[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2421 Introduced in Senate (IS)]







108th CONGRESS
  2d Session
                                S. 2421

  To modernize the health care system through the use of information 
  technology and to reduce costs, improve quality, and provide a new 
            focus on prevention with respect to health care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 13, 2004

  Mr. Kennedy introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To modernize the health care system through the use of information 
  technology and to reduce costs, improve quality, and provide a new 
            focus on prevention with respect to health care.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Care 
Modernization, Cost Reduction, and Quality Improvement Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                    TITLE I--INFORMATION TECHNOLOGY

   Subtitle A--Improving the Quality of Health Care Through Clinical 
                              Informatics

Sec. 101. Improving the quality of health care through clinical 
                            informatics.
Sec. 102. Reimbursement for operation of qualified clinical informatics 
                            system.
Subtitle B--Reducing Administrative Costs and Improving Service Through 
                         Information Technology

Sec. 111. Requirement for health insurers to implement computerized 
                            claims processing systems.
Sec. 112. Making health care more responsive to the consumer.
Sec. 113. Regulations.
   Subtitle C--Application to Public Health Service Act and Employee 
                 Retirement Income Security Act of 1974

Sec. 121. Application to group health plans and group health insurance 
                            coverage under the Public Health Service 
                            Act.
Sec. 122. Application to individual health insurance coverage under the 
                            Public Health Service Act.
Sec. 123. Application to group health plans and group health insurance 
                            coverage under the Employee Retirement 
                            Income Security Act of 1974.
                  Subtitle D--Miscellaneous Provisions

Sec. 131. Definitions.
                    TITLE II--PAYING FOR PERFORMANCE

Sec. 201. Health care provider quality standards.
                TITLE III--TARGETED QUALITY INITIATIVES

Sec. 301. Improving the quality of care for Americans with diabetes.
  ``Part R--Improving the Quality of Care for Americans With Diabetes

        ``Sec. 399A. State diabetes control and prevention programs.
        ``Sec. 399A-1. Improving quality of diabetes prevention and 
                            care.
        ``Sec. 399A-2. National diabetes education and outreach.
        ``Sec. 399A-3. Definition.
Sec. 302. Improving the quality of care for Americans with arthritis.
  ``Part S--Improving the Quality of Care for Americans With Arthritis

        ``Sec. 399B. State arthritis control and prevention programs. 
        ``Sec. 399B-1. Comprehensive arthritis action grants. 
        ``Sec. 399B-2. National arthritis education and outreach. 
        ``Sec. 399B-3. Definition.
Sec. 303. Stroke prevention, treatment, and rehabilitation.
  ``Part T--Stroke Prevention, Treatment, and Rehabilitation Programs

        ``Sec. 399C. Definitions.
        ``Sec. 399C-1. Grants to States for stroke care systems.
        ``Sec. 399C-2. Planning grants.
        ``Sec. 399C-3. Responsibilities of the secretary.
Sec. 304. Increasing language access for Americans with limited English 
                            proficiency.
``Part C--Increasing Language Access for Americans With Limited English 
                              Proficiency

        ``Sec. 251. Improving access to services for individuals with 
                            limited English proficiency.
        ``Sec. 252. National standards for culturally and 
                            linguistically appropriate services in 
                            healthcare.
        ``Sec. 253. Innovations in language access grants.
        ``Sec. 254. Standards for language access services.
        ``Sec. 255. Report on Federal efforts to provide culturally and 
                            linguistically appropriate health care 
                            services.
Sec. 305. Federal reimbursement for culturally and linguistically 
                            appropriate services.
Sec. 306. National Quality Advisory Council.
                  TITLE IV--PREVENTIVE HEALTH SERVICES

Sec. 401. Increasing health insurance coverage for prevention.
Sec. 402. Activities relating to nutrition and physical activity.
                    ``Part U--Preventive Health Care

        ``Sec. 399D. Encouraging consumption of healthy diets.
        ``Sec. 399D-1. Increasing physical activity.
Sec. 403. Improving immunization.
                    ``Part V--Improving Immunization

        ``Sec. 399E. Programs to improve the rate of immunization in 
                            adults and adolescents.
        ``Sec. 399E-1. Curriculum development.
        ``Sec. 399E-2. Assuring adequate supply of vaccines for adult 
                            and adolescent immunization programs.
        ``Sec. 399E-3. Research on immunization programs.
        ``Sec. 399E-4. Definition.
Sec. 404. Improving oral health.
                    ``Part W--Improving Oral Health

        ``Sec. 399F. Public education.
        ``Sec. 399F-1. Health care provider education.
        ``Sec. 399F-2. Monitoring and evaluating the quality of oral 
                            health.
        ``Sec. 399F-3. Studies and reports by the Institute of 
                            Medicine.
        ``Sec. 399F-4. Definition.

                    TITLE I--INFORMATION TECHNOLOGY

   Subtitle A--Improving the Quality of Health Care Through Clinical 
                              Informatics

SEC. 101. IMPROVING THE QUALITY OF HEALTH CARE THROUGH CLINICAL 
              INFORMATICS.

