting 
        ``2010'';
            (2) in paragraph (2), in the first sentence, by striking 
        ``2003'' and inserting ``2010''; and
            (3) in paragraph (3), by striking ``2002'' and inserting 
        ``2010''.

          Subtitle B--Minority Health and Genomics Commission

SEC. 511. SHORT TITLE.

    This subtitle may be cited as the ``Minority Health and Genomics 
Act of 2003''.

SEC. 512. MINORITY HEALTH AND GENOMICS COMMISSION.

    (a) Establishment.--There is established a commission to be known 
as the Minority Health and Genomics Commission (in this subtitle 
referred to as the ``Commission'').
    (b) Duties.--
            (1) Study.--The Commission shall conduct a thorough study 
        of, and develop recommendations on, issues relating to genomic 
        research as applied to minority groups and, under section 516, 
        submit a report to the appropriate committees of Congress that 
        recommends policies that the Commission finds will ultimately 
        improve healthcare and promote the elimination of health 
        disparities.
            (2) Issues.--The study under paragraph (1) shall address 
        specific issues and the needs of each minority group described 
        in subparagraph (A) in addition to issues involving genomic 
        research that affect the groups as a whole. In conducting such 
        study the Commission shall carry out the following:
                    (A) Establish standards in genomic research and 
                services that will promote the improvement of health 
                and health-related services for the following groups: 
                American Indians and Alaska Natives, African Americans, 
                Asian Americans, Hispanics, and Native Hawaiians and 
                other Pacific Islanders.
                    (B) Recommend minimum requirements and standards 
                for the equitable use of genetics research in patient 
                care and public health services for racial and ethnic 
                minority patients.
                    (C) Examine the accessibility, effectiveness, 
                availability, and cost efficiency of genomic research, 
                genetic testing, genetic counseling, and genetic 
                screening to minority populations.
                    (D) Determine and recommend procedures and policies 
                to address the need for cultural, linguistic, and 
                religious sensitivity training for genetic counselors 
                and researchers who work with minority groups.
                    (E) Evaluate whether minority persons are provided 
                with informed consent that is culturally and 
                linguistically appropriate to allow a fully informed 
                decision about their healthcare, availability of 
                treatments or options, or participation in any clinical 
                trial involving the collection of genetic material.
                    (F) Recommend how population sampling studies of 
                genetic information can be improved to aid in the 
                elimination of health disparities and improve 
                healthcare for minority communities.
                    (G) Examine how genetic material or information 
                derived from individual minorities is used the help 
                minority groups with the use of highly specific drug 
                therapies.
                    (H) Identify the accessibility, effectiveness, 
                availability, privacy, and benefit of genetic databases 
                and depositories to minority communities.
                    (I) Identify the accessibility, effectiveness, and 
                affordability of reproductive technologies to minority 
                groups.
                    (J) Recommend an incentives program for genomic 
                researchers that will encourage the study of disease 
                and genetic ailments that disproportionately affect 
                minority communities.

SEC. 513. REPORT.

    Not later than 2 years after the date of the enactment of this Act, 
the Commission shall prepare and submit to the appropriate committees 
of Congress, the President, and the general public a report containing 
a detailed statement of the findings and conclusions of the Commission 
with respect to matters described in section 512(b)(2), together with 
such recommendations as the Commission considers appropriate that may 
be specific to each minority group.

SEC. 514. MEMBERSHIP.

    (a) Number and Appointment.--The Commission shall be composed of 17 
members to be appointed as follows:
            (1) Four members shall be appointed by the Speaker of the 
        House of Representatives.
            (2) Four members shall be appointed by the minority leader 
        of the House of Representatives.
            (3) Four members shall be appointed by the majority leader 
        of the Senate.
            (4) Four members shall be appointed by the minority leader 
        of the Senate.
            (5) One member shall be appointed by the President.
    (b) Persons Eligible.--
            (1) In general.--The members of the Commission shall be 
        individuals who have knowledge or expertise, whether by 
        experience or training, in matters to be studied by the 
        Commission. The members may be from the public or private 
        sector, and may include employees of the Federal Government or 
        of State, territory, tribal, or local governments, members of 
        academia, legal scholars and practitioners, tribal leaders, 
        representatives of nonprofit organizations, or other interested 
        individuals who demonstrate a dedication to the use of genomics 
        to improve minority healthcare and the elimination of health 
        disparities among minorities.
            (2) Diversity.--It is the intent of Congress that 
        individuals appointed to the Commission represent diverse 
        interests, ethnicities, various professional backgrounds, and 
        are from different regions of the United States.
    (c) Consultation and Appointment.--
            (1) In general.--The President, Speaker of the House of 
        Representatives, minority leader of the House of 
        Representatives, majority leader of the Senate, and minority 
        leader of the Senate shall consult among themselves before 
        appointing the members of the Commission in order to achieve, 
        to the maximum extent practicable, fair and equitable 
        representation of various points of view with respect to 
        matters studied by the Commission.
            (2) Date of appointment.--The appointments of the members 
        of the Commission shall be made not later than 90 days after 
        the date of enactment of this Act.
    (d) Terms.--
            (1) In general.--Each member of the Commission shall be 
        appointed for the life of the Commission.
            (2) Vacancies.--A vacancy in the Commission shall be filled 
        in the manner in which the original appointment was made.
    (e) Basic Pay.--Members of the Commission shall serve without pay.
    (f) Travel Expenses.--Each member of the Commission shall receive 
travel expenses, including per diem in lieu of subsistence, in 
accordance with applicable provisions under subchapter I of chapter 57 
of title 5, United States Code.
    (g) Chairperson and Vice Chairperson.--The members of the 
Commission shall elect a Chairperson and Vice Chairperson of the 
Commission from among the members.
    (h) Meetings.--
            (1) In general.--The Commission shall meet at the call of 
        the Chairperson or a majority of its members.
            (2) Initial meeting.--Not later than 30 days after the date 
        on which all members of the Commission have been appointed, the 
        Commission shall hold its first meeting.

SEC. 515. POWERS OF COMMISSION.

    (a) Hearings and Sessions.--The Commission may, for the purpose of 
carrying out this subtitle, hold hearings, sit and act at times and 
places, take testimony, and receive evidence as the Commission 
considers appropriate to carry out this subtitle.
    (b) Powers of Members and Agents.--Any member or agent of the 
Commission may, if authorized by the Commission, take any action that 
the Commission is authorized to take by this section.
    (c) Obtaining Official Data.--Notwithstanding sections 552 and 552a 
of title 5, United States Code, the Commission may secure directly from 
any department or agency of the United States information necessary to 
enable it to carry out this subtitle. Upon request of the Commission, 
the head of that department or agency shall furnish that information to 
the Commission.
    (d) Postal Services.--The Commission may use the United States 
mails in the same manner and under the same conditions as other 
departments and agencies of the United States.
    (e) Website.--For purposes of conducting the study under section 
512(b)(1), the Commission shall establish and maintain a website to 
facilitate public comment and participation.
    (f) Staff of Federal Agencies.--Upon request of the Commission, the 
head of any Federal department or agency may detail, on a 
nonreimbursable basis, any of the personnel of that department or 
agency to the Commission to assist it in carrying out its duties under 
this subtitle.
    (g) Administrative Support Services.--Upon the request of the 
Commission, the Administrator of General Services may provide to the 
Commission, on a nonreimbursable basis, the administrative support 
services necessary for the Commission to carry out its responsibilities 
under this subtitle.

SEC. 516. TERMINATION.

    The Commission shall terminate 1 year after submitting its final 
report pursuant to section 513.

                        TITLE VI--ACCOUNTABILITY

SEC. 601. REPORT ON WORKFORCE DIVERSITY.

    (a) In General.--Not later than July 1, 2005, and annually 
thereafter, the Secretary, acting through the director of each entity 
within the Department of Health and Human Services, shall 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 healthcare workforce diversity.
    (b) Requirement.--The report under subsection (a) shall contain the 
following information:
            (1) The response of the entity involved to the upcoming 
        2004 Institute of Medicine report on workforce diversity, the 
        2002 Institute of Medicine report entitled The Future of the 
        Public Health in the 21st Century, and the Healthy People 2010 
        initiative.
            (2) A description of the personnel in each such entity who 
        are responsible for overseeing workforce diversity initiatives.
            (3) The level of workforce diversity achieved within each 
        such entity, including absolute numbers and percentages of 
        minority employees as well as the rank of such employees.
            (4) A description of any grant support that is provided by 
        each entity for workforce diversity initiatives, including the 
        amount of the grants and the percentage of grant funds as 
        compared to overall entity funding;
    (c) Public Availability.--The report under subsection (a) shall be 
made available for public review and comment.

SEC. 602. FEDERAL AGENCY PLAN TO ELIMINATE DISPARITIES AND IMPROVE THE 
              HEALTH OF MINORITY POPULATIONS.

    (a) In General.--Not later than September 1, 2005, each Federal 
health agency shall develop and implement a national strategic action 
plan to eliminate disparities on the basis of race, ethnicity, and 
primary language and improve the health and healthcare of minority 
populations, through programs relevant to the mission of the agency.
    (b) Publication.--Each action plan described in paragraph (1) 
shall--
            (1) be publicly reported in draft form for public review 
        and comment;
            (2) include a response to the review and comment described 
        in paragraph (1) in the final plan;
            (3) include the agency response to the 2002 Institute of 
        Medicine report, Unequal Treatment--Confronting Racial and 
        Ethnic Disparities in Healthcare;
            (4) demonstrate progress in meeting the Healthy People 2010 
        objectives; and
            (5) be updated, including progress reports, for inclusion 
        in an annual report to Congress.

SEC. 603. ACCOUNTABILITY WITHIN THE DEPARTMENT OF HEALTH AND HUMAN 
              SERVICES.

    Title XXIX of the Public Health Service Act, as amended by section 
502(b), is further amended by adding at the end the following:

                      ``Subtitle F--Accountability

``SEC. 2961. ELEVATION OF THE OFFICE OF CIVIL RIGHTS.

