[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2217 Introduced in Senate (IS)]







108th CONGRESS
  2d Session
                                S. 2217

         To improve the health of health disparity populations.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 12, 2004

   Mr. Frist introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
         To improve the health of health disparity populations.

    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 ``Closing the Health 
Care Gap Act of 2004''.
    (b) Table of contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND 
                                ANALYSIS

Sec. 101. Standardized measures of quality health care.
Sec. 102. Data collection.
            TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE

              Subtitle A--Access, Awareness, and Outreach

Sec. 201. Access and awareness grants.
Sec. 202. Innovative outreach programs.
             Subtitle B--Refundable Health Insurance Credit

Sec. 211. Refundable health insurance costs credit.
Sec. 212. Advance payment of credit to issuers of qualified health 
                            insurance.
  TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION

Sec. 301. Office of Minority Health and Health Disparities.
       TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING

Sec. 401. Workforce diversity and training.
Sec. 402. Higher education technical amendments.
Sec. 403. Model cultural competency curriculum development.
Sec. 404. Internet cultural competency clearinghouse.
                       TITLE V--ENHANCED RESEARCH

Sec. 501. Agency for Healthcare Research and Quality.
Sec. 502. National Institutes of Health.
                   TITLE VI--MISCELLANEOUS PROVISIONS

Sec. 601. Definitions.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The overall health of Americans has dramatically 
        improved over the last century, and Americans are justifiably 
        proud of the great strides that have been made in the health 
        and medical sciences.
            (2) As medical science and technology have advanced at a 
        rapid pace, however, the health care delivery system has not 
        been able to provide consistently high quality care to all 
        Americans.
            (3) In particular, people of lower socioeconomic status, 
        racial and ethnic minorities, and medically underserved 
        populations have experienced poor health and challenges in 
        accessing high quality health care.
            (4) Recent studies have raised significant questions 
        regarding differences in clinical care provided to racial and 
        ethnic minorities and other health disparity populations. These 
        differences are often grouped together under the broad heading 
        of ``health disparities''.
            (5) Studies indicate that a gap exists between ideal health 
        care and the actual health care that some Americans receive.
            (6) Data collection, analysis, and reporting by race, 
        ethnicity, and primary language across federally supported 
        health programs are essential for identifying, understanding 
        the causes of, monitoring, and eventually eliminating health 
        disparities.
            (7) Current health related data collection and reporting 
        activities largely reflect the efforts of the Department of 
        Health and Human Services. Despite considerable efforts by the 
        Department, data collection efforts governing racial, ethnic, 
        and health disparity populations remain inconsistent and 
        inadequate. They often quantify disparities but shed little 
        light on their causes.
            (8) Many Americans, and particularly racial and ethnic 
        minorities and other health disparity populations, miss 
        opportunities for preventive medical care. Similarly, 
        management of chronic illnesses in these populations presents 
        unique challenges to the nation's health care system.
            (9) The largest numbers of the medically underserved are 
        white individuals, and many of them have the same health care 
        access problems as do members of minority groups. Nearly 
        22,000,000 white individuals live below the poverty line with 
        many living in nonmetropolitan, rural areas such as Appalachia, 
        where the high percentage of countries designated as health 
        professional shortage areas (47 percent) and the high rate of 
        poverty contribute to disparity outcomes. However, there is a 
        higher proportion of racial and ethnic minorities in the United 
        States represented among the medically underserved.
            (10) While much research examines the question of racial 
        and ethnic differences in health care, less is known about the 
        magnitude and extent of differences in the quality of health 
        care related to nonsocioeconomic factors. Only recently have 
        scientists and quality improvement experts begun to address the 
        issue of how best to measure, track, and improve quality of 
        health care in diverse populations. Additional research in 
        order to understand the causes of disparities and develop 
        effective approaches to eliminate these gaps in health care 
        quality will be necessary.
            (11) There is a need to ensure appropriate representation 
        of racial and ethnic minorities, and other health disparity 
        populations, in the health care professions and in the fields 
        of biomedical, clinical, behavioral, and health services 
        research.
            (12) Preventable disparities in access to and quality of 
        health care are unacceptable. Health care delivered in the 
        United States should be care that is as safe, effective, 
        patient-centered, timely, efficient and equitable as possible.

TITLE I--IMPROVED HEALTH CARE QUALITY AND EFFECTIVE DATA COLLECTION AND 
                                ANALYSIS

SEC. 101. STANDARDIZED MEASURES OF QUALITY HEALTH CARE.

    (a) In General.--
            (1) Collaboration.--The Secretary of Health and Human 
        Services, the Secretary of Defense, the Secretary of Veterans 
        Affairs, the Director of the Indian Health Service, and the 
Director of the Office of Personnel Management (referred to in this 
section as the ``Secretaries'') shall work collaboratively to establish 
uniform, standardized health care quality measures across all Federal 
Government health programs. Such measures shall be designed to assess 
quality improvement efforts with regard to the safety, timeliness, 
effectiveness, patient-centeredness, and efficiency of health care 
delivered across all federally supported health care delivery programs 
including those in which health care services are delivered to health 
disparity populations.
            (2) Development of measures.--Relying on earlier work by 
        the Secretary of Health and Human Services or others (including 
        work such as the Healthy People 2010 or the IOM Quality Chasm 
        reports) and with an emphasis on health conditions 
        disproportionately affecting health disparity populations and 
        taking into account health literacy and primary language and 
        cultural factors, the Secretaries shall develop standardized 
        sets of quality measures for--
                    (A) 5 common health conditions by not later than 
                January 1, 2006; and
                    (B) an additional 10 common health conditions by 
                not later than January 1, 2007.
            (3) Pilot testing.--Each federally administered health care 
        program may conduct a pilot test of the quality measures 
        developed under paragraph (2) that shall include a collection 
        of patient-level data and a public release of comparative 
        performance reports.
    (b) Public Reporting Requirements.--The Secretaries shall work 
collaboratively to establish standardized public reporting requirements 
for clinicians, institutional providers, and health plans in each of 
the health programs described in subsection (a).
    (c) Full Implementation.--The Secretaries shall work 
collaboratively to prepare for the full implementation of all 
standardized sets of quality measures and reporting systems developed 
under subsections (a) and (b) by not later than January 1, 2009.
    (d) Progress Report.--The Secretary of Health and Human Services 
shall prepare an annual progress report that details the collaborative 
efforts carried out under subsection (a).
    (e) Comparative Quality Reports.--Beginning on January 1, 2008, in 
order to make comparative quality information available to health care 
consumers, including members of health disparity populations, health 
professionals, public health officials, researchers, and other 
appropriate individuals and entities, the Secretaries shall provide for 
the pooling and analysis of quality measures collected under this 
section. Nothing in this section shall be construed as modifying the 
privacy standards under the Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104-191).
    (f) Ongoing Evaluation of Use.--The Secretary of Health and Human 
Services shall ensure the ongoing evaluation of the use of the health 
care quality measures established under this section.
    (g) Existing Activities.--Notwithstanding any other provision of 
law, the standardized measures and reporting activities described in 
this section shall replace, to the extent practicable and appropriate, 
any existing measurement and reporting activities currently utilized by 
federally supported health care delivery programs.
    (h) Evaluation.--
            (1) Institute of medicine.--
                    (A) In general.--The Secretary of Health and Human 
                Services shall request the Institute of Medicine to 
                conduct an evaluation of the collaborative efforts of 
                the Secretaries to establish uniform, standardized 
                health care quality measures and reporting requirements 
                for federally supported health care delivery programs 
                as required under this section.
                    (B) Report.--Not later than 2 years after the date 
                of enactment of this Act, the Institute of Medicine 
                shall submit a report concerning the results of the 
                evaluation under subparagraph (A) to the Secretary.
            (2) Regulations.--
                    (A) Proposed.--Not later than 18 months after the 
                date on which the report is submitted under paragraph 
                (1)(B), the Secretary shall publish proposed 
                regulations regarding the uniform, standardized health 
                care quality measures and reporting requirements 
                described in this section.
                    (B) Final regulations.--Not later than 3 years 
                after the date on which the report is submitted under 
                paragraph (1)(B), the Secretary shall publish final 
                regulations regarding the uniform, standardized health 
                care quality measures and reporting requirements 
                described in this section.