    (a) Grants To Enhance the Use of Clinical Informatics.--
            (1) In general.--The Secretary shall award grants or 
        cooperative agreements to eligible entities to assist such 
        entities to acquire, develop, enhance, or implement (including 
        the training of personnel needed for effective implementation) 
        qualified clinical informatics systems that are consistent with 
        the technical standards promulgated by the Secretary under 
        subsection (d).
            (2) Definition.--In this section, the term ``qualified 
        clinical informatics system'' means a computerized system 
        (including both hardware and software components of such 
        system) that--
                    (A) maintains and provides immediate access to 
                patients' medical records in an electronic format;
                    (B) permits a qualified practitioner who wishes to 
                enter an order for a medication, treatment, diagnostic 
                procedure, or other intervention or service to enter 
                such order via a computer that is linked to a database 
                capable of accessing the medical record of the patient 
                who is intended to receive such medication, treatment, 
                diagnostic procedure, or other intervention;
                    (C) incorporates error notification software so 
                that a warning is generated by such system if an order 
                is entered that is likely to lead to a significant 
                adverse outcome for the patient;
                    (D) provides information to a qualified 
                practitioner regarding optimal or recommended 
                alternatives to an order described in subparagraph (B), 
                provided that such information is not primarily 
                commercial in nature;
                    (E) provides electronic alerts and reminders to 
                improve compliance with best practices, promote regular 
                screenings and other preventive practices, and 
                facilitate diagnoses and treatments;
                    (F) allows the secure electronic transmission of 
                information to other health care providers.
            (3) Guidance.--The Secretary, acting through the Director 
        of the Agency for Healthcare Research and Quality and such 
        other officials as may be appropriate, shall provide technical 
        guidance concerning the elements described in paragraph (2).
            (4) Entities eligible for grants or cooperative 
        agreements.--To be eligible to receive a grant or cooperative 
        agreement under this subsection, an entity shall--
                    (A) be a--
                            (i) Federally qualified health center (as 
                        defined in section 1861(aa)(4) of the Social 
                        Security Act (42 U.S.C. 1395x(aa)(4));
                            (ii) nonprofit hospital, health care 
                        clinic, skilled nursing facility, or other 
                        nonprofit health care facility determined by 
                        the Secretary to be eligible and to be in need 
                        of significant financial assistance to 
                        implement a qualified clinical informatics 
                        system; or
                            (iii) group practice as defined in section 
                        1877(h)(4) of the Social Security Act (42 
                        U.S.C. 1395nn(h)(4)), including a practice that 
                        meets the requirements of such section except 
                        that such practice has only one physician, and 
                        that is in need of significant assistance to 
                        implement a qualified clinical informatics 
                        system;
                    (B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require, including a description of the qualified 
                clinical informatics system that the entity intends to 
                implement using amounts received under paragraph (1); 
                and
                    (C) submit assurances satisfactory to the Secretary 
                that the entity will conduct the quality improvement 
                activities described in subsection (e)(1)(A) and 
                subsection (e)(1)(B) if applicable.
            (5) Matching requirement.--The Secretary may not make an 
        award under paragraph (1) to an entity described in paragraph 
        (4)(A) unless that entity agrees that, with respect to the 
        costs to be incurred by the entity in carrying out the 
        activities for which the grant or cooperative agreement is 
        being awarded, the entity will make available (directly or 
        through donations from public or private entities) non-Federal 
        contributions toward such costs in an amount equal to--
                    (A) with respect to an entity described in 
                paragraph (4)(A)(i), $1 for each $10 of Federal funds 
                provided under the grant or cooperative agreement; and
                    (B) with respect to an entity described in 
                paragraph (4)(A)(ii) or (iii), $1 for each $5 of 
                Federal funds provided under the grant or cooperative 
                agreement.
    (b) Revolving Loan Fund to Enhance Clinical Informatics.--
            (1) Establishment of revolving loan fund.--The Secretary 
        shall establish a revolving loan fund--
                    (A) from which the Secretary shall make loans 
                (subject to the conditions described in paragraph (3)) 
                to eligible entities to assist such entities to 
                acquire, develop, enhance, or implement (including the 
                training of personnel needed for effective 
                implementation) qualified clinical informatics systems 
                that are consistent with the technical standards 
                promulgated by the Secretary under subsection (d); and
                    (B) into which all payments, interest, charges, and 
                other amounts collected from loans made under 
                subparagraph (A) shall, notwithstanding any other 
                provision of law, be deposited.
            (2) Eligible entities.--To be eligible to receive a loan 
        under this subsection, an entity shall--
                    (A) be a--
                            (i) nonprofit hospital, health care clinic, 
                        community health center, skilled nursing 
                        facility, or other nonprofit health care 
                        facility; or
                            (ii) group practice as defined in section 
                        1877(h)(4) of the Social Security Act (42 
                        U.S.C. 1395nn(h)(4)), including a practice that 
                        meets the requirements of such section except 
                        that such practice has only one physician;
                    (B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require, including a description of the qualified 
                clinical informatics system that the entity intends to 
                implement using amounts received under paragraph (1); 
                and
                    (C) submit assurances satisfactory to the Secretary 
                that the entity will conduct the quality improvement 
                activities described in subsection (e)(1)(A) and 
                subsection (e)(1)(B) if applicable.
            (3) Conditions of loans.--
                    (A) In general.--Each loan under this subsection 
                shall be made at a rate of interest that is the greater 
                of--
                            (i) a rate that is 3 percentage points 
                        below the rate of interest payable on 
                        obligations of the Federal Government having 
                        terms of maturity of 10 years; or
                            (ii) zero.
                    (B) Term.--Each loan made under this subsection 
                shall be for a term that does not exceed 7 years.
                    (C) Repayment.--The Secretary may not make a loan 
                to an eligible entity under this subsection unless the 
                Secretary determines that there is a reasonable 
                expectation that the entity will repay the loan 
                according to the terms of the loan.
                    (D) Collateral.--The Secretary may require an 
                eligible entity receiving a loan under this subsection 
                to provide such collateral as the Secretary determines 
                to be necessary to secure the loan.
                    (E) Defaults and collections.--Prior to making a 
                loan under this subsection, the Secretary shall 
                establish written procedures and definitions relating 
                to defaults and collections of payments on such loans 
                and shall provide to each applicant for such a loan, at 
                the time of the application, a written copy of such 
                procedures and definitions.
                    (F) Regulations.--The Secretary may promulgate such 
                other regulations as may be necessary to carry out the 
                purposes of this subsection, including regulations 
                involving reporting and auditing.
            (4) Separate account and investments.--The revolving loan 
        fund established under this subsection shall be maintained by 
        the Secretary as a separate account. Any portion of the 
        revolving loan fund that is not required for expenditure shall 
        be invested in obligations of the United States or in 
        obligations guaranteed or insured by the United States.
    (c) Loan Guarantees.--
            (1) In general.--The Secretary shall establish a program 
        under which the Secretary may guarantee up to 90 percent of the 
        principal and interest on loans made by non-Federal lenders to 
        eligible entities for the costs of acquiring qualified clinical 
        informatics systems.
            (2) Eligible entities.--To be eligible to receive a loan 
        guarantee under this subsection, an entity shall--
                    (A) be a--
                            (i) nonprofit hospital, health care clinic, 
                        community health center, skilled nursing 
                        facility, or other nonprofit health care 
                        facility; or
                            (ii) group practice as defined in section 
                        1877(h)(4) of the Social Security Act (42 
                        U.S.C. 1395nn(h)(4)), including a practice that 
                        meets the requirements of such section except 
                        that such practice has only one physician;
                    (B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require, including a description of the qualified 
                clinical informatics system that the entity intends to 
                implement using amounts received under paragraph (1); 
                and
                    (C) submit assurances satisfactory to the Secretary 
                that the entity will conduct the quality improvement 
                activities described in subsection (e)(1)(A) and 
                subsection (e)(1)(B) if applicable.
            (3) Use of funds.--Loan funds guaranteed under this 
        subsection may be used to acquire qualified clinical 
        informatics systems that are consistent with the technical 
        standards promulgated by the Secretary under subsection (d).
            (4) Conditions of loan.--Guarantees of loans under this 
        subsection shall be subject to such further terms and 
        conditions as the Secretary determines to be necessary to 
        assure that the purposes of this subsection will be achieved.
    (d) Promulgation of Technical Standards.--Not later than January 1, 
2006, the Secretary shall develop or adopt technical standards for 
qualified clinical informatics systems relating to--
            (1) interoperability;
            (2) security;
            (3) the protection of confidentiality, consistent with the 
        regulations promulgated under section 264(c) of the Health 
Insurance Portability and Accountability Act (42 U.S.C. 1320d-2 note); 
and
            (4) such other subjects determined appropriate by the 
        Secretary.
    (e) Quality Improvement Activities.--
            (1) In general.--As used in this section, the term 
        ``quality improvement activities'' means--
                    (A) the use of a qualified clinical informatics 
                system to report data on the health care quality 
                standards developed under section 201 of this Act to a 
                utilization and quality control peer review 
                organization with a contract under part B of title XI 
                of the Social Security Act (42 U.S.C. 1320c et seq.), 
                or to any other patient safety organization recognized 
                by the Secretary, and to the Secretary in a manner 
                consistent with the standards developed under the 
                regulations promulgated under section 264(c) of the 
                Health Insurance Portability and Accountability Act (42 
                U.S.C. 1320d-2 note); and
                    (B) with respect to a health care provider that 
                employs more than 50 physicians (as such term is 
                defined in 1861(r) of the Social Security Act (42 
                U.S.C. 1395x(r)) or that is a hospital or other 
                institutional provider, the implementation of a program 
                to--
                            (i) analyze (through a process that may 
                        include the receipt of analyses conducted by 
                        other appropriate entities) data on the quality 
                        of health care provided by such provider; and
                            (ii) institute measures, based on the 
                        analysis conducted under clause (i), to improve 
                        the quality of health care provided by such 
                        provider.
            (2) Public availability of data on quality improvement.--
        The Secretary shall analyze and make publicly available the 
        data reported to the Secretary under paragraph (1)(A) in a 
        manner determined to be of value to patients and health care 
        practitioners.
    (f) Requirements for Standards.--
            (1) Consultation.--In developing the technical standards 
        under subsection (d), the Secretary shall consult with 
        participants in the Consolidated Health Informatics initiative, 
        or any successor to such initiative, and with public and 
        private entities determined appropriate by the Secretary. In 
        developing the standards under subsection (d), the Secretary 
        shall take into consideration applicable recommendations of--
                    (A) the National Committee on Vital and Health 
                Statistics; and
                    (B) the Consolidated Health Informatics initiative 
                or any successor to such initiative.
            (2) Objective.--Any standard developed or adopted under 
        subsection (d) shall be consistent with the objectives of 
        improving--
                    (A) patient safety; and
                    (B) the quality of care provided to patients.
            (3) Consistency.--The Secretary shall ensure that, to the 
        maximum extent practicable, the standards adopted or developed 
        under subsection (d) shall be consistent with--
                    (A) any standards otherwise adopted or developed by 
                the Secretary under the Social Security Act for 
                transactions and data elements to enable the electronic 
                transmission of prescriptions; and
                    (B) any standards adopted by the Consolidated 
                Health Informatics initiative, or any successor to such 
                initiative.
            (4) Additions and modifications to standards.--Not later 
        than January 1, 2007, and annually thereafter, the Secretary 
        shall review the standards developed or adopted under 
        subsection (d), and may modify such standards and measures if 
        determined appropriate. Any addition or modification to such 
        standards shall be completed in a manner which minimizes the 
        disruption and cost of compliance.
    (g) Responsibilities of the Secretary.--
            (1) Research on effectiveness.--The Secretary shall conduct 
        research on a representative sample of entities receiving 
        awards under subsections (a), (b), and (c) to determine the 
        extent to which qualified clinical informatics systems 
        implemented by such entities have improved the quality of care 
        provided to patients receiving care from such entities and 
        reduced the costs of providing high quality health care.
            (2) Technical assistance.--The Secretary shall provide such 
        technical assistance as is feasible to eligible entities in 
        carrying out activities under this section.
            (3) Use of technology systems and electronic payment of 
        claims.--The Secretary shall, to the extent technically 
        practicable--
                    (A) utilize information technology systems for--
                            (i) processing financial transactions;
                            (ii) providing reimbursement to providers;
                            (iii) adjudicating claims for 
                        reimbursement; and
                            (iv) providing statements of account or 
                        explanations of benefits to providers; and
                    (B) require the submission of claims for payment 
                via electronic means.
            (4) Consistency with standards.--Beginning on January 1, 
        2006, the Secretary may not purchase information technology 
        systems unless such systems are consistent with the applicable 
        standards developed under subsection (d).
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary.