    ``(a) In General.--The Secretary shall establish within the Office 
for Civil Rights an Office of Health Disparities, which shall be headed 
by a director to be appointed by the Secretary.
    ``(b) Purpose.--The Office of Health Disparities shall ensure that 
the health programs, activities, and operations of health entities 
which receive Federal financial assistance are in compliance with title 
VI of the Civil Rights Act, which prohibits discrimination on the basis 
of race, color, or national origin. The activities of the Office shall 
include the following:
            ``(1) The development and implementation of an action plan 
        to address racial and ethnic healthcare disparities, which 
        shall address concerns relating to the Office for Civil Rights 
        as released by the United States Commission on Civil Rights in 
        the report entitled `Health Care Challenge: Acknowledging 
        Disparity, Confronting Discrimination, and Ensuring Equity' 
        (September, 1999). This plan shall be publicly disclosed for 
        review and comment and the final plan shall address any 
        comments or concerns that are received by the Office.
            ``(2) Investigative and enforcement actions against 
        intentional discrimination and policies and practices that have 
        a disparate impact on minorities.
            ``(3) The review of racial, ethnic, and primary language 
        health data collected by Federal health agencies to assess 
        healthcare disparities related to intentional discrimination 
        and policies and practices that have a disparate impact on 
        minorities.
            ``(4) Outreach and education activities relating to 
        compliance with title VI of the Civil Rights Act.
            ``(5) The provision of technical assistance for health 
        entities to facilitate compliance with title VI of the Civil 
        Rights Act.
            ``(6) Coordination and oversight of activities of the civil 
        rights compliance offices established under section 2962.
            ``(7) Ensuring compliance with the 1997 Office of 
        Management and Budget Standards for Maintaining, Collecting, 
        and Presenting Federal Data on Race, Ethnicity and the 
        available language standards.
    ``(c) Funding and Staff.--The Secretary shall ensure the 
effectiveness of the Office of Health Disparities by ensuring that the 
Office is provided with--
            ``(1) adequate funding to enable the Office to carry out 
        its duties under this section; and
            ``(2) staff with expertise in--
                    ``(A) epidemiology;
                    ``(B) statistics;
                    ``(C) health quality assurance;
                    ``(D) minority health and health disparities; and
                    ``(E) civil rights.
    ``(d) Report.--Not later than December 31, 2005, and annually 
thereafter, the Secretary, in collaboration with the Director of the 
Office for Civil Rights, shall submit a report to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives that includes--
            ``(1) the number of cases filed, broken down by category;
            ``(2) the number of cases investigated and closed by the 
        office;
            ``(3) the outcomes of cases investigated; and
            ``(4) the staffing levels of the office including staff 
        credentials.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2962. ESTABLISHMENT OF HEALTH PROGRAM OFFICES FOR CIVIL RIGHTS 
              WITHIN FEDERAL HEALTH AND HUMAN SERVICES AGENCIES.

    ``(a) In General.--The Secretary shall establish civil rights 
compliance offices in each agency within the Department of Health and 
Human Services that administers health programs.
    ``(b) Purpose of Offices.--Each office established under subsection 
(a) shall ensure that recipients of Federal financial assistance under 
Federal health programs administer their programs, services, and 
activities in a manner that--
            ``(1) does not discriminate, either intentionally or in 
        effect, on the basis of race, national origin, language, 
        ethnicity, sex, age, or disability; and
            ``(2) promotes the reduction and elimination of disparities 
        in health and healthcare based on race, national origin, 
        language, ethnicity, sex, age, and disability.
    ``(c) Powers and Duties.--The offices established in subsection (a) 
shall have the following powers and duties:
            ``(1) The establishment of compliance and program 
        participation standards for recipients of Federal financial 
        assistance under each program administered by an agency within 
        the Department of Health and Human Services including the 
        establishment of disparity reduction standards to encompass 
        disparities in health and healthcare related to race, national 
        origin, language, ethnicity, sex, age, and disability.
            ``(2) The development and implementation of program-
        specific guidelines that interpret and apply Department of 
        Health and Human Services guidance under title VI of the Civil 
        Rights Act of 1964 to each Federal health program administered 
        by the agency.
            ``(3) The development of a disparity-reduction impact 
        analysis methodology that shall be applied to every rule issued 
        by the agency and published as part of the formal rulemaking 
        process under sections 555, 556, and 557 of title 5, United 
        States Code.
            ``(4) Oversight of data collection, analysis, and 
        publication requirements for all recipients of Federal 
        financial assistance under each Federal health program 
        administered by the agency, and compliance with the 1997 Office 
        of Management and Budget Standards for Maintaining, Collecting, 
        and Presenting Federal Data on Race and Ethnicity and the 
        available language standards.
            ``(5) The conduct of publicly available studies regarding 
        discrimination within Federal health programs administered by 
        the agency as well as disparity reduction initiatives by 
        recipients of Federal financial assistance under Federal health 
        programs.
            ``(6) Annual reports to the Committee on Health, Education, 
        Labor, and Pensions and the Committee on Finance of the Senate 
        and the Committee on Energy and Commerce and the Committee on 
        Ways and Means of the House of Representatives on the progress 
        in reducing disparities in health and healthcare through the 
        Federal programs administered by the agency.
    ``(d) Relationship to Office for Civil Rights in the Department of 
Justice.--
            ``(1) Department of health and human services.--The Office 
        for Civil Rights in the Department of Health and Human Services 
        shall provide standard-setting and compliance review 
        investigation support services to the Civil Rights Compliance 
        Office for each agency.
            ``(2) Department of justice.--The Office for Civil Rights 
        in the Department of Justice shall continue to maintain the 
        power to institute formal proceedings when an agency Office for 
        Civil Rights determines that a recipient of Federal financial 
assistance is not in compliance with the disparity reduction standards 
of the agency.
    ``(e) Definition.--In this section, the term `Federal health 
programs' mean programs--
            ``(1) under the Social Security Act (42 U.S.C. 301 et seq.) 
        that pay for healthcare and services; and
            ``(2) under this Act that provide Federal financial 
        assistance for healthcare, biomedical research, health services 
        research, and programs designed to improve the public's 
        health.''.

SEC. 604. OFFICE OF MINORITY HEALTH.

    Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is 
amended--
            (1) by striking the section heading and inserting the 
        following:

 ``office of minority health and racial, ethnic, and primary language 
                    health disparity elimination'';

            (2) by striking ``Office of Minority Health'' each place 
        that such appears and inserting ``Office of Minority Health and 
        Racial, Ethnic, and Primary Language Health Disparities 
        Elimination'';
            (3) by striking subsection (b) 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 and Racial, Ethnic, and Primary 
Language Health Disparities Elimination (in this section referred to as 
the `Deputy Assistant Secretary'), shall carry out the following:
            ``(1) Establish, implement, monitor, and evaluate short-
        range and long-range goals and objectives and oversee all other 
        activities within the Public Health Service that relate to 
        disease prevention, health promotion, service delivery, and 
        research concerning minority groups. 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) Oversee all activities within the Department of 
        Health and Human Services that relate to reducing or 
        eliminating disparities in health and healthcare in racial and 
        ethnic minority populations, including coordinating--
                    ``(A) the design of programs, support for programs, 
                and the evaluation of programs;
                    ``(B) the monitoring of trends in health and 
                healthcare;
                    ``(C) research efforts;
                    ``(D) the training of health providers; and
                    ``(E) information and education programs and 
                campaigns.
            ``(3) Enter into interagency and intra-agency agreements 
        with other agencies of the Public Health Service.
            ``(4) Ensure that the Federal health agencies and the 
        National Center for Health Statistics collect data on the 
        health status and healthcare of each minority group, using at a 
        minimum the categories specified in the 1997 OMB Standards for 
        Maintaining, Collecting, and Presenting Federal Data on Race 
        and Ethnicity as required under subtitle B and available 
        language standards.
            ``(5) Provide technical assistance to States, local 
        agencies, territories, Indian tribes, and entities for 
        activities relating to the elimination of racial and ethnic 
        disparities in health and healthcare.
            ``(6) Support a national minority health resource center to 
        carry out the following:
                    ``(A) Facilitate the exchange of information 
                regarding matters relating to health information, 
                health promotion and wellness, preventive health 
                services, and education in the appropriate use of 
                health services.
                    ``(B) Facilitate timely access to culturally and 
                linguistically appropriate information.
                    ``(C) Assist in the analysis of such information.
                    ``(D) Provide technical assistance with respect to 
                the exchange of such information (including 
                facilitating the development of materials for such 
                technical assistance).
            ``(7) Carry out programs to improve access to healthcare 
        services for individuals with limited English proficiency, 
        including developing and carrying out programs to provide 
        bilingual or interpretive services through the development and 
        support of a National Center for Cultural and Linguistic 
        Competence in Healthcare as provided for in section 2903.
            ``(8) Carry out programs to improve access to healthcare 
        services and to improve the quality of healthcare services for 
        individuals with low functional health literacy. As used in the 
        preceding sentence, the term `functional health literacy' means 
        the ability to obtain, process, and understand basic health 
        information and services needed to make appropriate health 
        decisions.
            ``(9) Advise in matters related to the development, 
        implementation, and evaluation of health professions education 
        on decreasing disparities in healthcare outcomes, with focus on 
        cultural competency as a method of eliminating disparities in 
        health and healthcare in racial and ethnic minority 
        populations.
            ``(10) Assist healthcare professionals, community and 
        advocacy organizations, academic centers and public health 
        departments in the design and implementation of programs that 
        will improve the quality of health outcomes by strengthening 
        the provider-patient relationship.''.
            (2) by redesignating subsections (c) through (f) and 
        subsections (g) and (h) as subsections (d) through (g) and 
        subsections (j) and (k), respectively;
            (3) by inserting after subsection (b), the following:
    ``(c) National Plan To Eliminate Racial and Ethnic Health and 
Healthcare Disparities.--
            ``(1) In general.--The Secretary, acting through the Deputy 
        Assistant Secretary, shall--
                    ``(A) not later than 1 year after the date of 
                enactment of the Healthcare Equality and Accountability 
                Act, establish and implement a comprehensive plan to 
                achieve the goal of Healthy People 2010 to eliminate 
                health disparities in the United States;
                    ``(B) establish the plan referred to in 
                subparagraph (A) in consultation with--
                            ``(i) the Director of the Centers for 
                        Disease Control and Prevention;
                            ``(ii) the Director of the National 
                        Institutes of Health;
                            ``(iii) the Director of the National Center 
                        on Minority Health and Health Disparities;
                            ``(iv) the Director of the Agency for 
                        Healthcare Research and Quality;
                            ``(v) the Administrator of the Health 
                        Resources and Services Administration;
                            ``(vi) the Administrator of the Centers for 
                        Medicare and Medicaid Services;
                            ``(vii) the Director of the Office for 
                        Civil Rights;
                            ``(viii) the Administrator of the Substance 
                        Abuse and Mental Health Services 
                        Administration;
                            ``(ix) the Commissioner of the Food and 
                        Drug Administration; and
                            ``(x) the heads of other appropriate public 
                        and private entities;
                    ``(C) ensure that the plan includes measurable 
                objectives, describes the means for achieving such 
                objectives, and designates a date by which such 
                objectives are expected to be achieved;
                    ``(D) ensure that all amounts appropriated for such 
                activities are expended in accordance with the plan;
                    ``(E) review the plan on at least an annual basis 
                and revise the plan as appropriate;
                    ``(F) ensure that the plan will serve as a binding 
                statement of policy with respect to the agencies' 
                activities related to disparities in health and 
                healthcare; and
                    ``(G) not later than March 1 of each year, submit 
                the plan (or any revisions to the plan), to the 
                Committee on Health, Education, Labor, and Pensions of 
                the Senate and the Committee on Energy and Commerce of 
                the House of Representatives.
            ``(2) Components of the plan.--The Deputy Assistant 
        Secretary shall ensure that the comprehensive plan established 
        under paragraph (1) addresses--
                    ``(A) the recommendations of the 2002 Institute of 
                Medicine report (Unequal Treatment) with respect to 
                racial and ethnic disparities in healthcare;
                    ``(B) health and disease prevention education for 
                racial, ethnic, and primary language health disparity 
                populations;
                    ``(C) research to identify sources of health and 
                healthcare disparities in minority groups;
                    ``(D) the implementation and assessment of 
                promising intervention strategies;
                    ``(E) data collection and the monitoring of the 
                healthcare and health status of health disparity 
                populations;
                    ``(F) care of individuals who lack proficiency with 
                the English language;
                    ``(G) care of individuals with low functional 
                health literacy;
                    ``(H) the training, recruitment, and retention of 
                minority health professionals;
                    ``(I) programs to expand and facilitate access to 
                healthcare services, including the use of telemedicine, 
                National Health Service Scholars, community health 
                workers, and case managers;
                    ``(J) public and health provider awareness of 
                racial and ethnic disparities in healthcare;
                    ``(K) methods to evaluate and measure progress 
                toward the goal of eliminating disparities in health 
                and healthcare in racial and ethnic minority 
                populations;
                    ``(L) the promotion of interagency and intra-agency 
                coordination and collaboration and public-private and 
                community partnerships; and
                    ``(M) the preparedness of health professionals to 
                care for racially, ethnically, and linguistically 
                diverse populations and low functional health literacy 
                populations including evaluations as required under 
                section 606 of the Healthcare Equality and 
                Accountability Act.'';
            (4) in subsection (d) (as so redesignated)--
                    (A) in paragraph (1), by inserting ``and Racial, 
                Ethnic, and Primary Language Health Disparities 
                Elimination'' after ``Minority Health''; and
                    (B) in paragraph (2)--
                            (i) by striking ``Deputy Assistant''; and
                            (ii) by striking ``(10) of subsection (b)'' 
                        and inserting ``(9) of subsection (c)'';
            (5) in subsection (e)(1) (as so redesignated)--
                    (A) in subparagraph (A), by striking ``subsection 
                (b)(9)'' and inserting ``subsection (b)(7)''; and
                    (B) in subparagraph (B), by striking ``subsection 
                (b)(10)'' and inserting ``subsection (b)(8)'';
            (6) in subsection (f)(3) (as so redesignated), by striking 
        ``subsection (f)'' and inserting ``subsection (g)'';
            (7) in subsection (g)(1) (as so redesignated)--
                    (A) by striking ``1999 and each second'' and 
                inserting ``2004 and each'';
                    (B) by striking ``Labor and Human Resources'' and 
                inserting ``Health, Education, Labor, and Pensions'';
                    (C) by striking ``2 fiscal years'' and inserting 
                ``fiscal year''; and
                    (D) by inserting after ``improving the health of 
                racial and ethnic minority groups'' the following: 
                ``reducing and eliminating disparities in health and 
                healthcare in racial and ethnic minority populations, 
                in accordance with the national plan specified under 
                subsection (c) and the goals of Healthy People 2010'';
            (8) by inserting after subsection (g) (as so redesignated) 
        the following:
    ``(h) Federal Partnership With Accreditation Entities.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Healthcare Equality and Accountability Act, 
        the Secretary, in collaboration with the Director of the Agency 
        for Healthcare Research and Quality, the Administrator of the 
        Centers for Medicare and Medicaid Services, the Director of the 
        Office for Minority Health, and the heads of appropriate State 
        agencies, shall convene a working group with members of 
        accreditation organizations and other quality standard setting 
        organizations to develop guidelines to evaluate and report on 
        the health and healthcare of minority populations served by 
        health centers, health plans, hospitals, and other federally 
        funded health entities.
            ``(2) Report.--Not later than 6 months after the convening 
        of the working group under paragraph (1), the working group 
        shall submit a report to the Secretary at such time, in such 
        manner, and containing such information as the Secretary may 
        require, including guidelines and recommendations on how each 
        accreditation body will work with constituent members to ensure 
        the adoption of such guidelines.
            ``(3) Demonstration projects.--The Secretary, acting 
        through the Administrator of the Centers for Medicare and 
        Medicaid Services, shall award grants for the establishment of 
        demonstration projects to assess the impact of providing 
        financial incentives for the reporting and analysis of the 
        quality of minority healthcare by hospitals, health plans, 
        health centers, and other healthcare entities.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        such sums as may be necessary for each of fiscal years 2005 
        through 2010.
    ``(i) Preparation of Health Professionals To Provide Healthcare to 
Minority Populations.--The Secretary, in collaboration with the 
Director of the Bureau of Health Professions and the Director of the 
Office of Minority Health, shall require that health professional 
schools that receive Federal funds train future health professionals to 
provide culturally and linguistically appropriate healthcare to diverse 
populations.''; and
            (9) by striking subsection (k) (as so redesignated) and 
        inserting the following:
    ``(k) Authorization of Appropriations.--For the purpose of carrying 
out this section (other than subsection (h)), there is authorized to be 
appropriated $100,000,000 for fiscal year 2004, and such sums as may be 
necessary for each of fiscal years 2005 through 2010.''.