SEC. 102. DATA COLLECTION.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall--
            (1) ensure that data collected under the medicare program 
        under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.) are accurate by race, ethnicity, and primary language and 
        available for inclusion in the National Health Disparities 
        Report;
            (2) enforce State data collection and reporting by race, 
        ethnicity, and primary language for enrollees in the medicaid 
        program under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.) and the State Children's Health Insurance Program 
        under title XXI of such Act (42 U.S.C. 1397aa et seq.) and 
        ensure that such data are available for inclusion in the 
        National Health Disparities Report;
            (3) ensure that ongoing and any new program initiatives--
                    (A) collect and report data by race, ethnicity, and 
                primary language and provide technical assistance to 
                promote compliance;
                    (B) address technological difficulties;
                    (C) ensure privacy and confidentiality of data 
                collected; and
                    (D) implement effective educational strategies;
            (4) expand educational programs to inform insurers, 
        providers, agencies and the public of the importance of data 
        collection by race, ethnicity, and primary language to 
        improving health care access and quality;
            (5) raise awareness that these data are critical for 
        achieving Healthy People 2010 goals and essential to the 
        nondiscrimination requirements of title VI of the Civil Rights 
        Act (42 U.S.C. 2000d et seq.); and
            (6) support research on existing best practices for data 
        collection.
    (b) Grants for Data Collection by Health Plans, Health Centers, and 
Hospitals.--
            (1) In general.--The Secretary, acting through the Director 
        of the Agency for Healthcare Research and Quality, may support 
        or conduct not to exceed 20 demonstration programs to enhance 
        the collection, analysis, and reporting of the data required 
        under this section.
            (2) Eligibility.--To be eligible to receive a grant under 
        this section an entity shall--
                    (A) be a health plan, federally qualified health 
                center or health center network, or hospital; and
                    (B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such as information as the Secretary may 
                require.
            (3) Use of funds.--A grantee shall use amounts received 
        under a grant under this subsection to--
                    (A) collect, analyze, and report data by race, 
                ethnicity, or other health disparity category for 
                patients served by the grantee, including--
                            (i) in the case of a hospital, emergency 
                        room patients and patients served on an 
                        inpatient or outpatient basis;
                            (ii) in the case of a health plan, data for 
                        enrollees; and
                            (iii) in the case of a federally qualified 
                        health center or health center network, primary 
                        care, specialty care, and referrals;
                    (B) provide analyses of racial, ethnic and other 
                disparities in health and health care, including 
                specific disease conditions, diagnostic and therapeutic 
                procedures, or outcomes;
                    (C) 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;
                    (D) develop mechanisms for sharing collected data, 
                subject to applicable privacy and confidentiality 
                regulations;
                    (E) 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 health care; and
                    (F) ensure the evaluation of activities conducted 
                under this section.

            TITLE II--EXPANDED ACCESS TO QUALITY HEALTH CARE

              Subtitle A--Access, Awareness, and Outreach

SEC. 201. ACCESS AND AWARENESS GRANTS.

    (a) Demonstration Projects.--The Secretary of Health and Human 
Services (in this section referred to as the ``Secretary'') may award 
contracts or competitive grants to eligible entities to support 
demonstration projects designed to improve the health and health care 
of health disparity populations through improved access to health care, 
health care navigation assistance, and health literacy education.
    (b) Eligible Entity Defined.--In this section the term ``eligible 
entity'' means--
            (1) a hospital;
            (2) an academic institution;
            (3) a State health agency;
            (4) an Indian Health Service hospital or clinic, Indian 
        tribal health facility, or urban Indian facility;
            (5) a nonprofit organization including a faith-based 
        organization or consortia, to the extent that a grant awarded 
        to such an entity is consistent with the requirements of 
        section 1955 of the Public Health Service Act (42 U.S.C. 300x-
        65) relating to grant award to nongovernmental entities;
            (6) a primary care practice-based research network as 
        defined by the Director of the Agency for Healthcare Research 
        and Quality;
            (7) a federally qualified health center (as defined in 
        section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 
        1396d(l)(2)(B))); or
            (8) any other entity determined to be appropriate by the 
        Secretary.
    (c) Application.--An eligible entity seeking a grant under this 
section shall submit an application to the Secretary at such time, in 
such manner, and containing such information as the Secretary may 
require, including assurances that the eligible entity will--
            (1) target patient populations that are members of racial 
        and ethnic minority groups or health disparity populations 
        through specific outreach activities;
            (2) coordinate with appropriate community organizations and 
        include appropriate community participation in planning and 
        implementation of activities;
            (3) coordinate culturally competent and appropriate care;
            (4) include a plan to ensure that the entity will become 
        self-sustaining when funding under the grant terminates; and
            (5) include quality and outcomes performance measures to 
        evaluate the effectiveness of activities funded under this 
        section to ensure that the activities are meeting their goals, 
        and disseminate findings from such evaluations.
    (d) Priorities.--In awarding contracts and grants under this 
section, the Secretary shall give priority to applicants that intend to 
use amounts received under this section to carry out all programs 
specified under subsection (e).
    (e) Use of Funds.--An eligible entity shall use amounts received 
under this section to carry out programs that involve at least 2 of the 
following:
            (1) Providing resources and guidance to individuals 
        regarding sources of health insurance coverage, as well as 
        information on how to obtain health coverage in the private 
        insurance market, through Federal and State programs, and 
        through other available coverage options.
            (2) Providing patient navigator services to help 
        individuals better utilize their health coverage by working 
        through the health system to obtain appropriate quality care, 
        including programs in which--
                    (A) trained individuals (such as representatives 
                from the community, nurses, social workers, physicians, 
                or patient advocates) are assigned to act as contacts--
                            (i) within the community; or
                            (ii) within the health care system, to 
                        facilitate access to health care services;
                    (B) partnerships are created with community 
                organizations (which may include hospitals, federally 
                qualified health centers or health center networks, 
                faith-based organizations, primary care providers, home 
                care, nonprofit organizations, health plans, or other 
                health providers determined appropriate by the 
                Secretary) to help facilitate access or to improve the 
                quality of care;
                    (C) activities are conducted to coordinate care and 
                preventive services and referrals;
                    (D) services are provided for translation, 
                interpretation, and other such linguistic services for 
                patients with limited English proficiency; or
                    (E) an entity receiving a grant under this section 
                negotiates on behalf of the patient with relevant 
                entities, or provides referrals and guides the patient 
                through the mediation or arbitration process, to 
                resolve issues that impede access to care.
            (3) Promoting broad health awareness and prevention 
        efforts, including patient education and health literacy 
        programs to help increase a patient's knowledge of how to best 
        participate in such patient's and such patient's children's 
        treatment decisions.
            (4) Enhancing preventive services and coordinated, 
        multidisciplinary disease management of chronic conditions, 
        such as diabetes mellitus, HIV/AIDS, asthma, cancer, 
        cardiovascular disease, and obesity.
    (f) Report.--Not later than 3 years after the date an entity 
receives a grant under this section and annually thereafter, the entity 
shall provide to the Secretary a report containing the results of any 
evaluation conducted pursuant to subsection (c)(5).
    (g) 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 2009.

SEC. 202. INNOVATIVE OUTREACH PROGRAMS.

    (a) Grants To Promote Innovative Outreach and Enrollment Under 
Medicaid and SCHIP.--Section 2104(e) of the Social Security Act (42 
U.S.C. 1397dd(e)) is amended--
            (1) by striking ``Amounts allotted'' and inserting the 
        following:
            ``(1) In general.--Subject to paragraph (2), amounts 
        allotted''; and
            (2) by adding at the end the following:
            ``(2) Grants to promote innovative outreach and enrollment 
        efforts.--
                    ``(A) In general.--Prior to September 30 of each 
                fiscal year, beginning with fiscal year 2004, the 
                Secretary shall reserve from any unexpended allotments 
                made to States under subsection (b) or (c) (including 
                any portion of such allotments that were redistributed 
                under subsection (f) or (g)) for a fiscal year that 
                would revert to the Treasury on October 1 of the 
                succeeding fiscal year but for the application of this 
                paragraph, the lesser of $50,000,000 or the total 
                amount of such unexpended allotments for purposes of 
                awarding grants under this paragraph for such 
                succeeding fiscal year to States or national, local, 
                and community-based public or nonprofit private 
                organizations to conduct innovative outreach and 
                enrollment efforts that are designed to increase the 
                enrollment and participation of eligible children under 
                this title and title XIX.
                    ``(B) Priority for grants in certain areas.--In 
                making grants under subparagraph (A)(ii), the Secretary 
                shall give priority to grant applicants that propose to 
                target geographic areas--
                            ``(i) with high rates of eligible but 
                        unenrolled children, including such children 
                        who reside in rural areas;
                            ``(ii) with high rates of families for whom 
                        English is not their primary language; or
                            ``(iii) with high rates of racial and 
                        ethnic minorities and health disparity 
                        populations.
                    ``(C) Application.--An organization that desires to 
                receive a grant under this paragraph shall submit an 
                application to the Secretary in such form and manner, 
                and containing such information, as the Secretary may 
                decide. Such application shall include quality and 
                outcomes performance measures to evaluate the 
effectiveness of activities funded by a grant under this paragraph to 
ensure that the activities are meeting their goals, and disseminate 
findings from such evaluations.''.
    (b) Demonstrations To Reduce Health Disparities.--
            (1) In general.--The Secretary of Health and Human Services 
        shall, through contracts or grants to public and private 
        entities, support demonstration programs for the purpose of 
        conducting interventions among health disparity populations 
        to--
                    (A) target, identify, and reduce or prevent 
                behavioral risk factors that contribute to health 
                disparities;
                    (B) promote translation, interpretation, and other 
                such linguistic services for patients with limited 
                English speaking proficiency;
                    (C) promote preventive services; or
                    (D) enhance coordinated, multidisciplinary disease 
                management of chronic conditions, such as diabetes 
                mellitus, HIV/AIDS, asthma, cancer, and obesity.
            (2) Application.--An entity desiring a contract or grant 
        under paragraph (1) shall submit an application to the 
        Secretary of Health and Human Services in such form and manner, 
        and containing such information, as the Secretary may require.
            (3) 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 2009.