SEC. 102. REIMBURSEMENT FOR OPERATION OF QUALIFIED CLINICAL INFORMATICS 
              SYSTEM.

    (a) Increased Reimbursement for Operating Clinical Informatics 
System.--
            (1) In general.--The Secretary shall increase, by the 
        amount specified in paragraph (2), the reimbursement provided 
        under any Federal health program to any provider that--
                    (A) operates a qualified clinical informatics 
                system that is consistent with the technical standards 
                promulgated under section 101(d); and
                    (B) conducts the quality improvement activities 
                described in section 101(e)(1)(A) and section 
                101(e)(1)(B) if applicable.
            (2) Amount of increased reimbursement.--The amount of the 
        increase in a reimbursement under paragraph (1) shall be equal 
        to--
                    (A) for fiscal year 2005, 1 percent of the amount 
                of the reimbursement involved;
                    (B) for fiscal year 2006, 0.8 percent of the amount 
                of the reimbursement involved;
                    (C) for fiscal year 2007, 0.6 percent of the amount 
                of the reimbursement involved;
                    (D) for fiscal year 2008, 0.4 percent of the amount 
                of the reimbursement involved; and
                    (E) for fiscal year 2009, 0.2 percent of the amount 
                of the reimbursement involved.
    (b) Decreased Reimbursement for Failure to Operate a Clinical 
Informatics System.--
            (1) In general.--The Secretary shall decrease, by the 
        amount specified in paragraph (2), the reimbursement provided 
        under any Federal health program to any provider unless such 
        provider--
                    (A) operates a qualified clinical informatics 
                system that is consistent with the technical standards 
                promulgated under section 101(d); and
                    (B) conducts the quality improvement activities 
                described in section 101(e)(1)(A) and section 
                101(e)(1)(B) if applicable.
            (2) Amount of decreased reimbursement.--The amount of the 
        decrease in a reimbursement under paragraph (1) shall be equal 
        to--
                    (A) for fiscal year 2010, 0.2 percent of the amount 
                of the reimbursement involved;
                    (B) for fiscal year 2011, 0.4 percent of the amount 
                of the reimbursement involved;
                    (C) for fiscal year 2012, 0.6 percent of the amount 
                of the reimbursement involved;
                    (D) for fiscal year 2013, 0.8 percent of the amount 
                of the reimbursement involved; and
                    (E) for fiscal year 2014, and each subsequent 
                fiscal year, 1.0 percent of the amount of the 
                reimbursement involved.
    (c) Limitation.--Subsection (b) shall not apply to any provider 
that employs less than 50 health care professionals.

Subtitle B--Reducing Administrative Costs and Improving Service Through 
                         Information Technology

SEC. 111. REQUIREMENT FOR HEALTH INSURERS TO IMPLEMENT COMPUTERIZED 
              CLAIMS PROCESSING SYSTEMS.

    (a) In General.--Not later than December 31, 2008, each group 
health plan and health insurance issuer offering health insurance 
coverage shall have in effect an automated, integrated system that 
allows for efficient and effective adjudication of claims and the 
detection of fraud and abuse in accordance with this section.
    (b) Elements of Adjudication.--The system described in subsection 
(a) shall include determinations concerning payments and coverage for 
items or services under the terms and conditions of the plan or 
coverage involved, including any cost-sharing amount that the 
participant, beneficiary, or enrollee is required to pay with respect 
to such claim.
    (c) Timeframe.--The plan or issuer shall complete the adjudication 
of claims under this section immediately after the plan or issuer 
receives--
            (1) the claim; and
            (2) any additional information requested by the plan or 
        issuer that is necessary to make a determination relating to 
        the claim.
    (d) Accuracy.--In adjudicating claims under this section the plan 
or issuer shall ensure that--
            (1) such claims are adjudicated with an accuracy of at 
        least 99 percent;
            (2) the plan or issuer has the ability to accept claims 
        submitted via the Internet; and
            (3) the plan or issuer has the ability to issue denials 
        where necessary instantaneously via the Internet, and to 
        provide an opportunity for challenge to and resolution of such 
        denials (except in cases of dispute over medical necessity) via 
        the Internet.
    (e) Detection System.--Not later than December 31, 2008, each group 
health plan and health insurance issuer offering health insurance 
coverage shall use the system described in subsection (a) to detect 
fraud and abuse in real-time as part of the adjudication of claims 
under this section.
    (f) Regulations.--The Secretary shall issue such regulations as may 
be necessary or appropriate to carry out this section.

SEC. 112. MAKING HEALTH CARE MORE RESPONSIVE TO THE CONSUMER.

    (a) Statement of Account for Consumers.--
            (1) In general.--Not later than December 31, 2008, each 
        group health plan and health insurance issuer offering health 
        insurance coverage shall have in effect a computerized system 
        that provides each participant, beneficiary, or enrollee with a 
        statement of account that--
                    (A) includes information, with respect to the 
                participant, beneficiary, or enrollee, on--
                            (i) claims received, claims denied, and the 
                        reasons for any denials;
                            (ii) status of coverage; and
                            (iii) deductible information; and
                    (B) is issued quarterly.
            (2) Internet access.--The plan or issuer may comply with 
        this subsection by making the quarterly statements available on 
        the Internet 24 hours a day, 7 days a week, through a secure 
website.
    (b) Statement of Account for Employers and Purchases.--Not later 
than December 31, 2008, each group health plan and health insurance 
issuer shall have in effect a computerized system to provide to 
employers and other purchasers of health insurance products a statement 
of account that--
            (1) includes--
                    (A) current information on coverage status; and
                    (B) reports of customer satisfaction that are 
                updated annually; and
            (2) is available 24 hours a day, 7 days a week, through--
                    (A) the Internet through a secure website; or
                    (B) a toll-free telephone number.
    (c) Internet Enrollment.--
            (1) In general.--Not later than December 31, 2008, each 
        group health plan and health insurance issuer shall have in 
        effect a computerized system to provide to employers and other 
        purchasers of health insurance products an option to enroll for 
        coverage under such health insurance products on the Internet 
        through a secure website.
            (2) Eligibility requirements.--The Internet website 
        described in paragraph (1) shall include information on 
        eligibility requirements for coverage.
    (d) Consumer Explanation of Benefits.--
            (1) In general.--Not later than December 31, 2008, each 
        group health plan and health insurance issuer shall have in 
        effect a computerized system to provide, to a participant, 
        beneficiary, or enrollee--
                    (A) an explanation of benefits at the point of 
                service or not later than 48 hours after the time that 
                service is provided; and
                    (B) a description of the coverage and cost of each 
                services provided to the participant, beneficiary, or 
                enrollee under the plan or coverage.
            (2) Language.--Any explanation of benefits under this 
        subsection shall be provided in a printed form and written in a 
        manner calculated to be understood by the average participant, 
        beneficiary, or enrollee.
    (e) Referrals and Authorizations.--
            (1) In general.--Not later than December 31, 2008, each 
        group health plan and health insurance issuer shall have in 
        effect a computerized system for making and checking referrals 
        and pre-authorizations where such referrals and pre-
        authorizations are required under the plan or coverage.
            (2) Access.--The system described in paragraph (1) shall 
        permit access by physicians and by participants, beneficiaries, 
        and enrollees to information on the completion of referrals and 
        pre-authorizations and whether health care services and 
        products have been authorized, through--
                    (A) the Internet through a secure website; or
                    (B) a toll-free telephone number.
    (f) Modernizing Financial Transactions in Health Care.--Not later 
than December 31, 2008, each group health plan and health insurance 
issuer offering health insurance coverage shall have in effect a 
computerized system that--
            (1) permits health care providers to receive claim payments 
        through electronic transfer of funds;
            (2) permits participants, beneficiaries, and enrollees to 
        make payments for deductibles or other required cost sharing 
        through electronic transfer of funds; and
            (3) provides automated, integrated audit controls to 
        monitor any duplicate payments or overpayments within the 
        adjudication system.