SEC. 605. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
              THE PUBLIC HEALTH SERVICE.

    (a) Establishment.--
            (1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, authorities, and 
        functions of the United States to provide healthcare services 
        to Indians and Indian tribes, as are or may be hereafter 
        provided by Federal statute or treaties, there is established 
        within the Public Health Service of the Department of Health 
        and Human Services the Indian Health Service.
            (2) Assistant secretary of indian health.--The Service 
        shall be administered by an Assistant Secretary of Indian 
        Health, who shall be appointed by the President, by and with 
        the advice and consent of the Senate. The Assistant Secretary 
        shall report to the Secretary. Effective with respect to an 
        individual appointed by the President, by and with the advice 
        and consent of the Senate the term of service of the Assistant 
        Secretary shall be 4 years. An Assistant Secretary may serve 
        more than 1 term.
    (b) Agency.--The Service shall be an agency within the Public 
Health Service of the Department, and shall not be an office, 
component, or unit of any other agency of the Department.
    (c) Functions and Duties.--The Secretary shall carry out through 
the Assistant Secretary of the Service--
            (1) all functions which were, on the day before the date of 
        enactment of the Indian Health Care Amendments of 1988, carried 
        out by or under the direction of the individual serving as 
        Director of the Service on such day;
            (2) all functions of the Secretary relating to the 
        maintenance and operation of hospital and health facilities for 
        Indians and the planning for, and provision and utilization of, 
        health services for Indians;
            (3) all health programs under which healthcare is provided 
        to Indians based upon their status as Indians which are 
        administered by the Secretary, including programs under--
                    (A) the Indian Health Care Improvement Act;
                    (B) the Act of November 2, 1921 (25 U.S.C. 13);
                    (C) the Act of August 5, 1954 (42 U.S.C. 2001, et 
                seq.);
                    (D) the Act of August 16, 1957 (42 U.S.C. 2005 et 
                seq.);
                    (E) the Indian Self-Determination Act (25 U.S.C. 
                450f, et seq.); and
                    (F) title XXIX of the Public Health Service Act; 
                and
            (4) all scholarship and loan functions carried out under 
        title I of the Indian Health Care Improvement Act.
    (d) Authority.--
            (1) In general.--The Secretary, acting through the 
        Assistant Secretary, shall have the authority--
                    (A) except to the extent provided for in paragraph 
                (2), to appoint and compensate employees for the 
                Service in accordance with title 5, United States Code;
                    (B) to enter into contracts for the procurement of 
                goods and services to carry out the functions of the 
                Service; and
                    (C) to manage, expend, and obligate all funds 
                appropriated for the Service.
            (2) Personnel actions.--Notwithstanding any other provision 
        of law, the provisions of section 12 of the Act of June 18, 
        1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all 
        personnel actions taken with respect to new positions created 
        within the Service as a result of its establishment under 
        subsection (a).
    (e) Rate of Pay.--
            (1) Positions at level iv.--Section 5315 of title 5, United 
        States Code, is amended by striking the following: ``Assistant 
        Secretaries of Health and Human Services (6).'' and inserting 
        ``Assistant Secretaries of Health and Human Services (7).''.
            (2) Positions at level v.--Section 5316 of such title is 
        amended by striking the following: ``Director, Indian Health 
        Service, Department of Health and Human Services.''.
    (f) Duties of Assistant Secretary for Indian Health.--Section 601 
of the Indian Health Care Improvement Act (25 U.S.C. 1661) is amended 
in subsection (a)--
            (1) by inserting ``(1)'' after ``(a)'';
            (2) in the second sentence of paragraph (1), as so 
        designated, by striking ``a Director,'' and inserting ``the 
        Assistant Secretary for Indian Health,'';
            (3) by striking the third sentence of paragraph (1), as so 
        designated, and all that follows through the end of the 
        subsection (a) of such section and inserting the following: 
        ``The Assistant Secretary for Indian Health shall carry out the 
        duties specified in paragraph (2).''; and
            (4) by adding after paragraph (1) the following:
            ``(2) The Assistant Secretary for Indian Health shall--
                    ``(A) report directly to the secretary concerning 
                all policy and budget-related matters affecting Indian 
                health;
                    ``(B) collaborate with the Assistant Secretary for 
                Health concerning appropriate matters of Indian health 
                that affect the agencies of the Public Health Service;
                    ``(C) advise each Assistant Secretary of the 
                Department of Health and Human Services concerning 
                matters of Indian health with respect to which that 
                Assistant Secretary has authority and responsibility;
                    ``(D) advise the heads of other agencies and 
                programs of the Department of Health and Human Services 
                concerning matters of Indian health with respect to 
                which those heads have authority and responsibility; 
                and
                    ``(E) coordinate the activities of the Department 
                of Health and Human Services concerning matters of 
                Indian health.''.
    (g) Continued Service by Incumbent.--The individual serving in the 
position of Director of the Indian Health Service on the date preceding 
the date of enactment of this Act may serve as Assistant Secretary for 
Indian Health, at the pleasure of the President after the date of 
enactment of this Act.
    (h) Conforming Amendments.--
            (1) Amendments to indian health care improvement act.--The 
        Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is 
        amended--
                    (A) in section 601--
                            (i) in subsection (c), by striking 
                        ``Director of the Indian Health Service'' both 
                        places it appears and inserting ``Assistant 
                        Secretary for Indian Health''; and
                            (ii) in subsection (d), by striking 
                        ``Director of the Indian Health Service'' and 
                        inserting ``Assistant Secretary for Indian 
                        Health''; and
                    (B) in section 816(c)(1), by striking ``Director of 
                the Indian Health Service'' and inserting ``Assistant 
                Secretary for Indian Health''.
            (2) Amendments to other provisions of law.--The following 
        provisions are each amended by striking ``Director of the 
        Indian Health Service'' each place it appears and inserting 
        ``Assistant Secretary for Indian Health'':
                    (A) Section 203(a)(1) of the Rehabilitation Act of 
                1973 (29 U.S.C. 761b(a)(1)).
                    (B) Subsections (b) and (e) of section 518 of the 
                Federal Water Pollution Control Act (33 U.S.C. 1377 (b) 
                and (e)).
                    (C) Section 803B(d)(1) of the Native American 
                Programs Act of 1974 (42 U.S.C. 2991b-2(d)(1)).
    (i) References.--Reference in any other Federal law, Executive 
order, rule, regulation, or delegation of authority, or any document of 
or relating to the Director of the Indian Health Service shall be 
deemed to refer to the Assistant Secretary for Indian Health.
    (j) Definitions.--For purposes of this section, the definitions 
contained in section 4 of the Indian Health Care Improvement Act shall 
apply.