             Subtitle B--Refundable Health Insurance Credit

SEC. 211. REFUNDABLE HEALTH INSURANCE COSTS CREDIT.

    (a) Allowance of Credit.--
            (1) In general.--Subpart C of part IV of subchapter A of 
        chapter 1 of the Internal Revenue Code of 1986 (relating to 
        refundable personal credits) is amended by redesignating 
        section 36 as section 37 and by inserting after section 35 the 
        following new section:

``SEC. 36. HEALTH INSURANCE COSTS FOR UNINSURED INDIVIDUALS.

    ``(a) Allowance of Credit.--In the case of an individual, there 
shall be allowed as a credit against the tax imposed by this subtitle 
for the taxable year an amount equal to the amount paid by the taxpayer 
during such taxable year for qualified health insurance for the 
taxpayer and the taxpayer's spouse and dependents.
    ``(b) Limitations.--
            ``(1) In general.--The amount allowed as a credit under 
        subsection (a) to the taxpayer for the taxable year shall not 
        exceed the lesser of--
                    ``(A) the sum of the monthly limitations for 
                coverage months during such taxable year for the 
                individuals referred to in subsection (a) for whom the 
                taxpayer paid during the taxable year any amount for 
                coverage under qualified health insurance, or
                    ``(B) 90 percent of the sum of the amounts paid by 
                the taxpayer for qualified health insurance for each 
                such individual for coverage months of the individual 
                during the taxable year.
            ``(2) Monthly limitation.--
                    ``(A) In general.--The monthly limitation for an 
                individual for each coverage month of such individual 
                during the taxable year is the amount equal to \1/12\ 
                of--
                            ``(i) $1,000 if such individual is the 
                        taxpayer,
                            ``(ii) $1,000 if--
                                    ``(I) such individual is the spouse 
                                of the taxpayer,
                                    ``(II) the taxpayer and such spouse 
                                are married as of the first day of such 
                                month, and
                                    ``(III) the taxpayer files a joint 
                                return for the taxable year, and
                            ``(iii) $500 if such individual is an 
                        individual for whom a deduction under section 
                        151(c) is allowable to the taxpayer for such 
                        taxable year.
                    ``(B) Limitation to 2 dependents.--Not more than 2 
                individuals may be taken into account by the taxpayer 
                under subparagraph (A)(iii).
                    ``(C) Special rule for married individuals.--In the 
                case of a taxpayer--
                            ``(i) who is married (within the meaning of 
                        section 7703) as of the close of the taxable 
                        year but does not file a joint return for such 
                        year, and
                            ``(ii) who does not live apart from such 
                        taxpayer's spouse at all times during the 
                        taxable year,
                the dollar limitation imposed under subparagraph 
                (A)(iii) shall be divided equally between the taxpayer 
                and the taxpayer's spouse unless they agree on a 
                different division.
            ``(3) Income phaseout of credit percentage.--
                    ``(A) Phaseout for single coverage.--If a taxpayer 
                with self-only coverage has modified adjusted gross 
                income in excess of $15,000 for a taxable year, the 90 
                percent under paragraph (1)(B) shall be reduced (but 
                not below zero) by--
                            ``(i) 2 percentage points for each $250 of 
                        such income in excess of $15,000 but not in 
                        excess of $20,000, and
                            ``(ii) 1.25 percentage points for each $250 
                        of such income in excess of $20,000.
                    ``(B) Amount of reduction for family coverage.--If 
                a taxpayer with family coverage has modified adjusted 
                gross income in excess of $25,000 for a taxable year, 
                the 90 percent under paragraph (1)(B) shall be reduced 
                (but not below zero) by--
                            ``(i) in the case of family coverage 
                        covering only 1 adult, 1.5 percentage points 
                        for each $250 of such excess, and
                            ``(ii) in the case of family coverage 
                        covering more than 1 adult, 0.643 percentage 
                        points for each $250 of such excess.
                Any percentage resulting from a reduction under clause 
                (ii) shall be rounded to the nearest one-tenth of a 
                percent.
                    ``(C) Modified adjusted gross income.--The term 
                `modified adjusted gross income' means adjusted gross 
                income determined--
                            ``(i) without regard to this section and 
                        sections 911, 931, and 933, and
                            ``(ii) after application of sections 86, 
                        135, 137, 219, 221, and 469.
    ``(c) Coverage Month.--For purposes of this section--
            ``(1) In general.--The term `coverage month' means, with 
        respect to an individual, any month if--
                    ``(A) as of the first day of such month such 
                individual is covered by qualified health insurance, 
                and
                    ``(B) the premium for coverage under such insurance 
                for such month is paid by the taxpayer.
            ``(2) Employer-subsidized coverage.--
                    ``(A) In general.--The term `coverage month' shall 
                not include any month for which such individual is 
                eligible to participate in any subsidized health plan 
                (within the meaning of section 162(l)(2)) maintained by 
                any employer of the taxpayer or of the spouse of the 
                taxpayer. A subsidized health plan shall not include a 
                plan substantially all of the coverage of which is of 
                excepted benefits described in section 9832(c).
                    ``(B) Premiums to nonsubsidized plans.--If an 
                employer of the taxpayer or the spouse of the taxpayer 
                maintains a health plan which is not a subsidized 
                health plan (as so defined) and which constitutes 
                qualified health insurance, employee contributions to 
                the plan shall be treated as amounts paid for qualified 
                health insurance.
            ``(3) Cafeteria plan and flexible spending account 
        beneficiaries.--The term `coverage month' shall not include any 
        month during a taxable year if any amount is not includible in 
        the gross income of the taxpayer for such year under section 
        106 with respect to--
                    ``(A) a benefit chosen under a cafeteria plan (as 
                defined in section 125(d)), or
                    ``(B) a benefit provided under a flexible spending 
                or similar arrangement.
            ``(4) Medicare, medicaid, and schip.--The term `coverage 
        month' shall not include any month with respect to an 
        individual if, as of the first day of such month, such 
        individual--
                    ``(A) is entitled to any benefits under part A of 
                title XVIII of the Social Security Act or is enrolled 
                under part B of such title, or
                    ``(B) is enrolled in the program under title XIX or 
                XXI of such Act (other than under section 1928 of such 
                Act).
            ``(5) Certain other coverage.--The term `coverage month' 
        shall not include any month during a taxable year with respect 
        to an individual if, at any time during such year, any benefit 
        is provided to such individual under--
                    ``(A) chapter 89 of title 5, United States Code,
                    ``(B) chapter 55 of title 10, United States Code,
                    ``(C) chapter 17 of title 38, United States Code, 
                or
                    ``(D) any medical care program under the Indian 
                Health Care Improvement Act.
            ``(6) Prisoners.--The term `coverage month' shall not 
        include any month with respect to an individual if, as of the 
        first day of such month, such individual is imprisoned under 
        Federal, State, or local authority.
            ``(7) Insufficient presence in united states.--The term 
        `coverage month' shall not include any month during a taxable 
        year with respect to an individual if such individual is 
        present in the United States on fewer than 183 days during such 
        year (determined in accordance with section 7701(b)(7)).
    ``(d) Qualified Health Insurance.--For purposes of this section--
            ``(1) In general.--The term `qualified health insurance' 
        means health insurance coverage (as defined in section 
        9832(b)(1)) which--
                    ``(A) is coverage described in paragraph (2), and
                    ``(B) meets the requirements of paragraph (3).
            ``(2) Eligible coverage.--Coverage described in this 
        paragraph is the following:
                    ``(A) Coverage under individual health insurance.
                    ``(B) Coverage under a group health plan (as 
                defined in section 5000 without regard to subsection 
                (d)).
                    ``(C) Coverage through a private sector health care 
                coverage purchasing pool.
                    ``(D) Coverage under a State high risk pool 
                described in subparagraph (C) of section 35(e)(1).
                    ``(E) Continuation coverage described in 
                subparagraph (A) or (B) of section 35(a)(1).
                    ``(F) Coverage under an eligible State buyin 
                program.
            ``(3) Requirements.--The requirements of this paragraph are 
        as follows:
                    ``(A) Cost limits.--Under the coverage, the sum of 
                the annual deductible and the other annual out-of-
                pocket expenses required to be paid (other than 
                premiums) for covered benefits does not exceed--
                            ``(i) $5,000 for self-only coverage, and
                            ``(ii) twice the dollar amount in clause 
                        (i) for family coverage, or
                    ``(B) Maximum benefits.--Under the coverage, the 
                annual and lifetime maximum benefits are not less than 
                $700,000.
            ``(4) Eligible state buyin program.--For purposes of 
        paragraph (2)(F)--
                    ``(A) In general.--The term `eligible State buyin 
                program' means a State program under which an 
                individual not otherwise eligible for assistance under 
                the State medicaid program under title XIX of the 
                Social Security Act or the State children's health 
                insurance program under title XXI of such Act is able 
                to buy health insurance coverage through a purchasing 
                arrangement entered into between the State and a 
                private sector health care purchasing group or health 
                plan for purposes of providing health insurance 
                coverage to recipients of assistance under such program 
                or for purposes of providing such coverage to State 
                employees.
                    ``(B) Requirements.--Subparagraph (A) shall only 
                apply to a State program if--
                            ``(i) the program uses private sector 
                        health care purchasing groups or health plans, 
                        and
                            ``(ii) the State maintains separate risk 
                        pools for participants under the State program.
    ``(e) Archer MSA Contributions; HSA Contributions.--If a deduction 
would be allowed under section 220 to the taxpayer for a payment for 
the taxable year to the Archer MSA of an individual or under section 
223 to the taxpayer for a payment for the taxable year to the Health 
Savings Account of such individual, subsection (a) shall not apply to 
the taxpayer for any month during such taxable year for which the 
taxpayer, spouse, or dependent is an eligible individual for purposes 
of either such section.
    ``(f) Inflation Adjustment.--
            ``(1) In general.--In the case of any taxable year 
        beginning after 2004, each dollar amount referred to in 
        subsections (b)(2)(A) and (d)(3) shall be increased by an 
        amount equal to--
                    ``(A) such dollar amount, multiplied by
                    ``(B) the cost-of-living adjustment determined 
                under section 213(d)(10)(B)(ii) for the calendar year 
                in which the taxable year begins, except that `2003' 
                shall be substituted for `1996' in subclause (II) 
                thereof.
            ``(2) Rounding.--If any amount as adjusted under paragraph 
        (1) is not a multiple of $10, such amount shall be rounded to 
        the next lowest multiple of $10.
    ``(g) Special Rules.--
            ``(1) Coordination with medical expense deduction.--The 
        amount which would (but for this paragraph) be taken into 
        account by the taxpayer under section 213 for the taxable year 
        shall be reduced by the credit (if any) allowed by this section 
        to the taxpayer for such year.
            ``(2) Coordination with deduction for health insurance 
        costs of self-employed individuals.--In the case of a taxpayer 
        who is eligible to deduct any amount under section 162(l) for 
        the taxable year, this section shall apply only if the taxpayer 
        elects not to claim any amount as a deduction under such 
        section for such year.
            ``(3) Denial of credit to dependents.--No credit shall be 
        allowed under this section to any individual with respect to 
        whom a deduction under section 151 is allowable to another 
        taxpayer for a taxable year beginning in the calendar year in 
        which such individual's taxable year begins.
            ``(4) Coordination with advance payment.--Rules similar to 
        the rules of section 35(g)(1) shall apply to any credit to 
        which this section applies.
            ``(5) Coordination with section 35.--If a taxpayer is 
        eligible for the credit allowed under this section and section 
        35 for any taxable year, the taxpayer shall elect which credit 
        is to be allowed.
    ``(h) Expenses Must Be Substantiated.--A payment for insurance to 
which subsection (a) applies may be taken into account under this 
section only if the taxpayer substantiates such payment in such form as 
the Secretary may prescribe.
    ``(i) Regulations.--The Secretary shall prescribe such regulations 
as may be necessary to carry out the purposes of this section.''.
    (b) Information Reporting.--
            (1) In general.--Subpart B of part III of subchapter A of 
        chapter 61 of the Internal Revenue Code of 1986 (relating to 
        information concerning transactions with other persons) is 
        amended by inserting after section 6050T the following:

``SEC. 6050U. RETURNS RELATING TO PAYMENTS FOR QUALIFIED HEALTH 
              INSURANCE.

    ``(a) In General.--Any person who, in connection with a trade or 
business conducted by such person, receives payments during any 
calendar year from any individual for coverage of such individual or 
any other individual under creditable health insurance, shall make the 
return described in subsection (b) (at such time as the Secretary may 
by regulations prescribe) with respect to each individual from whom 
such payments were received.
    ``(b) Form and Manner of Returns.--A return is described in this 
subsection if such return--
            ``(1) is in such form as the Secretary may prescribe, and
            ``(2) contains--
                    ``(A) the name, address, and TIN of the individual 
                from whom payments described in subsection (a) were 
                received,
                    ``(B) the name, address, and TIN of each individual 
                who was provided by such person with coverage under 
                creditable health insurance by reason of such payments 
                and the period of such coverage,
                    ``(C) the aggregate amount of payments described in 
                subsection (a), and
                    ``(D) such other information as the Secretary may 
                reasonably prescribe.
    ``(c) Creditable Health Insurance.--For purposes of this section, 
the term `creditable health insurance' means qualified health insurance 
(as defined in section 36(d)).
    ``(d) Statements To Be Furnished to Individuals With Respect to 
Whom Information Is Required.--Every person required to make a return 
under subsection (a) shall furnish to each individual whose name is 
required under subsection (b)(2)(A) to be set forth in such return a 
written statement showing--
            ``(1) the name and address of the person required to make 
        such return and the phone number of the information contact for 
        such person,
            ``(2) the aggregate amount of payments described in 
        subsection (a) received by the person required to make such 
        return from the individual to whom the statement is required to 
        be furnished, and
            ``(3) the information required under subsection (b)(2)(B) 
        with respect to such payments.
The written statement required under the preceding sentence shall be 
furnished on or before January 31 of the year following the calendar 
year for which the return under subsection (a) is required to be made.
    ``(e) Returns Which Would Be Required To Be Made by 2 or More 
Persons.--Except to the extent provided in regulations prescribed by 
the Secretary, in the case of any amount received by any person on 
behalf of another person, only the person first receiving such amount 
shall be required to make the return under subsection (a).''.
            (2) Assessable penalties.--
                    (A) Subparagraph (B) of section 6724(d)(1) of such 
                Code (relating to definitions) is amended by 
                redesignating clauses (xii) through (xviii) as clauses 
                (xiii) through (xix), respectively, and by inserting 
                after clause (xi) the following:
                            ``(xii) section 6050U (relating to returns 
                        relating to payments for qualified health 
                        insurance),''.
                    (B) Paragraph (2) of section 6724(d) of such Code 
                is amended by striking ``or'' at the end of 
                subparagraph (AA), by striking the period at the end of 
                the subparagraph (BB) and inserting ``, or'', and by 
                adding at the end the following:
                    ``(CC) section 6050U(d) (relating to returns 
                relating to payments for qualified health 
                insurance).''.
            (3) Clerical amendment.--The table of sections for subpart 
        B of part III of subchapter A of chapter 61 of such Code is 
        amended by inserting after the item relating to section 6050T 
        the following:

                              ``Sec. 6050U. Returns relating to 
                                        payments for qualified health 
                                        insurance.''.
    (c) Criminal Penalty for Fraud.--Subchapter B of chapter 75 of the 
Internal Revenue Code of 1986 (relating to other offenses) is amended 
by adding at the end the following:

``SEC. 7276. PENALTIES FOR OFFENSES RELATING TO HEALTH INSURANCE TAX 
              CREDIT.