SEC. 113. REGULATIONS.

    The Secretary shall issue such regulations as may be necessary or 
appropriate to carry out this subtitle.

   Subtitle C--Application to Public Health Service Act and Employee 
                 Retirement Income Security Act of 1974

SEC. 121. APPLICATION TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE 
              COVERAGE UNDER THE PUBLIC HEALTH SERVICE ACT.

    (a) In General.--Subpart 2 of part A of title XXVII of the Public 
Health Service Act is amended by adding at the end the following new 
section:

``SEC. 2707. IMPROVED QUALITY AND REDUCED COSTS.

    ``Each group health plan shall comply with the requirements under 
title I of the Health Care Modernization, Cost Reduction, and Quality 
Improvement Act, and each health insurance issuer shall comply with 
health care modernization requirements under such title with respect to 
group health insurance coverage it offers, and such requirements shall 
be deemed to be incorporated into this subsection.''.
    (b) Conforming Amendment.--Section 2721(b)(2)(A) of such Act (42 
U.S.C. 300gg-21(b)(2)(A)) is amended by inserting ``(other than section 
2707)'' after ``requirements of such subparts''.

SEC. 122. APPLICATION TO INDIVIDUAL HEALTH INSURANCE COVERAGE UNDER THE 
              PUBLIC HEALTH SERVICE ACT.

    Part B of title XXVII of the Public Health Service Act is amended 
by inserting after section 2752 the following new section:

``SEC. 2753. IMPROVED QUALITY AND REDUCED COSTS.

    ``Each health insurance issuer shall comply with requirements under 
title I of the Health Care Modernization, Cost Reduction, and Quality 
Improvement Act with respect to individual health insurance coverage it 
offers, and such requirements shall be deemed to be incorporated into 
this subsection.''.

SEC. 123. APPLICATION TO GROUP HEALTH PLANS AND GROUP HEALTH INSURANCE 
              COVERAGE UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY 
              ACT OF 1974.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 is amended by 
adding at the end the following new section:

``SEC. 714. IMPROVED QUALITY AND REDUCED COSTS.

    ``(a) In General.--A group health plan (and a health insurance 
issuer offering group health insurance coverage in connection with such 
a plan) shall comply with the requirements of title I of the Health 
Care Modernization, Cost Reduction, and Quality Improvement Act (as in 
effect as of the date of the enactment of such Act), and such 
requirements shall be deemed to be incorporated into this subsection.
    ``(b) Plan Satisfaction of Certain Requirements.--For purposes of 
subsection (a), insofar as a group health plan provides benefits in the 
form of health insurance coverage through a health insurance issuer, 
the plan shall be treated as meeting the requirements of title I of the 
Health Care Modernization, Cost Reduction, and Quality Improvement Act 
with respect to such benefits and not be considered as failing to meet 
such requirements because of a failure of the issuer to meet such 
requirements so long as the plan sponsor or its representatives did not 
cause such failure by the issuer.
    ``(c) Conforming Regulations.--The Secretary shall issue 
regulations to coordinate the requirements on group health plans and 
health insurance issuers under this section with the requirements 
imposed under the other provisions of this title.''.
    (b) Conforming Amendments.--
            (1) In general.--Section 732(a) of the Employee Retirement 
        Income Security Act of 1974 (29 U.S.C. 1185(a)) is amended by 
        striking ``section 711'' and inserting ``sections 711, 714, and 
        715''.
            (2) Table of contents.--The table of contents in section 1 
        of the Employee Retirement Income Security Act of 1974 is 
        amended by inserting after the item relating to section 713 the 
        following new item:

``Sec. 714. Improved quality and reduced costs.''.

                  Subtitle D--Miscellaneous Provisions

SEC. 131. DEFINITIONS.

    In this title:
            (1) Claim.--The term ``claim'' means any request for 
        coverage (including authorization of coverage), for 
        eligibility, or for payment in whole or in part, for an item or 
        service under a group health plan or health insurance coverage.
            (2) Cost sharing.--The term ``cost-sharing'' means any 
        deductibles, coinsurance, copayment amounts, and liability for 
        balance billing, for which the participant, beneficiary, or 
        enrollee will be responsible.
            (3) Enrollee.--The term ``enrollee'' means, with respect to 
        health insurance coverage offered by a health insurance issuer, 
        an individual enrolled with the issuer to receive such 
        coverage.
            (4) Group health plan.--The term ``group health plan'' has 
        the meaning given such term in section 733(a) of the Employee 
        Retirement Income Security Act of 1974 (29 U.S.C. 1191b(a)).
            (5) Health care provider.--The term ``health care 
        provider'' has the meaning given such term in section 
        1855(d)(5) of the Social Security Act.
            (6) Health insurance issuer.--The term ``health insurance 
        issuer'' has the meaning given such term in section 733(b) of 
        the Employee Retirement Income Security Act of 1974 (29 U.S.C. 
        1191b(b)).
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

                    TITLE II--PAYING FOR PERFORMANCE

SEC. 201. HEALTH CARE PROVIDER QUALITY STANDARDS.

    (a) Establishment.--
            (1) In general.--Not later than 2 years after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (referred to in this section as the ``Secretary'') 
        shall establish quality standards for health care providers to 
        be used as an element of payment or reimbursement for health 
        care items or services, including providers providing items or 
        services that are paid for by the Federal Government.
            (2) Requirements.--Standards under paragraph (1) shall--
                    (A) be selected and developed in consultation with 
                the National Quality Advisory Council, other Federal 
                agencies, and the private sector;
                    (B) be established in any area where such a 
                standard is determined by the Secretary to be feasible 
                and appropriate as a basis for payment or 
                reimbursement;
                    (C) be periodically revised and updated; and
                    (D) include standards relating to the process and 
                outcome of care, as determined feasible and appropriate 
                by the Secretary.
            (3) Appropriateness.--In determining feasibility and 
        appropriateness under paragraph (2)(B), the Secretary shall 
        take into account the cost of determining compliance with the 
        standard relative to the benefit of such standard.
    (b) Payments Based on Compliance With Standards.--
            (1) In general.--Each health care payor--
                    (A) shall, except as provided in subsection (c), 
                provide enhanced payments to health care providers that 
                achieve or make appropriate progress toward compliance 
                with the applicable quality standards developed under 
                subsection (a); and
                    (B) may provide for reduced payments to health care 
                providers that fail to make appropriate progress 
                toward, or fail to comply with, such standards.
            (2) Flexibility.--In determining whether to provide 
        enhanced or reduced payments under paragraph (1), the health 
        care payor may provide for a time-limited period in which--
                    (A) compliance with the standards are voluntary for 
                the health care provider involved; and
                    (B) with respect to a health care provider that has 
                failed to comply with the standards, the provider may 
                achieve compliance with the standard in order to gain 
                an enhanced payment or avoid a reduced payment.
            (3) Rule of construction.--Nothing in this subsection shall 
        be construed to--
                    (A) prohibit a health care payor from making 
                payments to health care providers for their performance 
                based on standards in addition to the standards 
                developed under subsection (a); and
                    (B) prohibit a health care payor from reducing 
                payments to health care providers who do not meet the 
                standard, unless specifically prohibited by the 
                Secretary.
    (c) Authority to Limit to Certain Categories or Types of 
Providers.--Each health care payor may--
            (1) limit the requirement for enhanced payments based on 
        compliance with a standard developed under subsection (a) to 
        certain categories or types of health care providers;
            (2) establish alternative standards applicable to the same 
        condition or course of treatment for different types or 
        categories of health care providers; and
            (3) provide for exceptions to the requirements for enhanced 
        payments based on circumstances in which payment based on a 
        standard would not serve the public interest.
    (d) Mandatory Negotiation of Payment for Value.--
            (1) In general.--If a health care provider determines--
                    (A) that, notwithstanding the standards developed 
                under subsection (a), it can provide health care items 
                or services in a manner that will reduce cost and 
                improve the quality of care; and
                    (B) that providing the items or services described 
                in subparagraph (A) will reduce the amount of 
                reimbursement that would otherwise be available to the 
                provider;
        the provider may request that the payor involved enter into 
        negotiations to establish an alternative basis of payment.
            (2) Good faith negotiation.--A payor that pays for items or 
        services described in paragraph (1) shall negotiate an 
        alternative basis of payment for health care items or services 
        in good faith. Nothing in the preceding sentence shall be 
        construed to require any payor to agree to a particular method 
        of payment or a level of payment that would result in increased 
        total costs to the payor.
    (e) Special Standards for Chronic Care.--
            (1) In general.--Standards developed under subsection (a) 
        for chronic care shall include--
                    (A) coordination of care;
                    (B) patient education in self-management; and
                    (C) systems for tracking and assuring achievement 
                of process and outcome objectives.
            (2) Contracts.--In carrying out this subsection, health 
        care payors shall enter into contracts with health care 
        providers that are willing to accept responsibility for the 
        outcome of care for specific individuals and shall make 
        standards-based payments to such providers. Such payments shall 
        cover the costs of services, such as training in patient self-
        management and coordination of care, either directly or through 
        payments to a contracting provider, pursuant to standards 
        specified by the Secretary.
    (f) Health Care Payor.--In this section, the term ``health care 
payor'' means any entity that pays for, or reimburses others for 
payment to, a health care provider for health care items or services, 
including a health insurance issuer and the Federal Government.
    (g) Reporting Requirements.--
            (1) In general.--Each health care provider to which this 
        section applies shall report to the Secretary data on the 
        compliance of the provider with this section, including data on 
        the quality of health care provided by such provider and 
        measures to improve the quality of health care provided by such 
        provider.
            (2) Public availability of data.--The Secretary shall 
        analyze and make publicly available the data reported to the 
        Secretary under paragraph (1) in a manner determined to be of 
        value to patients and health care practitioners.