SEC. 606. OFFICE OF MINORITY HEALTH AT THE CENTERS FOR MEDICARE AND 
              MEDICAID SERVICES.

    (a) In General.--Not later than 60 days after the date of enactment 
of this Act, the Secretary of Health and Human Services shall establish 
within the Centers for Medicare and Medicaid Services an Office of 
Minority Health (referred to in this section as the ``Office'').
    (b) Duties.--The Office shall be responsible for the coordination 
and facilitation of activities of the Centers for Medicare and Medicaid 
Services to improve minority health and healthcare and to reduce racial 
and ethnic disparities in health and healthcare, which shall include--
            (1) creating a strategic plan, which shall be made 
        available for public review, to improve the health and 
        healthcare of Medicare, Medicaid, and SCHIP beneficiaries;
            (2) promoting agency-wide policies relating to healthcare 
        delivery and financing that could have a beneficial impact on 
        the health and healthcare of minority populations;
            (3) assisting health plans, hospitals, and other health 
        entities in providing culturally and linguistically appropriate 
        healthcare services;
            (4) increasing awareness and outreach activities for 
        minority healthcare consumers and providers about the causes 
        and remedies for health and healthcare disparities;
            (5) developing grant programs and demonstration projects to 
        identify, implement and evaluate innovative approaches to 
        improving the health and healthcare of minority beneficiaries 
        in the Medicare, Medicaid, and SCHIP programs;
            (6) considering incentive programs relating to 
        reimbursement that would reward health entities for providing 
        quality healthcare for minority populations using established 
        benchmarks for quality of care;
            (7) collaborating with the compliance office to ensure 
        compliance with the anti-discrimination provisions under title 
        VI of the Civil Rights Act of 1964;
            (8) identifying barriers to enrollment in public programs 
        under the jurisdiction of the Centers for Medicare and Medicaid 
        Services;
            (9) monitoring and evaluating on a regular basis the 
        success of minority health programs and initiatives;
            (10) publishing an annual report about the activities of 
        the Centers for Medicare and Medicaid Services relating to 
        minority health improvement; and
            (11) other activities determined appropriate by the 
        Secretary of Health and Human Services.
    (c) Staff.--The staff at the Office shall include--
            (1) one or more individuals with expertise in minority 
        health and racial and ethnic health disparities; and
            (2) one or more individuals with expertise in healthcare 
        financing and delivery in underserved communities.
    (d) Coordination.--In carrying out its duties under this section, 
the Office shall coordinate with--
            (1) the Office of Minority Health in the Office of the 
        Secretary of Health and Human Services;
            (2) the National Centers for Minority Health and Health 
        Disparities in the National Institutes of Health; and
            (3) the Office of Minority Health in the Centers for 
        Disease Control and Prevention.
    (e) 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 may be necessary for each of fiscal 
years 2005 through 2010.

SEC. 607. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND DRUG 
              ADMINISTRATION.

    Chapter IX of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
391 et seq.) is amended by adding at the end the following:

``SEC. 908. OFFICE OF MINORITY AFFAIRS.

    ``(a) In General.--Not later than 60 days after the date of 
enactment of this section, the Secretary shall establish within the 
Office of the Commissioner of the Food and Drug Administration an 
Office of Minority Affairs (referred to in this section as the 
`Office').
    ``(b) Duties.--The Office shall be responsible for the coordination 
and facilitation of activities of the Food and Drug Administration to 
improve minority health and healthcare and to reduce racial and ethnic 
disparities in health and healthcare, which shall include--
            ``(1) promoting policies in the development and review of 
        medical products that reduce racial and ethnic disparities in 
        health and healthcare;
            ``(2) encouraging appropriate data collection, analysis, 
        and dissemination of racial and ethnic differences using, at a 
        minimum, the categories described in the 1997 Office of 
        Management and Budget standards, in response to different 
        therapies in both adult and pediatric populations;
            ``(3) providing, in coordination with other appropriate 
        government agencies, education, training, and support to 
        increase participation of minority patients and physicians in 
        clinical trials;
            ``(4) collecting and analyzing data using, at a minimum, 
        the categories described in the 1997 Office of Management and 
        Budget standards, on the number of participants from minority 
        racial and ethnic backgrounds in clinical trials used to 
        support medical product approvals;
            ``(5) the identification of methods to reduce language and 
        literacy barriers; and
            ``(6) publishing an annual report about the activities of 
        the Food and Drug Administration pertaining to minority health.
    ``(c) Staff.--The staff of the Office shall include--
            ``(1) one or more individuals with expertise in the design 
        and conduct of clinical trials of drugs, biological products, 
        and medical devices; and
            ``(2) one or more individuals with expertise in therapeutic 
        classes or disease states for which medical evidence suggests a 
        difference based on race or ethnicity.
    ``(d) Coordination.--In carrying out its duties under this section, 
the Office shall coordinate with--
            ``(1) the Office of Minority Health in the Office of the 
        Secretary of Health and Human Services;
            ``(2) the National Center for Minority Health and Health 
        Disparities in the National Institutes of Health; and
            ``(3) the Office of Minority Health in the Centers for 
        Disease Control and Prevention.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2005 through 2010.''.

SEC. 608. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL AND 
              ETHNIC BACKGROUND.

    (a) In General.--Chapter V of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 351 et seq.) is amended by adding after section 505B the 
following:

``SEC. 505C. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL 
              AND ETHNIC BACKGROUND.

    ``(a) Pre-Approval Studies.--If there is evidence that there may be 
a disparity on the basis of racial or ethnic background as to the 
safety or effectiveness of a drug, then--
            ``(1)(A) the investigations required under section 
        505(b)(1)(A) shall include adequate and well-controlled 
        investigations of the disparity; or
            ``(B) the evidence required under section 351(a) of the 
        Public Health Service Act for approval of a biologics license 
        application for the drug shall include adequate and well-
        controlled investigations of the disparity; and
            ``(2) if the investigations confirm that there is a 
        disparity, the labeling of the drug shall include appropriate 
        information about the disparity.
    ``(b) Post-Market Studies.--
            ``(1) In general.--If there is evidence that there may be a 
        disparity on the basis of racial or ethnic background as to the 
        safety or effectiveness of a drug for which there is an 
        approved application under section 505 or a license under 
        section 351 of the Public Health Service Act, the Secretary may 
        by order require the holder of the approved application or 
        license to conduct, by a date specified by the Secretary, post-
        marketing studies to investigate the disparity.
            ``(2) Labeling.--If the Secretary determines that the post-
        market studies confirm that there is a disparity described in 
        paragraph (1), the labeling of the drug shall include 
        appropriate information about the disparity.
            ``(3) Study design.--The Secretary may specify all aspects 
        of study design, including the number of studies and study 
        participants, in the order requiring post-market studies of the 
        drug.
            ``(4) Modifications of study design.--The Secretary may by 
        order modify any aspect of the study design as necessary after 
        issuing an order under paragraph (1).
            ``(5) Study results.--The results from studies required 
        under paragraph (1) shall be submitted to the Secretary as 
        supplements to the drug application or biological license 
        application.
    ``(c) Disparity.--The term `evidence that there may be a disparity 
on the basis of racial or ethnic background for adult and pediatric 
populations as to the safety or effectiveness of a drug' includes--
            ``(1) evidence that there is a disparity on the basis of 
        racial or ethnic background as to safety or effectiveness of a 
        drug in the same chemical class as the drug;
            ``(2) evidence that there is a disparity on the basis of 
        racial or ethnic background in the way the drug is metabolized; 
        and
            ``(3) other evidence as the Secretary may determine.
    ``(d) Applications Under Section 505(b)(2) and 505(j).--
            ``(1) In general.--A drug for which an application has been 
        submitted or approved under section 505(j) shall not be 
        considered ineligible for approval under that section or 
        misbranded under section 502 on the basis that the labeling of 
        the drug omits information relating to a disparity on the basis 
        of racial or ethnic background as to the safety or 
        effectiveness of the drug, whether derived from investigations 
        or studies required under this section or derived from other 
        sources, when the omitted information is protected by patent or 
        by exclusivity under clause (iii) or (iv) of section 
        505(j)(5)(D).
            ``(2) Labeling.--Notwithstanding clauses (iii) and (iv) of 
        section 505(j)(5)(D), the Secretary may require that the 
        labeling of a drug approved under section 505(j) that omits 
        information relating to a disparity on the basis of racial or 
        ethnic background as to the safety or effectiveness of the drug 
        include a statement of any appropriate contraindications, 
warnings, or precautions related to the disparity that the Secretary 
considers necessary.''.
    (b) Enforcement.--Section 502 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 352) is amended by adding at the end the 
following:
    ``(w)(1) If it is a drug and the holder of the approved application 
under section 505 or license under section 351 of the Public Health 
Service Act for the drug has failed to complete the investigations or 
studies, or comply with any other requirement, of section 505C.''.
    (c) Drug Fees.--Section 736(a)(1)(A)(ii) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 379h) is amended by adding after 
``required'' the following: ``, including supplements required under 
section 505C of the Act''.

SEC. 609. UNITED STATES COMMISSION ON CIVIL RIGHTS.

    (a) Coordination Within Department of Justice of Activities 
Regarding Health Disparities.--Section 3 of the Civil Rights Commission 
Act of 1983 (42 U.S.C. 1975a) is amended--
            (1) in paragraph (1)(B), by striking ``and'' at the end;
            (2) in paragraph (2), in the matter after and below 
        subparagraph (D), by striking the period and inserting ``; 
        and''; and
            (3) by adding at the end the following:
            ``(3) shall, with respect to activities carried out in 
        healthcare and correctional facilities toward the goal of 
        eliminating health disparities between the general population 
        and members of racial or ethnic minority groups, coordinate 
        such activities of--
                    ``(A) the Office for Civil Rights within the 
                Department of Justice;
                    ``(B) the Office of Justice Programs within the 
                Department of Justice;
                    ``(C) the Office for Civil Rights within the 
                Department of Health and Human Services; and
                    ``(D) the Office of Minority Health within the 
                Department of Health and Human Services (headed by the 
                Deputy Assistant Secretary for Minority Health).''.
    (b) Authorization of Appropriations.--Section 5 of the Civil Rights 
Commission Act of 1983 (42 U.S.C. 1975c) is amended by striking the 
first sentence and inserting the following: ``For the purpose of 
carrying out this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2005, and such sums as may be necessary for 
each of the fiscal years 2006 through 2010.''.