    ``Any person who knowingly misuses Department of the Treasury 
names, symbols, titles, or initials to convey the false impression of 
association with, or approval or endorsement by, the Department of the 
Treasury of any insurance products or group health coverage in 
connection with the credit for health insurance costs under section 36 
shall on conviction thereof be fined not more than $10,000, or 
imprisoned not more than 1 year, or both.''.
    (d) Conforming Amendments.--
            (1) Section 162(l) of the Internal Revenue Code of 1986 is 
        amended by adding at the end the following:
            ``(6) Election to have subsection apply.--No deduction 
        shall be allowed under paragraph (1) for a taxable year unless 
        the taxpayer elects to have this subsection apply for such 
        year.''.
            (2) Paragraph (2) of section 1324(b) of title 31, United 
        States Code, is amended by inserting before the period ``, or 
        from section 36 of such Code''.
            (3) The table of sections for subpart C of part IV of 
        subchapter A of chapter 1 of the Internal Revenue Code of 1986 
        is amended by striking the last item and inserting the 
        following:

                              ``Sec. 36. Health insurance costs for 
                                        uninsured individuals.
                              ``Sec. 37. Overpayments of tax.''
            (4) The table of sections for subchapter B of chapter 75 of 
        such Code is amended by adding at the end the following:

                              ``Sec. 7276. Penalties for offenses 
                                        relating to health insurance 
                                        tax credit.''
    (e) Effective Dates.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section shall apply to taxable years 
        beginning after December 31, 2003, without regard to whether 
        final regulations to carry out such amendments have been 
        promulgated by such date.
            (2) Penalties.--The amendments made by subsections (c) and 
        (d)(4) shall take effect on the date of the enactment of this 
        Act.

SEC. 212. ADVANCE PAYMENT OF CREDIT TO ISSUERS OF QUALIFIED HEALTH 
              INSURANCE.

    (a) In General.--Chapter 77 of the Internal Revenue Code of 1986 
(relating to miscellaneous provisions) is amended by adding at the end 
the following:

``SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH INSURANCE COSTS OF 
              ELIGIBLE INDIVIDUALS.

    ``(a) General Rule.--Not later than January 1, 2005, the Secretary 
shall establish a program for making payments on behalf of certified 
individuals to providers of qualified health insurance (as defined in 
section 36(d)) for such individuals.
    ``(b) Program Options.--The program under subsection (a) may--
            ``(1) provide that payments may be made on the basis of 
        modified adjusted gross income of certified individuals for the 
        preceding taxable year, and
            ``(2) provide that, in lieu of payments to providers, the 
        following amounts may be offset:
                    ``(A) Amounts required to be deposited by the 
                provider as estimated income tax under section 6654 or 
                6655.
                    ``(B) Amounts required to be deducted and withheld 
                under section 3401 (relating to wage withholding).
                    ``(C) Taxes imposed under section 3111(a) or 50 
                percent of taxes imposed under section 1401(a) 
                (relating to FICA employer taxes).
                    ``(D) Amounts required to be deducted under section 
                3102 with respect to taxes imposed under section 
                3101(a) or 50 percent of taxes imposed under section 
                1401(a) (relating to FICA employee taxes).
    ``(c) Certified Individual.--For purposes of this section, the term 
`certified individual' means any individual for whom a qualified health 
insurance credit eligibility certificate is in effect.
    ``(d) Qualified Health Insurance Credit Eligibility Certificate.--
For purposes of this section, a qualified health insurance credit 
eligibility certificate is a statement furnished by an individual to a 
provider of qualified health insurance which--
            ``(1) certifies that the individual will be eligible to 
        receive the credit provided by section 36 for the taxable year,
            ``(2) estimates the amount of such credit for such taxable 
        year, and
            ``(3) provides such other information as the Secretary may 
        require for purposes of this section.''
    (b) Clerical Amendment.--The table of sections for chapter 77 of 
the Internal Revenue Code of 1986 is amended by adding at the end the 
following:

                              ``Sec. 7529. Advance payment of health 
                                        insurance credit for purchasers 
                                        of qualified health 
                                        insurance.''
    (c) Effective Date.--The amendments made by this section shall take 
effect on July 1, 2005, without regard to whether final regulations to 
carry out such amendments have been promulgated by such date.

  TITLE III--STRONG NATIONAL LEADERSHIP, COOPERATION, AND COORDINATION

SEC. 301. OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES.

    (a) In General.--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 health disparities''; and

            (2) in subsection (a)--
                    (A) by striking ``Office of Minority Health'' each 
                place that such appears and inserting ``Office of 
                Minority Health and Health Disparities''; and
                    (B) by striking ``for Minority Health'' and 
                inserting ``for Minority Health and Health 
                Disparities''.
    (b) Duties.--Section 1707(b) of the Public Health Service Act (42 
U.S.C. 300u-6(b)) is amended--
            (1) in the matter preceding paragraph (1)--
                    (A) by inserting ``and health disparity 
                populations'' after ``groups'' and
                    (B) by striking ``for Minority Health'' and 
                inserting ``for Minority Health and Health 
                Disparities'';
            (2) in paragraph (1)--
                    (A) by striking ``Establish'' and all that follows 
                through ``coordinate'' and inserting ``Coordinate''; 
                and
            (B) by striking ``such individuals'' and inserting ``health 
        disparities'';
            (4) in paragraph (1)
            (3) in paragraph (5), by inserting ``or health disparity 
        populations'' after ``minority groups'';
            (4) in paragraph (6), by inserting ``or health disparity 
        population'' after ``minority group'';
            (5) by striking paragraphs (7) and (9);
            (6) by redesignating paragraphs (1), (2), (3), (4), (5), 
        (6), (8), and (10) as paragraphs (3), (4), (6), (7), (9), (10), 
        (11), and (12), respectively;
            (7) by inserting before paragraph (3) (as so redesignated) 
        the following:
            ``(1) Establish specific short- and long-term goals and 
        objectives for analyzing the causes of health disparities and 
        addressing them, with a particular focus on the areas of health 
        promotion, disease prevention, chronic care and research.
            ``(2) Work with agencies within the Department of Health 
        and Human Services and with the Surgeon General to establish a 
        strategic plan to analyze and address the causes of health 
        disparities. The plan shall include recommendations to improve 
        the collection, analysis, and reporting of data at the Federal, 
        State, territorial, Tribal, and local levels, including how 
        to--
                    ``(A) implement data collection while minimizing 
                the cost and administrative burdens of data collection 
                and reporting;
                    ``(B) expand awareness of the importance of such 
                data collection to improving health care quality; and
                    ``(C) provide researchers with greater access to 
                racial, ethnic, and other health disparity data.'';
            (8) by inserting after paragraph (4) (as so redesignated), 
        the following:
            ``(5) Increase awareness of disparities in health care 
        among health care providers, health plans, and the public.'';
            (9) in paragraph (6) (as so redesignated)--
                    (A) by striking ``Support'' and inserting ``In 
                cooperation with the appropriate agencies, support'';
                    (B) by inserting before the period the following: 
                ``for--
                    ``(A) expanding health care access;
                    ``(B) improving health care quality; and
                    ``(C) increasing health care educational 
                opportunity.'';
            (10) by inserting after paragraph (7) (as so redesignated), 
        the following:
            ``(8) Consistent with section 102 of the Closing the Health 
        Care Gap Act of 2004, coordinate the classification and 
        collection of health care data to allow for the ongoing 
        analysis of the causes of disparities and monitoring of 
        progress toward the elimination of disparities.''; and
            (11) by inserting after paragraph (12), as so redesignated, 
        the following:
            ``(13) Work with Federal agencies and departments outside 
        of the Department of Health and Human Services to maximize 
        program resources available to understand why disparities 
        exist, and effective ways to reduce and eliminate disparities.
            ``(14) Support a center for linguistic and cultural 
        competence to carry out the following:
                    ``(A) With respect to individuals who lack 
                proficiency in speaking the English language, enter 
                into contracts with public and nonprofit private 
                providers of primary health services for the purpose of 
                increasing the access of such individuals to such 
                services by developing and carrying out programs to 
                provide bilingual or interpretive services.
                    ``(B) Carry out programs to improve access to 
                health care services for individuals with limited 
                proficiency in speaking the English language. 
                Activities under this subparagraph shall include 
                developing and evaluating model projects.''.
    (c) Advisory Committee.--Section 1707(c) of the Public Health 
Service Act (42 U.S.C. 300u-6(c)) is amended--
            (1) in paragraph (1), by inserting ``and Health 
        Disparities'' after ``Minority Health'';
            (2) in paragraph (2), by inserting ``and health disparity 
        populations'' after ``minority group''; and
            (3) in paragraph (4)(B)--
                    (A) by inserting ``and health disparities'' after 
                ``minority health''; and
                    (B) by inserting ``and health disparity 
                populations'' after ``minority groups''.
    (d) Duty Requirements.--Section 1707(d) of the Public Health 
Service Act (42 U.S.C. 300u-6(d)) is amended--
            (1) in paragraph (1)(A), by striking ``(b)(9)'' and 
        inserting ``(b)(14);
            (2) in paragraph (1)(B), by striking ``(b)(10)'' and 
        inserting ``(b)(13)''; and
            (3) in paragraph (3), insert ``take into account the unique 
        cultural or linguistic issues facing such populations and'' 
        after ``subsection (b)''.
    (e) Reports.--Section 1707(f) of the Public Health Service Act (42 
U.S.C. 300u-6(f)) is amended--
            (1) in paragraph (1)--
                    (A) by striking the subsection heading and 
                inserting ``Report on activities.--'';
                    (B) by striking ``1999'' and inserting ``2006'';
                    (C) by striking ``Committee on Energy and Commerce 
                of the House of Representatives, and to the Committee 
                on Labor and Human Resources of the Senate'' and 
                inserting ``appropriate committees of Congress''; and
                    (D) by inserting ``and health disparity 
                populations'' after ``racial and ethnic minority 
                groups'';
            (2) in paragraph (2)--
                    (A) by striking ``1999'' and inserting ``2005''; 
                and
                    (B) by inserting ``and health disparity'' after 
                ``minority health'';
            (3) by redesignating paragraph (1) and (2) as paragraphs 
        (2) and (3), respectively; and
            (4) by inserting after the subsection heading, the 
        following:
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Closing the Health Care Gap Act of 2004, the 
        Secretary shall submit to the appropriate committees of 
        Congress, a report on the plan developed under subsection 
        (b)(2).''.
    (f) Authorization of Appropriations.--Section 1707(h) of the Public 
Health Service Act (42 U.S.C. 300u-6(h)) is amended--
            (1) by striking ``Funding.--'' and all that follows through 
        the paragraph designation in paragraph (1); and
            (2) by striking ``$30,000,000'' and all that follows 
        through the period and inserting ``$50,000,000 for fiscal year 
        2005, such sums as may be necessary for each of fiscal years 
        2006 through 2009.''.