                TITLE III--TARGETED QUALITY INITIATIVES

SEC. 301. IMPROVING THE QUALITY OF CARE FOR AMERICANS WITH DIABETES.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

  ``PART R--IMPROVING THE QUALITY OF CARE FOR AMERICANS WITH DIABETES

``SEC. 399A. STATE DIABETES CONTROL AND PREVENTION PROGRAMS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and in consultation with 
appropriate agencies, shall support comprehensive diabetes control and 
prevention programs by awarding grants to eligible entities to provide 
public health surveillance, prevention, and control activities, and to 
assure affordable, high-quality diabetes care.
    ``(b) Eligibility.--A State or territory is an eligible entity 
under this section.
    ``(c) Use of Funds.--Consistent with the comprehensive diabetes 
control and prevention plan submitted under subsection (d), an eligible 
entity that receives a grant under this section may use funds received 
under such grant to--
            ``(1) conduct health and community research, including 
        research on behavioral interventions, to prevent diabetes 
        (including the development of related complications) and the 
        onset of type 2 diabetes in persons with pre-diabetes or 
        persons at high risk for developing diabetes;
            ``(2) conduct projects, including community-based programs 
        of diabetes control and prevention, and similar collaborations 
        with academic institutions, hospitals, community centers, 
        health insurers, researchers, health professionals, and 
        nonprofit organizations;
            ``(3) conduct public health surveillance and 
        epidemiological activities relating to the prevalence of 
        diabetes and assessing disparities in diabetes control and 
        prevention, including such disparities in underserved 
        populations;
            ``(4) provide public information and education programs; 
        and
            ``(5) provide education and training for health 
        professionals, including allied health professionals.
    ``(d) Application.--An eligible entity that seeks funding 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 a comprehensive plan for diabetes-related prevention 
and control strategies and activities to be undertaken or supported by 
the eligible entity, which--
            ``(1) is developed with the advice of stakeholders from the 
        public, private, and nonprofit sectors with expertise relating 
        to diabetes control, prevention, and treatment;
            ``(2) is intended to reduce the incidence, morbidity, and 
        mortality of type 1 and 2 diabetes, with a priority on 
        preventing and controlling diabetes in at-risk populations and 
        reducing disparities in underserved populations; and
            ``(3) describes the diabetes-related services and 
        activities to be undertaken or supported by the eligible 
        entity.

``SEC. 399A-1. IMPROVING QUALITY OF DIABETES PREVENTION AND CARE.

    ``(a) In General.--After completion of activities under subsection 
(d), the Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, and in collaboration with the Director 
of the Agency for Healthcare Research and Quality, shall award 
competitive grants to eligible entities to apply the best practices 
identified by the Secretary under subsection (d) for diabetes 
prevention and control.
    ``(b) Eligibility.--An entity is eligible for a grant under this 
section if such entity is--
            ``(1) a State, territory, Indian tribe, tribal 
        organization, public or nonprofit entity; or
            ``(2) a partnership of an entity described in paragraph (1) 
        and an appropriate private sector organization.
    ``(c) Priority.--In awarding grants under this section, the 
Secretary shall give priority to eligible entities that propose to 
carry out programs to reduce disparities in diabetes prevention and 
control for high-risk or underserved populations.
    ``(d) Best Practices.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of this section, the Secretary shall identify 
        evidence-based best practices, evidence-based guidelines and 
        other effective models for diabetes prevention and control, 
        which may be adopted and applied by eligible entities under 
        this section.
            ``(2) Specific best practices.--Best practices, as 
        described in paragraph (1), may include--
                    ``(A) State or community-based interventions, 
                school-based screening, care and prevention programs, 
                health systems improvement strategies, and health and 
                environmental policies that promote improved nutrition 
                and physical activity;
                    ``(B) case management or disease management quality 
                improvements programs;
                    ``(C) appropriate communication, training, or 
                regional outreach and health promotion initiatives, 
                including Internet-based initiatives; or
                    ``(D) models developed or validated by diabetes 
                research and training centers established under section 
                431.
    ``(e) Application.--An eligible entity that seeks funding under 
this section shall prepare and submit to the Secretary an application 
at such time, in such manner, and containing such information as the 
Secretary determines to be necessary, including information regarding 
how such entity would use funds received under this section to 
supplement activities carried out under such entity's comprehensive 
diabetes control and prevention plan under section 399A.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $50,000,000 for fiscal year 
2005, and such sums as may be necessary for each of fiscal years 2006 
through 2009.

``SEC. 399A-2. NATIONAL DIABETES EDUCATION AND OUTREACH.

    ``(a) Purpose.--The Secretary, acting through the Diabetes Mellitus 
Interagency Coordinating Committee, shall coordinate a national 
diabetes education program to support, develop, and implement education 
initiatives and outreach strategies appropriate for both type 1 and 2 
diabetes. Such activities may include public awareness campaigns, 
public service announcements and community partnership workshops, as 
well as programs targeted at businesses and employers, managed care 
organizations, and health care providers.
    ``(b) Priority.--The Secretary shall emphasize translation of new 
scientific and clinical findings into utilizable information for health 
care providers and patients. The Secretary shall also give priority to 
reaching high-risk or underserved populations.
    ``(c) Collaboration.--In carrying out this section, the Secretary 
shall consult and collaborate with stakeholders from the public, 
private, and nonprofit sectors with expertise relating to diabetes 
control, prevention, and treatment.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $15,000,000 for fiscal year 
2005 and such sums as may be necessary for each of fiscal years 2006 
through 2009.''.

``SEC. 399A-3. DEFINITION.

    ``In this part, the term `State' has the meaning given such term in 
section 2, and includes Indian tribes.''.

SEC. 302. IMPROVING THE QUALITY OF CARE FOR AMERICANS WITH ARTHRITIS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 301, is further amended by adding at the end the 
following:

  ``PART S--IMPROVING THE QUALITY OF CARE FOR AMERICANS WITH ARTHRITIS

``SEC. 399B. STATE ARTHRITIS CONTROL AND PREVENTION PROGRAMS.

    ``(a) In General.--The Secretary shall award grants to eligible 
entities to provide support for comprehensive arthritis control and 
prevention programs and to enable such entities to provide public 
health surveillance, prevention, and control activities related to 
arthritis and other rheumatic diseases.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall be a State or Indian tribe.
    ``(c) Application.--To be eligible to receive a grant under this 
section, an entity shall submit to the Secretary an application at such 
time, in such manner, and containing such agreements, assurances, and 
information as the Secretary may require, including a comprehensive 
arthritis control and prevention plan that--
            ``(1) is developed with the advice of stakeholders from the 
        public, private, and nonprofit sectors that have expertise 
        relating to arthritis control, prevention, and treatment that 
        increase the quality of life and decrease the level of 
        disability;
            ``(2) is intended to reduce the morbidity of arthritis, 
        with priority on preventing and controlling arthritis in at-
        risk populations and reducing disparities in arthritis 
        prevention, diagnosis, management, and quality of care in 
        underserved populations;
            ``(3) describes the arthritis-related services and 
        activities to be undertaken or supported by the entity; and
            ``(4) is developed in a manner that is consistent with the 
        National Arthritis Action Plan or a subsequent strategic plan 
        designated by the Secretary.
    ``(d) Use of Funds.--An eligible entity shall use amounts received 
under a grant awarded under subsection (a) to conduct, in a manner 
consistent with the comprehensive arthritis control and prevention plan 
submitted by the entity in the application under subsection (c)--
            ``(1) public health surveillance and epidemiological 
        activities relating to the prevalence of arthritis and 
        assessment of disparities in arthritis prevention, diagnosis, 
        management, and care;
            ``(2) public information and education programs; and
            ``(3) education, training, and clinical skills improvement 
        activities for health professionals, including allied health 
        personnel.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399B-1. COMPREHENSIVE ARTHRITIS ACTION GRANTS.