SEC. 610. SENSE OF CONGRESS CONCERNING FULL FUNDING OF ACTIVITIES TO 
              ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES.

    (a) Findings.--Congress makes the following findings:
            (1) The health status of the American populace is declining 
        and the United States currently ranks below most industrialized 
        nations in health status measured by longevity, sickness, and 
        mortality.
            (2) Within the spectrum of declining health, racial and 
        ethnic minority populations tend to be in the poorest of health 
        and face substantial cultural, social, and economic barriers to 
        obtaining quality healthcare.
            (3) The problems affecting minority health have been 
        exacerbated by the fact that adequate resources (funding, 
        staffing, stewardship, and accountability) have not been 
        devoted to initiatives designed to examine and eliminate racial 
        and ethnic disparities in health.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) funding should be doubled by fiscal year 2005 for the 
        National Center for Minority Health Disparities, the Office of 
        Civil Rights in the Department of Health and Human Services, 
        the National Institute of Nursing Research, and the Office of 
        Minority Health;
            (2) adequate funding by fiscal year 2005, and subsequent 
        funding increases, should be provided for health professions 
        training programs, the Racial and Ethnic Approaches to 
        Community Health (REACH) at the Center for Disease Control and 
        Prevention, the Minority HIV/AIDS Initiative, and the 
        Excellence Centers to Eliminate Ethnic/Racial Disparities 
        (EXCEED) Program at the Agency for Healthcare Research and 
        Quality;
            (3) current and newly-created health disparity elimination 
        incentives, programs, agencies, and departments under this Act 
        (and the amendments made by this Act) should receive adequate 
        staffing and funding by fiscal year 2005; and
            (4) stewardship and accountability should be provided by 
        Congress and the President for health disparity elimination.

TITLE VII--STRENGTHENING HEALTH INSTITUTIONS THAT PROVIDE HEALTHCARE TO 
                          MINORITY POPULATIONS

SEC. 701. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title XXIX of the Public Health Service Act, as amended by section 
602, is further amended by adding at the end the following:

``Subtitle G--Strengthening Health Institutions That Provide Healthcare 
                        to Minority Populations

                     ``CHAPTER 1--GENERAL PROGRAMS

``SEC. 2971. GRANT SUPPORT FOR QUALITY IMPROVEMENT INITIATIVES.

    ``(a) In General.--The Secretary, in collaboration with the 
Administrator of the Health Resources and Services Administration, the 
Director of the Agency for Healthcare Research and Quality, and the 
Administrator of the Centers for Medicare and Medicaid Services, shall 
award grants to eligible entities for the conduct of demonstration 
projects to improve the quality of and access to healthcare.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a health center, hospital, health plan, health 
        system, community clinic. or other health entity determined 
        appropriate by the Secretary--
                    ``(A) that, by legal mandate or explicitly adopted 
                mission, provides patients with access to services 
                regardless of their ability to pay;
                    ``(B) that provides care or treatment for a 
                substantial number of patients who are uninsured, are 
                receiving assistance under a State program under title 
                XIX of the Social Security Act, or are members of 
                vulnerable populations, as determined by the Secretary; 
                and
                    ``(C)(i) with respect to which, not less than 50 
                percent of the entity's patient population is made up 
                of racial and ethnic minorities; or
                    ``(ii) that--
                            ``(I) serves a disproportionate percentage 
                        of local, minority racial and ethnic patients, 
                        or that has a patient population, at least 50 
                        percent of which is limited English proficient; 
                        and
                            ``(II) provides an assurance that amounts 
                        received under the grant will be used only to 
support quality improvement activities in the racial and ethnic 
population served; and
            ``(2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to applicants under subsection (b)(2) 
that--
            ``(1) demonstrate an intent to operate as part of a 
        healthcare partnership, network, collaborative, coalition, or 
        alliance where each member entity contributes to the design, 
        implementation, and evaluation of the proposed intervention; or
            ``(2) intend to use funds to carry out systemwide changes 
        with respect to healthcare quality improvement, including--
                    ``(A) improved systems for data collection and 
                reporting;
                    ``(B) innovative collaborative or similar 
                processes;
                    ``(C) group programs with behavioral or self-
                management interventions;
                    ``(D) case management services;
                    ``(E) physician or patient reminder systems;
                    ``(F) educational interventions; or
                    ``(G) other activities determined appropriate by 
                the Secretary.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under subsection (a) to support the implementation and evaluation 
of healthcare quality improvement activities or minority health and 
healthcare disparity reduction activities that include--
            ``(1) with respect to healthcare systems, activities 
        relating to improving--
                    ``(A) patient safety;
                    ``(B) timeliness of care;
                    ``(C) effectiveness of care;
                    ``(D) efficiency of care; and
                    ``(E) patient centeredness; and
            ``(2) with respect to patients, activities relating to--
                    ``(A) staying healthy;
                    ``(B) getting well;
                    ``(C) living with illness or disability; and
                    ``(D) coping with end of life issues.
    ``(e) Common Data Systems.--The Secretary shall provide financial 
and other technical assistance to grantees under this section for the 
development of common data systems.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2971A. CENTERS OF EXCELLENCE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall designate 
centers of excellence at public hospitals, and other health systems 
serving large numbers of minority patients, that--
            ``(1) meet the requirements of section 2971(b)(1);
            ``(2) demonstrate excellence in providing care to minority 
        populations; and
            ``(3) demonstrate excellence in reducing disparities in 
        health and healthcare.
    ``(b) Requirements.--A hospital or health system that serves as a 
Center of Excellence under subsection (a) shall--
            ``(1) design, implement, and evaluate programs and policies 
        relating to the delivery of care in racially, ethnically, and 
        linguistically diverse populations;
            ``(2) provide training and technical assistance to other 
        hospitals and health systems relating to the provision of 
        quality healthcare to minority populations; and
            ``(3) develop activities for graduate or continuing medical 
        education that institutionalize a focus on cultural competence 
        training for health care providers.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 2971B. CONSULTATION, CONSTRUCTION AND RENOVATION OF AMERICAN 
              INDIAN AND ALASKA NATIVE FACILITIES; REPORTS.

    ``(a) Consultation.--Prior to the expenditure of, or the making of 
any firm commitment to expend, any funds appropriated for the planning, 
design, construction, or renovation of facilities pursuant to the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act), 
the Secretary, acting through the Service, shall--
            ``(1) consult with any Indian tribe that would be 
        significantly affected by such expenditure for the purpose of 
        determining and, whenever practicable, honoring tribal 
        preferences concerning size, location, type, and other 
        characteristics of any facility on which such expenditure is to 
        be made; and
            ``(2) ensure, whenever practicable, that such facility 
        meets the construction standards of any nationally recognized 
        accrediting body by not later than 1 year after the date on 
        which the construction or renovation of such facility is 
        completed.
    ``(b) Closure of Facilities.--
            ``(1) In general.--Notwithstanding any provision of law 
        other than this subsection, no Service hospital or outpatient 
        healthcare facility or any inpatient service or special care 
        facility operated by the Service, may be closed if the 
        Secretary has not submitted to the Congress at least 1 year 
        prior to the date such proposed closure an evaluation of the 
        impact of such proposed closure which specifies, in addition to 
        other considerations--
                    ``(A) the accessibility of alternative healthcare 
                resources for the population served by such hospital or 
                facility;
                    ``(B) the cost effectiveness of such closure;
                    ``(C) the quality of healthcare to be provided to 
                the population served by such hospital or facility 
                after such closure;
                    ``(D) the availability of contract healthcare funds 
                to maintain existing levels of service;
                    ``(E) the views of the Indian tribes served by such 
                hospital or facility concerning such closure;
                    ``(F) the level of utilization of such hospital or 
                facility by all eligible Indians; and
                    ``(G) the distance between such hospital or 
                facility and the nearest operating Service hospital.
            ``(2) Temporary closure.--Paragraph (1) shall not apply to 
        any temporary closure of a facility or of any portion of a 
        facility if such closure is necessary for medical, 
        environmental, or safety reasons.
    ``(c) Priority System.--
            ``(1) Establishment.--The Secretary shall establish a 
        healthcare facility priority system, that shall--
                    ``(A) be developed with Indian tribes and tribal 
                organizations through negotiated rulemaking;
                    ``(B) give the needs of Indian tribes the highest 
                priority, with additional priority being given to those 
                service areas where the health status of Indians within 
                the area, as measured by life expectancy based upon the 
most recent data available, is significantly lower than the average 
health status for Indians in all service areas; and
                    ``(C) at a minimum, include the lists required in 
                paragraph (2)(B) and the methodology required in 
                paragraph (2)(E);
        except that the priority of any project established under the 
        construction priority system in effect on the date of this Act 
        shall not be affected by any change in the construction 
        priority system taking place thereafter if the project was 
        identified as one of the top 10 priority inpatient projects or 
        one of the top 10 outpatient projects in the Indian Health 
        Service budget justification for fiscal year 2004, or if the 
        project had completed both Phase I and Phase II of the 
        construction priority system in effect on the date of this 
        title.
            ``(2) Report.--The Secretary shall submit to the President 
        and Congress a report that includes--
                    ``(A) a description of the healthcare facility 
                priority system of the Service, as established under 
                paragraph (1);
                    ``(B) healthcare facility lists, including--
                            ``(i) the total healthcare facility 
                        planning, design, construction and renovation 
                        needs for Indians;
                            ``(ii) the 10 top-priority inpatient care 
                        facilities;
                            ``(iii) the 10 top-priority outpatient care 
                        facilities;
                            ``(iv) the 10 top-priority specialized care 
                        facilities (such as long-term care and alcohol 
                        and drug abuse treatment); and
                            ``(v) any staff quarters associated with 
                        such prioritized facilities;
                    ``(C) the justification for the order of priority 
                among facilities;
                    ``(D) the projected cost of the projects involved; 
                and
                    ``(E) the methodology adopted by the Service in 
                establishing priorities under its healthcare facility 
                priority system.
            ``(3) Consultation.--In preparing each report required 
        under paragraph (2) (other than the initial report) the 
        Secretary shall annually--
                    ``(A) consult with, and obtain information on all 
                healthcare facilities needs from, Indian tribes and 
                tribal organizations including those tribes or tribal 
                organizations operating health programs or facilities 
                under any funding agreement entered into with the 
                Service under the Indian Self-Determination and 
                Education Assistance Act; and
                    ``(B) review the total unmet needs of all tribes 
                and tribal organizations for healthcare facilities 
                (including staff quarters), including needs for 
                renovation and expansion of existing facilities.
            ``(4) Criteria.--For purposes of this subsection, the 
        Secretary shall, in evaluating the needs of facilities operated 
        under any funding agreement entered into with the Service under 
        the Indian Self-Determination and Education Assistance Act, use 
        the same criteria that the Secretary uses in evaluating the 
        needs of facilities operated directly by the Service.
            ``(5) Equitable integration.--The Secretary shall ensure 
        that the planning, design, construction, and renovation needs 
        of Service and non-Service facilities, operated under funding 
        agreements in accordance with the Indian Self-Determination and 
        Education Assistance Act are fully and equitably integrated 
        into the healthcare facility priority system.
    ``(d) Review of Need for Facilities.--
            ``(1) Report.--Beginning in 2005, the Secretary shall 
        annually submit to the President and Congress a report which 
        sets forth the needs of the Service and all Indian tribes and 
        tribal organizations, including urban Indian organizations, for 
        inpatient, outpatient and specialized care facilities, 
        including the needs for renovation and expansion of existing 
        facilities.
            ``(2) Consultation.--In preparing each report required 
        under paragraph (1) (other than the initial report), the 
        Secretary shall consult with Indian tribes and tribal 
        organizations including those tribes or tribal organizations 
        operating health programs or facilities under any funding 
        agreement entered into with the Service under the Indian Self-
        Determination and Education Assistance Act, and with urban 
        Indian organizations.
            ``(3) Criteria.--For purposes of this subsection, the 
        Secretary shall, in evaluating the needs of facilities operated 
        under any funding agreement entered into with the Service under 
        the Indian Self-Determination and Education Assistance Act, use 
        the same criteria that the Secretary uses in evaluating the 
        needs of facilities operated directly by the Service.
            ``(4) Equitable integration.--The Secretary shall ensure 
        that the planning, design, construction, and renovation needs 
        of facilities operated under funding agreements, in accordance 
        with the Indian Self-Determination and Education Assistance 
        Act, are fully and equitably integrated into the development of 
        the health facility priority system.
            ``(5) Annual nominations.--Each year the Secretary shall 
        provide an opportunity for the nomination of planning, design, 
        and construction projects by the Service and all Indian tribes 
        and tribal organizations for consideration under the healthcare 
        facility priority system.
    ``(e) Inclusion of Certain Programs.--All funds appropriated under 
the Act of November 2, 1921 (25 U.S.C. 13), for the planning, design, 
construction, or renovation of health facilities for the benefit of an 
Indian tribe or tribes shall be subject to the provisions of section 
102 of the Indian Self-Determination and Education Assistance Act.
    ``(f) Innovative Approaches.--The Secretary shall consult and 
cooperate with Indian tribes, tribal organizations and urban Indian 
organizations in developing innovative approaches to address all or 
part of the total unmet need for construction of health facilities, 
including those provided for in other sections of this title and other 
approaches.
    ``(g) Location of Facilities.--
            ``(1) Priority.--The Bureau of Indian Affairs and the 
        Service shall, in all matters involving the reorganization or 
        development of Service facilities, or in the establishment of 
        related employment projects to address unemployment conditions 
        in economically depressed areas, give priority to locating such 
        facilities and projects on Indian lands if requested by the 
        Indian owner and the Indian tribe with jurisdiction over such 
        lands or other lands owned or leased by the Indian tribe or 
        tribal organization so long as priority is given to Indian land 
        owned by an Indian tribe or tribes.
            ``(2) Definition.--In this subsection, the term `Indian 
        lands' means--
                    ``(A) all lands within the exterior boundaries of 
                any Indian reservation;
                    ``(B) any lands title to which is held in trust by 
                the United States for the benefit of any Indian tribe 
                or individual Indian, or held by any Indian tribe or 
                individual Indian subject to restriction by the United 
States against alienation and over which an Indian tribe exercises 
governmental power; and
                    ``(C) all lands in Alaska owned by any Alaska 
                Native village, or any village or regional corporation 
                under the Alaska Native Claims Settlement Act, or any 
                land allotted to any Alaska Native.
    ``(h) Definitions.--For purposes of this section, the definitions 
contained in section 4 of the Indian Health Care Improvement Act shall 
apply.