       TITLE IV--PROFESSIONAL EDUCATION, AWARENESS, AND TRAINING

SEC. 401. WORKFORCE DIVERSITY AND TRAINING.

    (a) Purpose.--Part B of title VII of the Public Health Service Act 
(42 U.S.C. 293 et seq.) is amended by inserting before section 736 the 
following:

``SEC. 736A. PURPOSE OF PROGRAM.

    ``It is the purpose of this part to improve health care quality and 
access in medically underserved communities, to improve the cultural 
competence of health care providers by increasing minority 
representation in the health professions, and to strengthen the 
research and education programs of designated health professions 
schools that disproportionately serve health disparity populations.''.
    (b) Centers of Excellence.--Section 736 of the Public Health 
Service Act (42 U.S.C. 293) is amended--
            (1) by striking subsection (a) and inserting the following:
    ``(a) In General.--The Secretary shall make grants to, and enter 
into contracts with, public and nonprofit private health or educational 
entities, including designated health professions schools described in 
subsection (c), for the purpose of assisting the schools in supporting 
programs of excellence in health professions education for racial or 
ethnic minority or health disparity populations.'';
            (2) in subsection (b)--
                    (A) in paragraph (2), by striking ``under-
                represented minority'' and inserting ``racial or ethnic 
                minority'';
                    (B) in paragraph (3), by striking ``under-
                represented minority'' and inserting ``racial or ethnic 
                minority'';
                    (C) in paragraph (4), by striking ``minority 
                health'' and inserting ``health disparity'';
                    (D) in paragraph (5), by striking ``under-
                represented minority groups'' and inserting ``racial or 
                ethnic minorities and health disparity populations'';
                    (E) in paragraph (6)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``under-represented minority'' 
                        and inserting ``individuals from racial or 
                        ethnic minorities or health disparity 
                        populations''; and
                            (ii) by striking ``and'' at the end;
                    (F) in paragraph (7), by striking the period and 
                inserting ``; and''; and
                    (G) by adding at the end the following:
            ``(8) to conduct accountability and other reporting 
        activities, as required by the Secretary.'';
            (3) in subsection (c)--
                    (A) in paragraph (1)(B)--
                            (i) in clause (i), by striking ``under-
                        represented minority'' and inserting 
                        ``individuals from racial or ethnic minorities 
                        or health disparity populations'';
                            (ii) in clause (ii), by striking ``under-
                        represented minority'' and inserting ``such'';
                            (iii) in clause (iii)--
                                    (I) by striking ``under-represented 
                                minority individuals'' the first place 
                                that such appears and inserting ``such 
                                students'';
                                    (II) by striking ``such 
                                individuals'' and inserting ``such 
                                students''; and
                                    (III) by striking ``under-
                                represented minority'' the second place 
                                that such appears and inserting 
                                ``such''; and
                            (iv) in clause (iv), by striking ``under-
                        represented minority individuals'' and 
                        inserting ``individuals from racial or ethnic 
                        minorities or health disparity populations''; 
                        and
                    (B) in paragraph (2)(B)--
                            (i) in clause (i), by striking ``under-
                        represented'' and inserting ``racial or''; and
                    (C) in paragraph (5)(B)--
                            (i) by striking ``under-represented'' and 
                        inserting ``racial or''; and
                            (ii) by inserting ``or a health disparity 
                        population'' after ``minorities'';
            (4) in subsection (d)(1), by striking ``Under-Represented 
        Minority Health'' and inserting ``Minority Health and Health 
        Disparity'';
            (5) in subsection (h)--
                    (A) in paragraph (1), by striking ``$26,000,000'' 
                and all that follows and inserting ``$50,000,000 for 
                fiscal year 2005, and such sums as may be necessary for 
                each of fiscal years 2006 through 2009''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (C)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``are $30,000,000 or 
                                more'' and inserting ``exceed 
                                $30,000,000 but are less than 
                                $40,000,000''; and
                                    (II) in clause (iv), by striking 
                                ``any remaining funds'' and inserting 
                                ``any remaining excess amount''; and
                            (ii) by adding at the end the following:
                    ``(D) Funding in excess of $40,000,000.--If amounts 
                appropriated under paragraph (1) for a fiscal year are 
                $40,000,000 or more, the Secretary shall make 
                available--
                            ``(i) not less than $16,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        subsection (c)(2)(A);
                            ``(ii) not less than $16,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        paragraph (3) or (4) of subsection (c) 
                        (including meeting conditions pursuant to 
                        subsection (e));
                            ``(iii) not less than $8,000,000 for grants 
                        under subsection (a) to health professions 
                        schools that meet the conditions described in 
                        subsection (c)(5); and
                            ``(iv) after grants are made with funds 
                        under clauses (i) through (iii), any remaining 
                        funds for grants under subsection (a) to health 
                        professions schools that meet the conditions 
                        described in paragraph (2)(A), (3), (4), or (5) 
                        of subsection (c).''; and
            (6) by adding at the end the following:
    ``(i) Evaluation.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Closing the Health Care Gap Act of 2004, the 
        Secretary shall request that the Institute of Medicine evaluate 
        the effectiveness of the programs under this section in meeting 
        the purpose of this part. The Institute of Medicine shall 
        submit a report on the evaluation to the Secretary.
            ``(2) Working group.--Upon submission of the report under 
        paragraph (1), the Secretary shall convene a working group 
        composed of stakeholders, including designated health 
        professions schools described in subsection (c), to define 
        quality performance measures and reporting requirements of 
        grant recipients that shall be tied to the purpose of this 
        part.
            ``(3) Regulations.--Not later than 18 months after the date 
        the Institute of Medicine submits the report under paragraph 
        (1), the Secretary shall publish proposed regulations regarding 
        the quality performance measures and reporting requirements 
        described in paragraph (2). Not later than 3 years after the 
        date the Institute of Medicine submits the report under 
        paragraph (1), the Secretary shall publish final regulations 
        regarding the quality performance measures and reporting 
        requirements described in paragraph (2).''.
    (c) Scholarships for Disadvantaged Students.--Section 737 of the 
Public Health Service Act (42 U.S.C. 293a) is amended--
            (1) in subsection (c), by striking ``under-represented 
        minority'' and inserting ``minority and health disparity''; and
            (2) in subsection (d)(1)(B), by inserting ``or health 
        disparity'' after ``minority''.
    (d) Loan Repayments and Fellowships Regarding Faculty Positions.--
Section 738(b) of the Public Health Service Act (42 U.S.C. 293b(b)) is 
amended--
            (1) in paragraph (1), by striking ``underrepresented'';
            (2) in paragraph (3)(A), by striking ``underrepresented 
        minority individuals'' and inserting ``individuals from racial 
        or ethnic minorities or health disparity populations''; and
            (3) by striking paragraph (5).
    (e) National Health Service Corps.--
            (1) Assignment.--Section 333(a)(3) of the Public Health 
        Service Act (42 U.S.C. 254f(a)(3)) is amended--
                    (A) in the second sentence--
                            (i) by striking ``shall give preference'' 
                        and inserting the following: ``shall--
            ``(A) give preference''; and
                            (ii) by striking the period and inserting 
                        ``; and''; and
                    (B) by adding at the end the following:
            ``(B) give preference to applications from entities 
        described in subparagraph (A) that serve individuals a majority 
        of whom are members of a racial or ethnic minority or other 
        health disparity population with annual incomes at or below 
        twice those set forth in the most recent poverty guidelines 
        issued by the Secretary pursuant to section 402(2) of the 
        Community Services Block Grant Act.''.
            (2) Priorities.--Section 333A(a) of the Public Health 
        Service Act (42 U.S.C. 254f-1(a)) is amended--
                    (A) by redesignating paragraphs (1) through (3) as 
                paragraphs (2) through (4), respectively; and
                    (B) by inserting before paragraph (2) (as so 
                redesignated), the following:
            ``(1) give preference to applications as described in 
        section 333(a)(3);''.
    (e) Authorization of Appropriations.--Section 740 of the Public 
Health Service Act (42 U.S.C. 293d) is amended--
            (1) in subsection (a), by striking ``2002'' and inserting 
        ``2009'';
            (2) in subsection (b), by striking ``2002'' and inserting 
        ``2009'';
            (3) in subsection (c), by striking ``2002'' and inserting 
        ``2009''; and
            (4) by striking subsection (d).
    (f) Grants for Health Professions Education.--Section 741 of the 
Public Health Service Act (42 U.S.C. 293e) is amended--
            (1) in subsection (a)(2), in the first sentence by striking 
        ``Unless'' and all that follows through ``the Secretary'' and 
        inserting ``The Secretary''; and
            (2) in subsection (b), by striking ``$3,500,000'' and all 
        that follows through the period and inserting ``such sums as 
        may be necessary for each of fiscal years 2005 through 2009.''.
    (g) Health Careers Opportunity Program.--Subpart 2 of part E of 
title VII of the Public Health Service Act (42 U.S.C. 295 et seq.) is 
amended--
            (1) in section 770 by inserting ``(other than section 
        771)'' after ``this subpart'';
            (2) by redesignating section 770 as section 771; and
            (3) by inserting after section 769 the following:

``SEC. 770. HEALTH CAREERS OPPORTUNITY PROGRAM.

    ``(a) In General.--The Secretary may make grants and enter into 
cooperative agreements and contracts with eligible entities for any of 
the following purposes:
            ``(1) Identifying and recruiting students who--
                    ``(A) are from disadvantaged backgrounds or health 
                disparity populations; and
                    ``(B) are interested in a career in the health 
                professions.
            ``(2) Providing counseling or other services designed to 
        assist such individuals in entering a health professions school 
        and successfully completing their education at such a school.
            ``(3) Providing, for a period prior to the entry of such 
        individuals into the regular course of education of such a 
        school, preliminary education designed to assist the 
        individuals in successfully completing such regular course of 
        education at such a school, or referring such individuals to 
        institutions providing such preliminary education.
    ``(b) Receipt of Award.--
            ``(1) Eligible entities; requirement of consortium.--The 
        Secretary may make an award under subsection (a) only if an 
        eligible entity meets the following conditions:
                    ``(A) The eligible entity is a public or private 
                entity, and such entity has established a consortium 
                consisting of private community-based organizations and 
                health professions schools.
                    ``(B) The health professions schools in the 
                consortium are schools of medicine or osteopathic 
                medicine, public health, nursing, dentistry, optometry, 
                pharmacy, allied health, or podiatric medicine, or 
                graduate programs in mental health practice (including 
                programs in clinical psychology).
                    ``(C)(i) Except as provided in clause (ii), the 
                membership of the consortium includes not less than 1 
                nonprofit private community-based organization and not 
                less than 3 health professions schools.
                    ``(ii) In the case of an eligible entity whose 
                exclusive activity under the award will be carrying out 
                1 or more programs described in subsection (a)(5), the 
                membership of the consortium includes not less than 1 
                nonprofit private community-based organization and not 
                less than 1 health professions school.
                    ``(D) The members of the consortium have entered 
                into an agreement specifying--
                            ``(i) that each of the members will comply 
                        with the conditions upon which the award is 
                        made; and
                            ``(ii) whether and to what extent the award 
                        will be allocated among the members.
            ``(2) Requirement of competitive awards.--Awards under 
        subsection (a) shall be made on a competitive basis.
    ``(c) Requirements.--The Secretary may make an award under 
subsection (a) only if the Secretary determines that, in the case of 
activities carried out under the award that prove to be effective 
toward achieving the purposes of the activities--
            ``(1) the members of the consortium involved have or will 
        have the financial capacity to continue the activities, 
regardless of whether financial assistance under subsection (a) 
continues to be available; and
            ``(2) the members of the consortium demonstrate to the 
        satisfaction of the Secretary a commitment to continue such 
        activities, regardless of whether such assistance continues to 
        be available.
    ``(d) Objectives Under Awards.--Before making a first award to an 
eligible entity under subsection (a), the Secretary shall establish 
objectives regarding the activities to be carried out under the award, 
which objectives are applicable until the next fiscal year for which 
such award is made after a competitive process of review. In making an 
award after such a review, the Secretary shall establish additional 
objectives for the applicant.
    ``(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 fiscal years 2005 through 2009.''.

SEC. 402. HIGHER EDUCATION TECHNICAL AMENDMENTS.

    Section 326(c) of the Higher Education Act of 1965 (20 U.S.C. 
1063b(c)) is amended--
            (1) in paragraph (2), by inserting before the semicolon, 
        the following: ``, and for the acquisition and development of 
        real property that is adjacent to the campus to improve the 
        academic environment'';
            (2) in paragraph (6), by striking ``and'' at the end;
            (3) in paragraph (7), by striking the period and inserting 
        a semicolon; and
            (4) by adding at the end the following:
            ``(8) Support of faculty exchanges, development, and 
        fellowship to enable attainment of advanced degrees in their 
        field of instruction; and
            ``(9) Tutoring, counseling, and student service programs 
        designed to improve academic success.''.

SEC. 403. MODEL CULTURAL COMPETENCY CURRICULUM DEVELOPMENT.

    (a) Curricula Development and Model Curricula.--The Secretary of 
Health and Human Services (in this section referred to as the 
``Secretary'') may award grants to eligible entities for curricula 
development for the training of health care providers and health 
professions students regarding cultural competency, and for 
demonstration projects to test new innovations for cultural competence 
education model curricula for and identify additional barriers to 
culturally appropriate care.
    (b) Application.--Each eligible entity desiring a grant under 
subsection (a) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    (c) 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 2009.

SEC. 404. INTERNET CULTURAL COMPETENCY CLEARINGHOUSE.