    ``(a) In General.--The Secretary shall award grants on a 
competitive basis to eligible entities to enable such eligible entities 
to assist in the implementation of a national strategy for arthritis 
control and prevention.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall be a national public or private nonprofit 
entity.
    ``(c) Application.--To be eligible to receive a grant under this 
section, an entity shall submit to the Secretary an application at such 
time, in such manner, and containing such agreements, assurances, and 
information as the Secretary may require, including a description of 
how funds received under a grant awarded under this section will--
            ``(1) supplement or fulfill unmet needs identified in the 
        comprehensive arthritis control and prevention plan of a State 
        or Indian tribe;
            ``(2) otherwise help achieve the goals of the National 
        Arthritis Action Plan or a subsequent strategic plan designated 
        by the Secretary.
    ``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to eligible entities submitting 
applications proposing to carry out programs for controlling and 
preventing arthritis in at-risk populations or reducing disparities in 
underserved populations.
    ``(e) Use of Funds.--An eligible entity shall use amounts received 
under a grant awarded under subsection (a) for 1 or more of the 
following purposes:
            ``(1) To expand the availability of physical activity 
        programs designed specifically for people with arthritis.
            ``(2) To provide awareness education to patients, family 
        members, and health care providers, to help such individuals 
        recognize the signs and symptoms of arthritis, and to address 
        the control and prevention of arthritis.
            ``(3) To decrease long-term consequences of arthritis by 
        making information available to individuals with regard to the 
        self-management of arthritis.
            ``(4) To provide information on nutrition education 
        programs with regard to preventing or mitigating the impact of 
        arthritis.
    ``(f) Evaluation.--An eligible entity that receives a grant under 
this section shall submit to the Secretary an evaluation of the 
operations and activities carried out under such grant that includes an 
analysis of increased utilization and benefit of public health programs 
relevant to the activities described in the appropriate provisions of 
subsection (e).
    ``(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. 399B-2. NATIONAL ARTHRITIS EDUCATION AND OUTREACH.

    ``(a) In General.--The Secretary shall coordinate a national 
education and outreach program to support, develop, and implement 
education initiatives and outreach strategies appropriate for arthritis 
and other rheumatic diseases.
    ``(b) Initiatives and Strategies.--Initiatives and strategies 
implemented under the program described in paragraph (1) may include 
public awareness campaigns, public service announcements, and community 
partnership workshops, as well as programs targeted at businesses and 
employers, managed care organizations, and health care providers.
    ``(c) Priority.--In carrying out subsection (a), the Secretary--
            ``(1) may emphasize prevention, early diagnosis, and 
        appropriate management of arthritis, and opportunities for 
        effective patient self-management; and
            ``(2) shall give priority to reaching high-risk or 
        underserved populations.
    ``(d) Collaboration.--In carrying out this section, the Secretary 
shall consult and collaborate with stake-holders from the public, 
private, and nonprofit sectors with expertise relating to arthritis 
control, prevention, and treatment.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399B-3. DEFINITION.

    ``In this part, the term `State' has the meaning given such term in 
section 2, and includes Indian tribes.''.

SEC. 303. STROKE PREVENTION, TREATMENT, AND REHABILITATION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 302, is further amended by adding at the end the 
following:

  ``PART T--STROKE PREVENTION, TREATMENT, AND REHABILITATION PROGRAMS

``SEC. 399C. DEFINITIONS.

    In this part:
            ``(1) Stroke care system.--The term `stroke care system' 
        means a statewide system to provide for the diagnosis, 
        prehospital care, hospital definitive care, and rehabilitation 
        of stroke patients.
            ``(2) Stroke.--The term `stroke' means a `brain attack' in 
        which blood flow to the brain is interrupted or in which a 
        blood vessel or aneurysm in the brain breaks or ruptures.

``SEC. 399C-1. GRANTS TO STATES FOR STROKE CARE SYSTEMS.

    ``(a) Grants.--The Secretary shall award grants to States for the 
development and implementation of stroke care systems that provide 
high-quality prevention, diagnosis, treatment, and rehabilitation.
    ``(b) Required Uses.--
            ``(1) In general.--In carrying out activities described in 
        subsection (a), each State that is awarded a grant under this 
        section shall--
                    ``(A) establish, enhance, or expand a statewide 
                stroke care system for the purpose of ensuring access 
                to high-quality stroke prevention, diagnosis, 
                treatment, and rehabilitation, except that activities 
                conducted under this subparagraph shall be consistent 
                with guidelines or recommendations issued by the 
                Secretary under section 399C-3(a)(2) to the extent that 
                such guidelines or recommendations have been issued;
                    ``(B) establish, enhance, or expand, as 
                appropriate, stroke care centers, except that 
                activities conducted under this subparagraph shall be 
                consistent with guidelines or recommendations issued by 
                the Secretary under section 399C-3(a)(2), to the extent 
                that such guidelines or recommendations have been 
                issued;
                    ``(C) conduct evaluation activities to monitor 
                clinical outcomes and procedures and to verify 
                resources, infrastructure, and operations devoted to 
                stroke care;
                    ``(D) enhance, develop, and implement a model 
                curriculum for training emergency medical services 
                personnel in the identification, assessment, 
                stabilization, and prehospital treatment of stroke 
                patients, which curriculum may, at the discretion of 
                the State, consist of or be based on the model 
                curriculum developed by the Secretary under section 
                399C-3(a)(1);
                    ``(E) enhance coordination of emergency medical 
                services with respect to stroke care;
                    ``(F) establish, enhance, or improve a central data 
                reporting and analysis system described in subsection 
                (c);
                    ``(G) establish, enhance, or improve a support 
                network described in subsection (d) to provide 
                assistance to facilities with smaller populations of 
                stroke patients or less advanced on-site stroke 
                treatment resources;
                    ``(H) consult with organizations and individuals 
                with expertise in stroke prevention, diagnosis, 
                treatment, and rehabilitation; and
                    ``(I) with respect to carrying out subparagraph (C) 
                through (H), use the best available evidence and 
                consensus recommendations of professional associations.
            ``(2) Permissible uses.--In developing and implementing a 
        stroke care system described in paragraph (1), each State that 
        is awarded a grant under this section may--
                    ``(A) improve existing State stroke prevention 
                programs; and
                    ``(B) conduct a stroke education and information 
                campaign, including by--
                            ``(i) making public service announcements 
                        about the warning signs of stroke and the 
importance of treating stroke as a medical emergency; and
                            ``(ii) providing education regarding ways 
                        to prevent stroke and the effectiveness of 
                        stroke treatment.
    ``(c) Central Data Reporting and Analysis System.--A central data 
reporting and analysis system described in this section is a system 
that collects data from facilities that provide direct care to stroke 
patients and uses the data--
            ``(1) to identify the number of stroke patients treated in 
        the State;
            ``(2) to monitor patient care in the State for stroke 
        patients at all phases of stroke for the purpose of evaluating 
        the diagnosis, treatment, and treatment outcome of such stroke 
        patients;
            ``(3) to identify the total amount of uncompensated and 
        under-compensated stroke care expenditures for each fiscal year 
        by each stroke care facility in the State;
            ``(4) to identify the number of acute stroke patients who 
        receive advanced drug therapy; and
            ``(5) to identify patients transferred within the statewide 
        stroke care system, including reasons for such transfer.
    ``(d) Support Network.--A support network described in this section 
may include the following:
            ``(1) The use of telehealth technology to connect 
        facilities described in subsection (b)(1)(G) to more advanced 
        stroke care facilities.
            ``(2) The provision of neuroimaging, laboratory, and any 
        other equipment necessary to facilitate the establishment of a 
        telehealth network.
            ``(3) The use of phone consultation, where useful.
            ``(4) The use of referral links when a patient needs more 
        advanced care than is available at the facility providing 
        initial care.
            ``(5) The provision of any other assistance determined 
        appropriate by the State.
    ``(e) Restrictions on Use of Payments.--The Secretary may not make 
payments to a State under this section for a fiscal year unless the 
State agrees that the payments will not be expended--
            ``(1) to make cash payments to intended recipients of 
        services provided pursuant to this section;
            ``(2) to satisfy any requirement for the expenditure of 
        non-Federal funds as a condition for the receipt of Federal 
        funds;
            ``(3) to provide financial assistance to any entity other 
        than a public or nonprofit private entity; or
            ``(4) for construction, alteration, or improvement of any 
        building or facility.
    ``(f) Failure To Comply With Agreements.--
            ``(1) Repayment of payments.--
                    ``(A) Requirement.--The Secretary may, in 
                accordance with paragraph (2), require a State to repay 
                any payments received by the State under this section 
                that the Secretary determines were not expended by the 
                State in accordance with the agreements required to be 
                made by the State as a condition of the receipt of the 
                payments.
                    ``(B) Offset of amounts.--If a State fails to make 
                a repayment required in subparagraph (A), the Secretary 
                may offset the amount of the repayment against any 
                amount due to be paid to the State under this section.
            ``(2) Opportunity for a hearing.--Before requiring 
        repayment of payments under paragraph (1), the Secretary shall 
        provide to the State an opportunity for a hearing.
    ``(g) Application Requirements.--The Secretary may not award a 
grant to a State under this section unless--
            ``(1) the State submits an application containing 
        agreements in accordance with this section;
            ``(2) the agreements are made through certification from 
        the chief executive officer of the State;
            ``(3) with respect to such agreements, the application 
        provides assurances of compliance satisfactory to the 
        Secretary;
            ``(4) the application contains the plan provisions and the 
        information required to be submitted to the Secretary; and
            ``(5) the application otherwise is in such form, is made in 
        such manner, and contains such agreements, assurances, and 
        information as the Secretary determines to be necessary to 
        carry out this section.
    ``(h) Technical Assistance.--The Secretary shall, without charge to 
a State receiving payments under this section, provide to the State (or 
to any public or nonprofit entity designated by the State) technical 
assistance with respect to the planning, development, and operation of 
any program carried out pursuant to this section. The Secretary may 
provide such technical assistance directly, through contracts, or 
through grants.
    ``(i) Supplies and Services in Lieu of Grant Funds.--
            ``(1) In general.--Upon the request of a State receiving 
        payments under this section, the Secretary may, subject to 
        paragraph (2), provide supplies, equipment, and services to the 
        State and may detail to the State any officer or employee of 
        the Department of Health and Human Services, for the purpose of 
        assisting the State to achieve the purpose of the payments.
            ``(2) Reduction in payments.--With respect to a request 
        described in paragraph (1), the Secretary shall reduce the 
        amount of payments to the State under this section by an amount 
        equal to the costs of detailing personnel and the fair 
market value of any supplies, equipment, or services provided by the 
Secretary. The Secretary shall, for the payment of expenses incurred in 
complying with such request, expend the amounts withheld.
    ``(j) Limitation on Administrative Expenses.--The Secretary may not 
award a grant to a State under this section unless the State agrees to 
use not more than 10 percent of amounts received under the grant for 
administrative expenses.
    ``(k) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399C-2. PLANNING GRANTS.