``SEC. 2971C. RECONSTRUCTION AND IMPROVEMENT GRANTS FOR PUBLIC HEALTH 
              CARE FACILITIES SERVING PACIFIC ISLANDERS AND THE INSULAR 
              AREAS.

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

        ``CHAPTER 2--NATIONAL HEALTH SAFETY NET INFRASTRUCTURE.

                   ``Subchapter A--General Provisions

``SEC. 2972. PAYMENTS TO HEALTHCARE FACILITIES.

    ``(a) In General.--The Secretary, with the approval of the Health 
Safety Net Infrastructure Trust Fund Board of Trustees described in 
section 2972C(d) (hereafter in this subtitle referred to as the `Trust 
Fund Board'), shall make payments, from amounts in the Health Safety 
Net Infrastructure Trust Fund established under section 2972C(a) 
(hereafter in this subtitle referred to as the `Trust Fund'), for 
capital financing assistance to eligible healthcare facilities whose 
applications for assistance have been approved under this subtitle.
    ``(b) General Eligibility Requirements for Assistance.--
            ``(1) Eligible healthcare facilities described.--
                    ``(A) In general.--A healthcare facility shall be 
                generally eligible for capital financing assistance 
                under this subtitle if the healthcare facility--
                            ``(i) receives an additional payment under 
                        section 1886(d)(5)(F) of the Social Security 
                        Act and is described in clause (i)(II) or 
                        clause (vii)(I) of such section, or is deemed a 
                        disproportionate share hospital under a State 
                        plan for medical assistance under title XIX of 
                        the Social Security Act on the basis described 
                        in section 1923(b)(1) of such Act;
                            ``(ii) is a hospital which meets the 
                        criteria for designation by the Secretary as an 
                        essential access community hospital under 
                        section 1820(i)(1) of such Act or a rural 
                        primary care hospital under section 1820(i)(2) 
                        of such Act (whether or not such hospital is 
                        actually designated under such section);
                            ``(iii) is a Federally qualified health 
                        center (as defined in section 1905(l)(2)(B) of 
                        such Act);
                            ``(iv) is a hospital which--
                                    ``(I) is a sole community provider; 
                                or
                                    ``(II) has closed within the 
                                preceding 12 months;
                            ``(v) is a facility which--
                                    ``(I) provides service to ill or 
                                injured individuals prior to the 
                                transportation of such individuals to a 
                                hospital or provides inpatient care to 
                                individuals needing such care for a 
                                period not longer than 96 hours;
                                    ``(II) is located in a county (or 
                                equivalent unit of local government) 
                                with fewer than 6 residents per square 
                                mile or is located more than 35 road 
                                miles from the nearest hospital;
                                    ``(III) permits a physician 
                                assistant or nurse practitioner to 
                                admit and treat patients under the 
                                supervision of a physician not present 
                                in such facility; and
                                    ``(IV) has obtained a waiver from 
                                the Secretary permitting the facility 
                                to participate in the medicare program 
                                under title XVIII of the Social 
                                Security Act; or
                            ``(vi) is a hospital that the Secretary 
                        otherwise determines to be an appropriate 
                        recipient of assistance under this subtitle on 
                        the basis of the existence of a patient care 
                        operating deficit, a demonstrated inability to 
                        secure or repay financing for a qualifying 
                        project on reasonable terms, or such other 
                        criteria as the Secretary considers 
                        appropriate.
                    ``(B) Development of criteria.--For purposes of 
                subparagraph (A)(vi), with respect to rural hospitals 
                which are at risk or critical to healthcare access, the 
                Prospective Payment Review Commission, not later than 
January 1, 1994, shall develop criteria to assist the Secretary in 
deciding if such hospitals deserve assistance, after considering, at a 
minimum, the following factors:
                            ``(i) At-risk rural hospitals.--In the case 
                        of rural hospitals the closure of which within 
                        the next year is imminent or the continued 
                        operation of which over a 2- to 5-year period 
                        is questionable, such factors as the level of 
                        health resources available in a community as 
                        measured by physician supply, the population 
                        base of the area served by the hospital and 
                        utilization of services by such population as 
                        measured by service area population, and 
                        financial indicators predictive of closure.
                            ``(ii) Rural hospitals critical to 
                        healthcare access.--In the case of rural 
                        hospitals which provide access to essential 
                        health services within a service area where no 
                        other provider of such essential services 
                        exists, such factors as the market share of the 
                        hospital for an area or population, the number 
                        of outpatient visits, the proximity of the next 
                        closest provider of such services, and the 
                        degree to which the area population is 
                        medically underserved.
            ``(2) Ownership requirements.--In order to be eligible for 
        assistance under this subtitle, a healthcare facility (other 
        than a healthcare facility described in clauses (ii) and (v) of 
        paragraph (1)) must--
                    ``(A) be owned or operated by a unit of State or 
                local government;
                    ``(B) be a quasi-public corporation, defined as a 
                private, nonprofit corporation or public benefit 
                corporation which is formally granted one or more 
                governmental powers by legislative action through (or 
                is otherwise partially funded by) the State 
                legislature, city or county council;
                    ``(C) be a private nonprofit healthcare facility 
                which has contracted with, or is otherwise funded by, a 
                governmental agency to provide healthcare services to 
                low income individuals not eligible for assistance 
                under title XVIII or title XIX of the Social Security 
                Act, where revenue from such contracts constitute at 
                least 10 percent of the facility's operating revenues 
                over the prior 3 fiscal years; or
                    ``(D) be a nonprofit small rural healthcare 
                facility (as determined by the Secretary).
            ``(3) Priority.--In making payments under this section, the 
        Secretary shall give priority to eligible healthcare entities 
        that are federally qualified health centers (as defined in 
        section 1905(l)(2)(B) of the Social Security Act), or other 
        similar entities at least 50 percent of the patients of which 
        are minority or low-income individuals.
    ``(c) Meeting Additional Specific Criteria.--Healthcare facilities 
that are generally eligible for assistance under this subtitle under 
subsection (b) may apply for the specific programs described in this 
subtitle and must meet any additional criteria for participation in 
such programs.
    ``(d) Assistance Available.--Capital financing assistance available 
under this subtitle shall include loan guarantees, interest rate 
subsidies, matching loans and direct grants. Healthcare facilities 
determined to be generally eligible for assistance under this subtitle 
may apply for and receive more than one type of assistance under this 
subtitle.

``SEC. 2972A. APPLICATION FOR ASSISTANCE.