    (a) Development.--The Director of the Office of Minority Health and 
Health Disparities, with assistance from the Administrator of the 
Agency for Healthcare Research and Quality, shall develop and maintain 
an Internet clearinghouse to improve health care quality for 
individuals with specific cultural needs or with limited English 
proficiency or low functional health literacy and to reduce or 
eliminate the duplication of effort to translate materials.
    (b) Templates.--In developing the clearinghouse under subsection 
(a), the Director of the Office of Minority Health and Health 
Disparities shall develop, test, and make available templates for 
standard documents that are necessary for patients and consumers to 
access and make educated decisions about their health care, including--
            (1) administrative and legal documents;
            (2) clinical information such as how to take medications, 
        how to prevent transmission of a contagious disease, and other 
        prevention and treatment instructions; and
            (3) patient education and outreach materials such as 
        immunization notices, health warnings, or screening notices.
    (c) Online Library or Database.--The Director of the Office of 
Minority Health and Health Disparities shall develop a readily 
accessible online library or database with searchable clinically 
relevant cultural information that is important for health care 
providers to have on hand in the direct provision of medical care to 
individuals from specific minority, ethnic, or other health disparity 
groups.

                       TITLE V--ENHANCED RESEARCH

SEC. 501. AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.

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

``SEC. 918. ENHANCED RESEARCH WITH RESPECT TO HEALTH DISPARITIES.

    ``(a) Accelerating the Elimination of Disparities.--
            ``(1) In general.--The Secretary, acting through the 
        Director, may award grants or contracts to eligible entities 
        (as defined in paragraph (4)) for short-term research to 
        analyze the causes of disparities and identify or develop and 
        evaluate effective strategies in closing the health care gap 
        between minority and health disparity populations and 
        nonminority populations or non-health disparity populations.
            ``(2) Prompt use of research.--To ensure that research 
        described in paragraph (1) is effective and is disseminated and 
        applied promptly, the Director shall--
                    ``(A) expand practice-based research networks 
                (primary care and larger delivery systems) to include 
                networks of delivery sites serving large numbers of 
                minority and health disparity populations including--
                            ``(i) public hospitals;
                            ``(ii) health centers; and
                            ``(iii) other sites as determined 
                        appropriate by the Director;
                    ``(B) work with health care providers to identify 
                and develop those interventions for minority and health 
                disparity populations for which effective 
implementation strategies are not clear; and
                    ``(C) develop a broad virtual network of continuous 
                learning among health care providers (including 
                institutions that did not receive a grant or contract 
                under paragraph (1)) so that those participating in 
                research can share findings and experience throughout 
                the duration of such research and to facilitate 
                interest in and prompt adoption of such findings and 
                experience.
            ``(3) Technical assistance.--The Director of the Agency for 
        Healthcare Research and Quality shall provide technical 
        assistance to assist in the implementation of strategies of 
        evidence-based practices that will reduce health care 
        disparities.
            ``(4) Eligible entities.--In paragraph (1), the term 
        `eligible entities' means institutions with researchers who 
        have experience in conducting research relating to minority 
        health and health disparity populations.
            ``(5) Public hospitals.--In this subsection, the term 
        `public hospitals' means a hospital (as defined in section 
        1886(d)(1)(B) of the Social Security Act) that--
                    ``(A) is owned or operated by a unit of State or 
                local government, is a public or private non-profit 
                corporation which is formally granted governmental 
                powers by a unit of State or local government, or is a 
                private non-profit hospital that has a contract with a 
                State or local government to provide health care 
                services to low income individuals who are not entitled 
                to benefits under title XVIII of the Social Security 
                Act or eligible for assistance under the State plan 
                under title XIX of the Social Security Act; and
                    ``(B) for the most recent cost reporting period 
                that ended before the calendar quarter involved, had a 
                disproportionate share adjustment percentage (as 
                determined under section 1886(d)(5)(F) of the Social 
                Security Act) greater than 11.75 percent or was 
                described in section 1886(d)(5)F)(i)(II) of such Act.
    ``(b) Realizing the Potential of Disease Management.--
            ``(1) Public-private sector partnership to assess 
        effectiveness of existing data management strategies.--The 
        Director shall establish a public-private partnership to assess 
        the effectiveness of disease management strategies and identify 
        effective interventions and support strategies with respect to 
        minority and health disparity populations.
            ``(2) Effective management of patients with multiple 
        chronic diseases.--
                    ``(A) Initiative for disease management 
                strategies.--The Director shall coordinate an 
                initiative to identify those chronic conditions for 
                which disease-specific disease management strategies 
                pose conflicts in preferred clinical interventions.
                    ``(B) Research.--The Director, with support from 
                other agencies within the Department of Health and 
                Human Services shall conduct a program of research 
                based in community and primary-care settings to test 
                and evaluate the implications for patient outcomes of 
                alternative approaches for reconciling conflicts from 
                disease-specific disease management initiatives.
    ``(c) Development of Effective Measurement of Disparities.--
            ``(1) In general.--The Director shall conduct a 
        demonstration project to--
                    ``(A) assess alternative strategies for identifying 
                population subgroups at highest risk of poor quality 
                and poor health;
                    ``(B) improve data collection for health care 
                priority populations (as described in section 
                901(c)(1)(B));
                    ``(C) improve the ability to identify the causes of 
                disparities; and
                    ``(D) track progress in reducing health care 
                disparities with a focus on--
                            ``(i) the minimum data set necessary to 
                        track such progress; and
                            ``(ii) the identification of measures for 
                        which data currently being collected are 
                        insufficient.
            ``(2) Report.--Not later than 3 years after the date the 
        demonstration project described in paragraph (1) receives 
        funding, the Director shall submit to the appropriate 
        committees of Congress a report containing the findings of the 
        demonstration project together with any policy recommendations.
    ``(d) Analysis of Racial, Ethnic, and Other Health Disparity 
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 & Medicaid Services and the 
Director of the Centers for Disease Control and Prevention, shall 
provide technical assistance to agencies of the Department of Health 
and Human Services in meeting Federal standards for race, ethnicity, 
and other health disparity data collection and analysis of racial, 
ethnic, and other disparities in health and health care in Federally-
administered 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, 
        ethnic, or other health disparities;
            ``(4) identifying the level at which data analysis should 
        be conducted; and
            ``(5) sharing data with external organizations for research 
        and quality improvement purposes.''.

SEC. 502. NATIONAL INSTITUTES OF HEALTH.

    The Director of the National Institutes of Health, in consultation 
with the Director of the National Center on Minority Health and Health 
Disparities, shall expand and intensify research at the National 
Institutes of Health relating to the sources of health and health care 
disparities, and increase efforts to recruit minority scientists and 
research professionals into the field of health disparity research.

                   TITLE VI--MISCELLANEOUS PROVISIONS

SEC. 601. DEFINITIONS.

    (a) In General.--In this Act, including the amendments made by this 
Act:
            (1) Culturally competent.--
                    (A) In general.--The term ``culturally competent'', 
                with respect to the manner in which health-related 
                services, education, and training are provided, means 
                providing the services, education, and training in the 
                language and cultural context that is most appropriate 
                for the individuals for whom the services, education, 
                and training are intended, including as necessary the 
                provision of bilingual services.
                    (B) Modification.--The definition established in 
                subparagraph (A) may be modified as needed at the 
                discretion of the Secretary after providing a 30-day 
                notice to Congress.
            (2) Minority health conditions.--The term ``minority health 
        conditions'', with respect to individuals who are members of 
        minority groups, means all diseases, disorders, and conditions 
        (including with respect to mental health and substance abuse)--
                    (A) unique to, more serious, or more prevalent in 
                such groups;
                    (B) for which the factors of medical risk or types 
                of medical intervention may be different for such 
                groups, or for which it is unknown whether such factors 
                or types are different for such individuals; or
                    (C) with respect to which there has been 
                insufficient research involving such individual members 
                of such groups as subjects or insufficient data on such 
                individuals.
            (3) Minority health disparities research.--The term 
        ``minority health disparities research'' means basic, clinical, 
        behavioral and health services research on minority health 
        conditions (as defined in paragraph (2)), including research to 
        prevent, diagnose, and treat such conditions.
            (4) Minority.--The terms ``minority'' and ``minorities'' 
        refer to individuals from a minority group.
            (5) Minority group.--The term ``minority group'' has the 
        meaning given the term ``racial and ethnic minority group'' in 
        section 1707 of the Public Health Service Act (42 U.S.C. 300u-
        6).
    (b) Health Disparity Populations.--In this Act, including the 
amendments made by this Act:
            (1) Health disparity population.--The term ``health 
        disparity population'' has the meaning given such term in 
        section 903(d)(1) of the Public Health Service Act (42 U.S.C. 
        299a-1(d)(1)).
            (2) Health disparities research.--The term ``health 
        disparities research'' shall include basic, clinical, 
        behavioral, and health services research on health disparity 
        populations (including individual members and communities of 
        such populations) that relates to health disparities as defined 
        under paragraph (1), including the causes of such disparities 
        and methods to prevent, diagnose, and treat such disparities.
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