    ``(a) Grants.--The Secretary may award a grant to a State to assist 
such State in formulating a plan to develop a stroke care system in 
accordance with section 399C-1 or in otherwise meeting the requirements 
of such section.
    ``(b) Submission to Secretary.--The chief executive officer of a 
State that receives a grant under this section shall submit to the 
Secretary a copy of the plan developed using the amounts provided under 
such grant. Such plan shall be submitted to the Secretary as soon as 
practicable after the plan has been developed.
    ``(c) Single Grant Limitation.--A State is not eligible to receive 
a grant under this section if the State previously received a grant 
under this section.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399C-3. RESPONSIBILITIES OF THE SECRETARY.

    ``(a) In General.--The Secretary shall, with respect to stroke 
care--
            ``(1) develop a model curriculum for training emergency 
        medical services personnel, including dispatchers, first 
        responders, emergency medical technicians, and paramedics, in 
        the identification, assessment, stabilization, and prehospital 
        treatment of stroke patients; and
            ``(2) issue recommendations or guidelines on best practices 
        for the establishment and operation of statewide stroke care 
        systems, including recommendations or guidelines on best 
        practices for the establishment and operation of stroke care 
        centers.
    ``(b) Grants, Cooperative Agreements, and Contracts.--The Secretary 
may make grants, and enter into cooperative agreements and contracts, 
for the purpose of carrying out subsection (a).
    ``(c) Rules of Construction.--
            ``(1) Existing guidelines.--Nothing in subsection (a)(2) 
        shall be construed to require the Secretary to issue new 
        recommendations or guidelines where existing recommendations or 
        guidelines issued or adopted by the Secretary are applicable to 
        the establishment of statewide stroke systems. Where an 
        existing recommendation or guideline is applicable to the 
        establishment of statewide stroke systems, the Secretary may 
        deem such recommendation or guideline to have been issued under 
        subsection (a)(2).
            ``(2) Advisory nature of guidelines.--Recommendations or 
        guidelines issued under subsection (a)(2) shall be considered 
        advisory in nature and shall not be construed to constitute a 
        standard of care for the treatment of stroke.''.

SEC. 304. INCREASING LANGUAGE ACCESS FOR AMERICANS WITH LIMITED ENGLISH 
              PROFICIENCY.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by adding at the end thereof the following:

``PART C--INCREASING LANGUAGE ACCESS FOR AMERICANS WITH LIMITED ENGLISH 
                              PROFICIENCY

``SEC. 251. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS WITH LIMITED 
              ENGLISH PROFICIENCY.

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

``SEC. 252. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES IN HEALTHCARE.

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

``SEC. 253. INNOVATIONS IN LANGUAGE ACCESS GRANTS.

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

``SEC. 254. STANDARDS FOR LANGUAGE ACCESS SERVICES.

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

``SEC. 255. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND 
              LINGUISTICALLY APPROPRIATE HEALTH CARE SERVICES.

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

SEC. 305. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES.

    (a) Medicare.--Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended by adding at the end the following:

   ``medicare payment for culturally and linguistically appropriate 
                                services

    ``Sec. 1898. (a) Payment for Culturally and Linguistically 
Appropriate Services.--Notwithstanding any other provision of this 
title, by not later than January 1, 2006, the Secretary shall provide 
several alternative additions to the payment amounts for items and 
services for which payment may be made under the payment systems 
described in subsection (d) for items and services furnished to a LEP 
beneficiary (as defined by the Secretary) for the estimated cost of 
providing quality culturally and linguistically appropriate language 
services (including in-person and telephonic interpreter services and 
written translation services.
    ``(b) Application to Specific Providers.--The Secretary shall apply 
the addition described in subsection (a) to each specific individual or 
entity paid under a payment system described in subsection (d) that 
reflects the cost of most efficiently providing such quality services 
by that individual or entity.
    ``(c) Considerations in Developing Alternative Amounts.--In 
developing the alternative amounts described in subsection (a), the 
Secretary shall--
            ``(1) consider which types of language access services are 
        most appropriate for the improvement of the quality of care of 
        LEP beneficiaries (as so defined), and ensure that 
        interpretation is one of these services;
            ``(2) consider what those services should include and such 
        other factors as the Secretary determines to be appropriate;
            ``(3) consider the cost to a hospital of contracting for 
        such services, the cost of providing such services internally, 
        the cost of providing such services through electronic and 
        telecommunications means, the extra cost of ensuring such 
        services are available with respect to languages not frequently 
        used in the United States, and the extra cost of ensuring such 
        services are available in rural areas;
            ``(4) ensure the adequate adjustment of such additions for 
        annual changes in the cost of providing such services.
    ``(d) Payment Systems Described.--The payment systems described in 
this subsection are the payments systems under this title, including 
the following:
            ``(1) Inpatient hospital services.--The prospective payment 
        system for inpatient hospital services under section 1886(d).
            ``(2) Hospital outpatient department services.--The 
        prospective payment system for hospital outpatient department 
        services under section 1833(t).
            ``(3) Psychiatric hospitals.--The payment system applicable 
        with respect to psychiatric hospitals (as defined in section 
        1861(f)).
            ``(4) Rehabilitation facilities.--The prospective payment 
        system for rehabilitation facilities under section 1886(j).
            ``(5) Children's, long-term care, and cancer hospitals.--
        The payment systems applicable with respect to hospitals 
        described in clause (iii), (iv), or (v) of section 
        1886(d)(1)(B).
            ``(6) Skilled nursing facilities.--The prospective payment 
        system for skilled nursing facility services under section 
        1888(e).
            ``(7) Home health services.--The prospective payment system 
        for home health services under section 1895.
            ``(8) Renal dialysis facilities.--The payment system for 
        services provided to end-stage renal disease patients under 
        section 1881.
            ``(9) Physicians' fee schedule.--The physicians' fee 
        schedule under section 1848.
            ``(10) Medicare Advantage program.--The Medicare Advantage 
        program under part C.
            ``(11) Voluntary prescription drug benefit program.--The 
        voluntary prescription drug benefit program under part D.''.
    (b) Medicaid.--Section 1903(a)(3) of the Social Security Act (42 
U.S.C. 1396b(a)(3)) is amended--
            (1) in subparagraph (D), by striking ``plus'' at the end 
        and inserting ``and''; and
            (2) by adding at the end the following:
                    ``(E) 90 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to the provision of culturally and 
                linguistically appropriate services, including oral 
                interpretation, translations of written materials, and 
                other cultural and linguistic services for individuals 
                with limited English proficiency and disabilities who 
                apply for, or receive, medical assistance under the 
                State plan (including any waiver granted to the State 
                plan); plus''.
    (c) SCHIP.--Section 2105(a)(1) of the Social Security Act (42 
U.S.C.1397ee(a)), as amended by section 515, is amended--
            (1) in the matter preceding subparagraph (A), by inserting 
        ``or, in the case of expenditures described in subparagraph 
        (D)(iv), 90 percent'' after ``enhanced FMAP''; and
            (2) in subparagraph (D)--
                    (A) in clause (iii), by striking ``and'' at the 
                end;
                    (B) by redesignating clause (iv) as clause (v); and
                    (C) by inserting after clause (iii) the following:
                            ``(iv) for expenditures attributable to the 
                        provision of culturally and linguistically 
                        appropriate services, including oral 
                        interpretation, translations of written 
                        materials, and other language services for 
                        individuals with limited English proficiency 
                        and disabilities who apply for, or receive, 
                        child health assistance under the plan; and''.
    (d) Effective Date.--The amendments made by this section take 
effect on October 1, 2005.