    ``(a) In General.--No healthcare facilities may receive assistance 
for a qualifying project under this subtitle unless the healthcare 
facility--
            ``(1) has filed with the Secretary, in a form and manner 
        specified by the Secretary, with the advice and approval of the 
        Trust Fund Board (as described in section 2972C(d)), an 
        application for assistance under this subtitle;
            ``(2) establishes in its application (for its most recent 
        cost reporting period) that it meets the criteria for general 
        eligibility under this subtitle;
            ``(3) includes a description of the project, including the 
        community in which it is located, and describes utilization and 
        services characteristics of the project and the healthcare 
        facility, and the patient population that is to be served;
            ``(4) describes the extent to which the project will 
        include the financial participation of State and local 
        governments if assistance is granted under this subtitle, and 
        all other sources of financing sought for the project; and
            ``(5) establishes, to the satisfaction of the Secretary and 
        the Trust Fund Board, that the project meets the additional 
        criteria for each type of capital financing assistance for 
        which it is applying.
    ``(b) Criteria for Approval.--The Secretary, with the approval of 
the Trust Fund Board, shall determine for each application for 
assistance under this subtitle--
            ``(1) whether the healthcare facility meets the general 
        eligibility criteria under section 2972(b);
            ``(2) whether the healthcare facility meets the specific 
        eligibility criteria of each type of assistance for which it 
        has applied, including whether the healthcare facility meets 
        any criteria for priority consideration for the type of 
        assistance for which it has applied;
            ``(3) whether the capital project for which assistance is 
        being requested is a qualifying project under this subtitle; 
        and
            ``(4) whether funds are available, pursuant to the 
        limitations of each program, to fully fund the request for 
        assistance.
    ``(c) Priority of Applications.--In addition to meeting the 
criteria otherwise described in this subtitle, at the discretion of the 
Trust Fund Board, the Secretary shall give preference to those 
applications for qualifying projects that--
            ``(1)(A) are necessary to bring existing safety net 
        healthcare facilities into compliance with accreditation 
        standards of fire and life safety, seismic, or other related 
        Federal, State or local regulatory standards;
            ``(B) improve the provision of essential services such as 
        emergency medical and trauma services, AIDS and infectious 
        disease, perinatal, burn, primary care, and other services 
        which the Trust Fund Board may designate; or
            ``(C) provide access to otherwise unavailable essential 
        health services to the indigent and other needy persons within 
        the healthcare facility's territorial area;
            ``(2) include specific State or local governmental or other 
        non-Federal assurances of financial support if assistance for a 
        qualifying project is granted under this subtitle; and
            ``(3) are unlikely to be financed without assistance 
        granted under this subtitle.
    ``(d) Submission of Applications.--Applications under this subtitle 
shall be submitted to the Secretary through the Trust Fund Board. If 
two or more healthcare facilities join in the project, the application 
shall be submitted by all participating healthcare facilities jointly. 
Such applications shall set forth all of the descriptions, plans, 
specifications, and assurances as required by this subtitle and contain 
other such information as the Trust Fund Board shall require.
    ``(e) Opportunity for Appeal.--The Trust Fund Board shall afford a 
healthcare facility applying for a loan guarantee under this section an 
opportunity for a hearing if the guarantee is denied.
    ``(f) Applications for Amendments.--Amendment of an approved 
application shall be subject to approval in the same manner as an 
original application.

``SEC. 2972B. PUBLIC SERVICE RESPONSIBILITIES.

    ``(a) In General.--Any healthcare facility accepting capital 
financing assistance under this subtitle shall agree--
            ``(1) to make the services of the facility or portion 
        thereof to be constructed, acquired, or modernized available to 
        all persons; and
            ``(2) to provide a significant volume of services to 
        persons unable to pay therefore, consistent with other 
        provisions of this Act and the amount of assistance received 
        under this subtitle.
    ``(b) Enforcement.--The Director of the Office for Civil Rights of 
the Department of Health and Human Services shall be given the power to 
enforce the public service responsibilities described in this section.

``SEC. 2972C. HEALTH SAFETY NET INFRASTRUCTURE TRUST FUND.

    ``(a) Creation of Trust Fund.--There is established in the Treasury 
of the United States a trust fund to be known as the Health Safety Net 
Infrastructure Trust Fund, consisting of such amounts as may be 
transferred, appropriated, or credited to such Trust Fund as provided 
in this subtitle.
    ``(b) Authorization of Appropriations to Trust Fund.--There are 
authorized to be appropriated to the Trust Fund such sums as may be 
necessary to carry out the purposes of this subtitle.
    ``(c) Expenditures From Trust Fund.--Amounts in the Trust Fund 
shall be available, pursuant to appropriations Acts, only for making 
expenditures to carry out the purposes of this subtitle.
    ``(d) Board of Trustees; Composition; Meetings; Duties.--
            ``(1) In general.--There shall be created a Health Safety 
        Net Infrastructure Trust Fund Board of Trustees composed of the 
        Secretary of Health and Human Services, the Secretary of the 
        Treasury, the Assistant Secretary for Health, the Director of 
        the Office of Minority Health, and the Administrator of the 
        Centers for Medicare and Medicaid Services (all serving in 
        their ex officio capacities), and 5 public members who shall be 
        appointed for 4 year terms by the President, from the following 
        categories--
                    ``(A) one chief health officer from a State;
                    ``(B) one chief executive officer of a healthcare 
                facility that meets the general eligibility criteria of 
                this subtitle;
                    ``(C) one representative of the financial 
                community; and
                    ``(D) two additional public or consumer 
                representatives.
            ``(2) Duties.--The Board of Trustees shall meet no less 
        than quarterly and shall have the responsibility to approve 
        implementing regulations, to establish criteria, and to 
        recommend and approve expenditures by the Secretary under the 
        programs set forth in this subtitle.
            ``(3) Managing trustee.--The Secretary of the Treasury 
        shall serve as the Managing Trustee of the Trust Fund, and 
        shall be responsible for the investment of funds. The 
        provisions of subsections (b) through (e) of section 1817 of 
        the Social Security Act shall apply to the Trust Fund and the 
        Managing Trustee of the Trust Fund in the same manner as they 
        apply to the Federal Hospital Insurance Trust Fund and the 
        Managing Trustee of that Trust Fund.

``SEC. 2972D. ADMINISTRATION.

    ``(a) In General.--The Administrator of the Centers for Medicare 
and Medicaid Services shall serve as Secretary of the Board of Trustees 
and shall administer the programs under this subtitle.
    ``(b) Limitation on Administrative Expenses.--Not more than 5 
percent of the funds annually appropriated to the Trust Fund may be 
available for administration of the Trust Fund or programs under this 
subtitle.

                    ``Subchapter B--Loan Guarantees

``SEC. 2973. PROVISION OF LOAN GUARANTEES TO SAFETY NET HEALTHCARE 
              FACILITIES.

    ``(a) In General.--The Safety Net Infrastructure Trust Fund will 
provide a Federal guarantee of loan repayment, including guarantees of 
repayment of refinancing loans, to non-Federal lenders making loans to 
eligible healthcare facilities for healthcare facility replacement 
(either by construction or acquisition), modernization and renovation 
projects, and capital equipment acquisition.
    ``(b) Purposes.--The loan guarantee program shall be designed by 
the Trust Fund Board with the goal of rebuilding and maintaining the 
essential health services of healthcare facilities eligible for 
assistance under this subtitle.

``SEC. 2973A. ELIGIBLE LOANS.

    ``(a) In General.--Loan guarantees under this chapter are available 
for loans made to eligible healthcare facilities for replacement 
facilities (either newly constructed or acquired), modernization and 
renovation of existing facilities, and for capital equipment 
acquisition.
    ``(b) Loan Guarantee Must Be Essential to Bond Financing.--Eligible 
healthcare facilities must demonstrate that a Federal loan guarantee is 
essential to obtaining bond financing from non-Federal lenders at a 
reasonably affordable rate of interest.
    ``(c) Additional Eligibility Criteria for Loan Guarantees.--In 
order to be eligible for assistance under this chapter, a healthcare 
facility must demonstrate that the following criteria are met:
            ``(1) The healthcare facility has evidence of an ability to 
        meet debt service.
            ``(2) The assistance, when considered with other resources 
        available to the project, is necessary and will restore, 
        improve, or maintain the financial or physical soundness of the 
        healthcare facility.
            ``(3) The applicant agrees to assume the public service 
        responsibilities described in section 2972B.
            ``(4) The project is being, or will be, operated and 
        managed in accordance with a management-improvement-and-
        operating plan which is designed to reduce the operating costs 
        of the project, which has been approved by the Trust Fund 
        Board, and which includes--
                    ``(A) a detailed maintenance schedule;
                    ``(B) a schedule for correcting past deficiencies 
                in maintenance, repairs, and replacements;
                    ``(C) a plan to upgrade the project to meet cost-
                effective energy efficiency standards prescribed by the 
                Trust Fund Board;
                    ``(D) a plan to improve financial and management 
                control systems;
                    ``(E) a detailed annual operating budget taking 
                into account such standards for operating costs in the 
                area as may be determined by the Trust Fund Board; and
                    ``(F) such other requirements as the Trust Fund 
                Board may determine.
            ``(5) The application includes stringent provisions for 
        continued State or local support of the program, both with 
        respect to operating and financial capital.
            ``(6) The terms, conditions, maturity, security (if any), 
        and schedule and amount of repayments with respect to the loan 
        are sufficient to protect the financial interests of the United 
        States and are otherwise reasonable and in accord with 
        regulation, including a determination that the rate of interest 
        does not exceed such annual percentage on the principal 
        obligation outstanding as the Trust Fund Board determines to be 
        reasonable, taking into account the range of interest rates 
        prevailing in the private market for similar loans and the 
        risks assumed by the United States.
            ``(7) The healthcare facility must meet such other 
        additional criteria as the Secretary may impose.
    ``(e) State or Local Participation.--Projects in which State or 
local governmental entities participate in the form of first guarantees 
of part or all of the total loan value shall be given a preference for 
loan guarantees under this chapter.

``SEC. 2973B. GUARANTEE ALLOTMENTS.

    ``(a) In General.--$150,000,000 shall be annually allocated within 
the Trust Fund to the loan guarantee program established by this 
chapter in order to create a cumulative reserve in support of loan 
guarantees.
    ``(b) Loan Guarantees for Rural Healthcare Facilities.--At least 20 
percent of the dollar value of loan guarantees made under this program 
during any given year shall be allocated for eligible rural healthcare 
facilities, to the extent a sufficient number of applications are made 
by such healthcare facilities.
    ``(c) Guarantees for Small Loans.--At least $200,000,000 of the 
annual dollar value of loan guarantees made under the program shall be 
reserved for loans of under $50,000,000, if there are a sufficient 
number of applicants for loans of that size.
    ``(d) Special Rule for Refinancing Loans.--Not more than 20 percent 
of the amount allocated each year to the loan guarantee program 
established by this chapter may be allocated to guarantee refinancing 
loans during the year.

``SEC. 2973C. TERMS AND CONDITIONS OF LOAN GUARANTEES.

    ``(a) In General.--The principal amount of the guaranteed loan, 
when added to any Federal grant assistance made under this subtitle, 
may not exceed 95 percent of the total value of the project, including 
land.
    ``(b) Guarantees Provided May Not Supplant Other Funds.--Guarantees 
provided under this chapter may not be used to supplant other forms of 
State or local support.
    ``(c) Right To Recover Funds.--The United States shall be entitled 
to recover from any applicant healthcare facility the amount of 
payments made pursuant to any loan guarantee under this chapter, unless 
the Trust Fund Board for good cause waives its right of recovery, and 
the United States shall, upon making any such payment pursuant to any 
such loan guarantee be subrogated to all of the rights of the 
recipients of the payments.
    ``(d) Modification of Terms.--Loan guarantees made under this 
chapter shall be subject to further terms and conditions as the Trust 
Fund Board determines to be necessary to assure that the purposes of 
this Act will be achieved, and any such terms and conditions may be 
modified by the Trust Fund Board to the extent that it determines such 
modifications to be consistent with the financial interest of the 
United States.
    ``(e) Terms Are Incontestable Absent Fraud or Misrepresentation.--
Any loan guarantee made by the Trust Fund Board pursuant to this 
chapter shall be incontestable in the hands of an applicant on whose 
behalf such guarantee is made, and as to any person who makes or 
contracts to make a loan to such applicant in reliance thereon, except 
for fraud or misrepresentation on the part of such applicant or other 
person.

``SEC. 2973D. PREMIUMS FOR LOAN GUARANTEES.

    ``(a) In General.--The Trust Fund Board shall determine a 
reasonable loan insurance premium which shall be charged for loan 
guarantees under this chapter, taking into account the availability of 
the reserves created under section 2973B. Premium charges shall be 
payable in cash to the Trust Fund Board, either in full upon issuance, 
or annually in advance. In addition to the premium charge herein 
provided for, the Trust Fund Board is authorized to charge and collect 
such amount as it may deem reasonable for the appraisal of a property 
or project offered for insurance and for the inspection of such 
property or project.
    ``(b) Payment in Advance.--In the event that the principal 
obligation of any loan accepted for insurance under this chapter is 
paid in full prior to the maturity date, the Trust Fund Board is 
authorized in its discretion to require the payment by the borrower of 
an adjusted premium charge in such amount as the Board determines to be 
equitable, but not in excess of the aggregate amount of the premium 
charges that the healthcare facility would otherwise have been required 
to pay if the loan had continued to be insured until maturity date.
    ``(c) Trust Fund Board May Waive Premiums.--The Trust Fund Board 
may in its discretion partially or totally waive premiums charged for 
loan insurance under this section for financially distressed healthcare 
facilities (as described by the Secretary).

``SEC. 2973E. PROCEDURES IN THE EVENT OF LOAN DEFAULT.

    ``(a) In General.--Failure of the borrower to make payments due 
under or provided by the terms of a loan accepted for insurance under 
this chapter shall constitute a default.
    ``(b) Assignment of Defaulted Loans.--If a default continues for 30 
days, then, upon the lender's transfer to the Trust Fund Board of all 
its rights and interests arising under the defaulted loan or in 
connection with the loan transaction, the lender shall be entitled to 
debentures which, together with a certificate of claim, are equal in 
value to the amount the lender would have received if, on the date of 
transfer, the borrower had repaid the loan in full, together with the 
amount of necessary expenses incurred by the lender in connection with 
the default.
    ``(c) Foreclosure by Lender.--Subject to the approval of the Trust 
Fund Board, or as provided in regulations, the lender may foreclose on 
the property securing the defaulted loan.
    ``(d) Foreclosure by Trust Fund Board.--The Trust Fund Board is 
authorized to--
            ``(1) acquire possession of and title to any property 
        securing a defaulted loan by voluntary conveyance in 
        extinguishment of the indebtedness, or
            ``(2) institute proceedings for foreclosure on the property 
        securing any such defaulted loan and prosecute such proceedings 
        to conclusion.
    ``(e) Handling and Disposal of Property; Settlement of Claims.--
            ``(1) Payment for certain expenses.--Notwithstanding any 
        other provision of law relating to the acquisition, handling, 
        or disposal of real and other property by the United States, 
        the Trust Fund Board shall also have power, for the protection 
        of the interests of the Trust Fund, to pay out of the Trust 
        Fund all expenses or charges in connection with, and to deal 
        with, complete, reconstruct, rent, renovate, modernize, insure, 
        make contracts for the management of, or establish suitable 
        agencies for the management of, or sell for cash or credit or 
        lease in its discretion, any property acquired by the Trust 
        Fund under this section.
            ``(2) Settlement of claims.--Notwithstanding any other 
        provision of law, the Trust Fund Board shall also have the 
power to pursue to final collection by way of compromise or otherwise 
all claims assigned and transferred to the Trust Fund in connection 
with the assignment, transfer, and delivery provided for in this 
section, and at any time, upon default, to foreclose or refrain from 
foreclosing on any property secured by any defaulted loan assigned and 
transferred to or held by the Trust Fund.
            ``(3) Limitations on authority.--Subsections (a) and (b) 
        shall not be construed to apply to any contract for hazard 
        insurance, or to any purchase or contract for services or 
        supplies on account of such property if the amount thereof does 
        not exceed $1,000.
    ``(f) Regulations.--The Trust Fund Board shall propose and the 
Secretary shall promulgate regulations governing procedures in the 
event of a default on a loan accepted for insurance under this chapter.

            ``Subchapter C--Grants for Urgent Capital Needs

``SEC. 2976. PROVISION OF GRANTS.

    ``(a) In General.--The Trust Fund Board shall make available 
$400,000,000 in direct grants annually. The Secretary, with the 
approval of the Trust Fund Board, shall make direct grants to eligible 
healthcare facilities with urgent capital needs.
    ``(b) Purposes.--Direct grants shall be available to eligible 
healthcare facilities for 3 types of projects:
            ``(1) Emergency certification and licensure grants would be 
        available to eligible healthcare facilities that are threatened 
        with closure or loss of accreditation or certification of a 
        facility or of essential services as a result of life or safety 
        code violations or similar facility or equipment failures. Such 
        grants would provide limited funding for repair and renovation 
        where failure to fund would disrupt the provision of essential 
        public health services such as emergency care.
            ``(2) Emergency grants would be available for capital 
        renovation, expansion, or replacement necessary to the 
        maintenance or expansion of essential safety and health 
        services such as obstetrics, perinatal, emergency and trauma, 
        primary care and preventive health services.
            ``(3) Planning grants would be available to eligible 
        healthcare facilities who require pre-approval assistance to 
        meet regulatory requirements related to management and finance 
        in order to apply for loans, loan guarantees, and interest 
        subsidies under this subtitle.
    ``(c) Priority to Financially Distressed Healthcare Facilities.--
Priority for direct grants under this section would be given to 
financially distressed healthcare facilities (as described by the 
Secretary).
    ``(d) Application Process.--The Secretary, with the approval of the 
Trust Fund Board, shall create an expedited application process for 
direct grants.

``SEC. 2976B. ELIGIBLE PROJECTS.

    ``(a) Matching Grants.--
            ``(1) Limitation on amount.--Grants for capital 
        expenditures by eligible healthcare facilities will be limited 
        to $25,000,000.
            ``(2) Matching requirement.--At least half of the projects 
        funded in a year must receive at least 50 percent of their 
        funding from State or local sources. The remaining projects 
        funded during the year could be financed up to 90 percent with 
        a combination of Federal grants and loans.
            ``(3) Reservation for rural healthcare facilities.--No less 
        than 20 percent of the grant funds in any given year would be 
        reserved for rural healthcare facilities, provided that a 
        sufficient number of applications are approved.
    ``(b) Planning Grants.--Applicants who can demonstrate general 
qualification for the direct matching loan, loan guarantee, or interest 
subsidy programs under this subtitle or eligibility for mortgage 
insurance under section 242 of the National Housing Act will be 
eligible for a grant of up to $500,000 to assist in implementation of 
key budgetary and financial systems as well as management and 
governance restructuring.''.

                  TITLE VIII--MISCELLANEOUS PROVISIONS

SEC. 801. DEFINITIONS.

    For purposes of this Act (including the amendments made by this Act 
other than the amendments made by subtitles A through G of title I):
            (1) Appropriate healthcare services.--The term 
        ``appropriate healthcare services'' includes services or 
        treatments to address physical, mental, and behavioral 
        diseases, conditions, or syndromes. The definition contained in 
        this paragraph shall not apply for purposes of sections 206 and 
        606.
            (2) Hispanic.--The term ``Hispanic'' means individuals 
        whose origin is Mexican, Puerto Rican, Cuban, Central or South 
        American, or any other Spanish-speaking country.
            (3) Indian.--The term ``Indian'', unless otherwise 
        designated, means any person who is a member of an Indian tribe
            (4) Indian tribe.--The term ``Indian tribe'' means any 
        Indian tribe, band, nation, or other organized group or 
        community, including any Alaska Native village or group or 
        regional or village corporation as defined in or established 
        pursuant to the Alaska Native Claims Settlement Act (85 Stat. 
        688) (43 U.S.C. 1601 et seq.), which is recognized as eligible 
        for the special programs and services provided by the United 
        States to Indians because of their status as Indians.
            (5) Limited english proficient.--The term ``limited English 
        proficient'' with respect to an individual means an individual 
        who cannot speak, read, write, or understand the English 
        language at a level that permits them to interact effectively 
        with clinical or nonclinical staff at a healthcare 
        organization.
            (6) Minority.--
                    (A) In general.--The terms ``minority'' and 
                ``minorities'' refer to individuals from a minority 
                group.
                    (B) Populations.--The term ``minority'', with 
                respect to populations, refers to racial and ethnic 
                minority groups.
            (7) Minority group.--The term ``minority group'' has the 
        meaning given the term ``racial and ethnic minority group''.
            (8) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' means American Indians and Alaska 
        Natives, African Americans (including Blacks), Asian Americans, 
        Hispanics (including Latinos), and Native Hawaiians and other 
        Pacific Islanders.
            (9) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (10) State.--The term ``State'' means each of the several 
        states, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Indian tribes, the Virgin Islands, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.
            (11) Tribal organization.--The term ``tribal organization'' 
        means the elected governing body of any Indian tribe or any 
        legally established organization of Indians which is controlled 
        by one or more such bodies or by a board of directors elected 
        or selected by one or more such bodies (or elected by 
the Indian population to be served by such organization) and which 
includes the maximum participation of Indians in all phases of its 
activities.
            (12) Underrepresented minority.--The terms 
        ``underrepresented minority'' and ``underrepresented 
        minorities'' refer to individuals who are members of racial or 
        ethnic minority groups that are underrepresented in the health 
        professions relative to their numbers in the general 
        population.
            (13) Underserved populations.--The term ``underserved 
        population'' means the population of an urban or rural area 
        designated by the Secretary as an area with a shortage of 
        personal health services or a population group designated by 
        the Secretary as having a shortage of such services.

SEC. 802. DAVIS-BACON ACT.

    All laborers and mechanics employed by contractors or 
subcontractors in the performance of construction work financed in 
whole or in part with assistance under this Act (or an amendment made 
by this Act), including capital financing assistance, or grants or loan 
guarantees from the Safety Net Infrastructure Trust Fund (established 
under section 2972C of the Public Health Service Act), shall be paid 
wages at rates not less than those prevailing on similar work in the 
locality involved as determined by the Secretary of Labor in accordance 
with subchapter IV of chapter 31 of title 40, United States Code 
(commonly referred to as the Davis-Bacon Act). The Secretary of Labor 
shall have, with respect to such labor standards, the authority and 
functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 
3176; 64 Stat 1267) and section 3145 of title 40, United States Code.
                                 <all>