SEC. 306. NATIONAL QUALITY ADVISORY COUNCIL.

    (a) Establishment.--There is hereby established the National 
Quality Advisory Council (in this section referred to as the 
``Council'').
    (b) Members.--
            (1) Number and appointment.--The Council shall be composed 
        of 15 members to be appointed by the Comptroller General in 
accordance with this subsection.
            (2) Qualification.--
                    (A) In general.--The members of the Council shall 
                include individuals with national recognition for their 
                expertise in health care quality, quality measurement 
                systems, consumer reporting, health care management, 
                health plans and integrated delivery systems, health 
                care financing, minority (and other vulnerable 
                populations) health, and other related fields who 
                provide a mix of different professions and broad 
                geographic and culturally diverse representation.
                    (B) Inclusion.--The members of the Council shall 
                include physicians and other health professionals, 
                employers, third-party payers, individuals skilled in 
                the conduct and interpretation of biomedical health 
                services and health quality research and with expertise 
                in outcomes and effectiveness research and technology 
                assessment, and representatives of consumers from 
                diverse backgrounds.
                    (C) Majority nonproviders.--Individuals who are 
                directly involved in the provision, or management of 
                the delivery, of items and services covered under this 
                title shall not constitute a majority of the members of 
                the Council.
                    (D) Ethical disclosure.--The Comptroller General 
                shall establish a system for the public disclosure, by 
                members of the Council, of financial and other 
                potential conflicts of interest relating to such 
                members.
            (3) Terms.--
                    (A) In general.--The terms of the members of the 
                Council shall be for 5 years except that the 
                Comptroller General shall stagger the terms of the 
                members first appointed.
                    (B) Vacancies.--Any member appointed to fill a 
                vacancy occurring in the Council before the expiration 
                of the term for which the member's predecessor was 
                appointed shall be appointed only for the remainder of 
                that term. A member may serve after the expiration of 
                that member's term until a successor has been 
                appointed. A vacancy in the membership of the 
                Commission shall be filled in the manner in which the 
                original appointment was made.
            (4) Compensation.--While carrying out the business of the 
        Council (including travel time), a member of the Council shall 
        be entitled to compensation at the per diem equivalent rate 
        provided for level IV of the Executive Schedule under section 
        5315 of title 5, United States Code, and while so serving away 
        from home and the member's regular place of business, a member 
        may be allowed travel expenses, as authorized by the 
        Chairperson of the Council. Physicians who are members of the 
        Council may be provided a physician comparability allowance by 
        the Council in the same manner as Government physicians may be 
        provided such an allowance by an agency under section 5948 of 
        title 5, United States Code. For purposes of pay (other than 
        pay of members of the Council) and employment benefits, rights, 
        and privileges, all personnel of the Commission shall be 
        treated as if they were employees of the United States Senate.
            (5) Chairperson; vice chairperson.--The Comptroller General 
        shall designate a member of the Council, at the time of the 
        appointment of such member, to serve as the Chairperson of the 
        Council and another member to serve as Vice Chairperson of the 
        Council for that term of appointment, except that in the case 
        of the vacancy of the Chairpersonship or Vice Chairpersonship, 
        the Comptroller General may designate another member to serve 
        for the remainder of that member's term.
            (6) Meetings.--The Council shall meet at the call of the 
        Chairperson, but in no event less than once every 6 months.
    (c) Duties.--
            (1) Review of national health care quality.--The Council 
        shall--
                    (A) identify national aims and objectives for 
                health care quality improvement;
                    (B) track the progress of the United States in 
                meeting the aims and objectives identified under 
                subparagraph (A);
                    (C) make recommendations to Congress and the public 
                concerning health care quality policies and programs 
                for improvement; and
                    (D) not later than March 1 of each year (beginning 
                in 2005), submit a report to Congress and the public 
                containing the results of reviews conducted under this 
                subsection and the recommendations of the Council 
                concerning health care quality policies and programs.
            (2) Topics to be reviewed.--
                    (A) National aims.--The Council shall review, at 
                the minimum, the following national aims:
                            (i) Reducing avoidable mortality and the 
                        underlying causes of illness, injury, and 
                        disability.
                            (ii) Expanding research on new treatments 
                        and evidence on effectiveness.
                            (iii) Assuring the appropriate use of 
                        health care services.
                            (iv) Reducing health care errors.
                            (v) Addressing oversupply and undersupply 
                        of health care resources.
                            (vi) Increasing patients' participation in 
                        their care and the public's engagement in 
                        improving health system performance.
                    (B) National objectives.--The Council shall develop 
                measurable objectives within each of the national aims 
                described in subparagraph (A) (as well as within any 
                newly identified aims) and such objectives should be 
                revised over time as improvements occur and new 
                concerns arise.
                    (C) Quality measurement and reporting standards.--
                The Council shall conduct the following activities:
                            (i) Conduct assessments of the adequacy of 
                        current quality measures and reporting 
                        standards for the American population at large 
                        as well as for sub-populations defined by age, 
                        gender, race, ethnicity, income, disability, 
                        and geography.
                            (ii) Identify processes for the development 
                        of new quality measures and reporting standards 
                        as needed.
                            (iii) Make recommendations to health care 
                        organizations and providers regarding quality 
                        measurement and reporting, both publicly and 
                        privately.
                            (iv) Track the use of recommended quality 
                        measurement and reporting standards.
                            (v) Make recommendations to Congress 
                        concerning health care quality measurement and 
                        reporting requirements.
                    (D) Disparities in health care quality.--The 
                Council shall include as part of its overall review 
                under this paragraph, an assessment of health care 
                quality for, at the minimum, the following populations:
                            (i) Children and adolescents.
                            (ii) Senior citizens.
                            (iii) Disabled individuals.
                            (iv) Racial, ethnic and limited English 
                        proficient individuals.
                            (v) Women.
                            (vi) Low income individuals.
                            (vii) Geographically diverse populations.
                    (E) Interventions for improvement of health care 
                quality and health system performance.--The Council 
                shall conduct the following activities:
                            (i) Review the evidence base to determine 
                        the most effective methods for improving 
                        patient care and the performance of the health 
                        care system, including regulation, 
                        accreditation, performance based payment, 
                        information technologies, management systems, 
                        professional certification, and public 
                        reporting of data.
                            (ii) Identify gaps and deficiencies of 
                        research to ascertain the most predictable 
                        processes and policies associated with 
                        improvements in quality.
                            (iii) Make recommendations to health care 
                        organizations and providers regarding quality 
                        improvement methods, including appropriate 
                        clinical guidelines, both publicly and 
                        privately.
                            (iv) Make recommendations to Congress 
                        concerning policies and processes for 
                        improvement.
                    (F) Consumer bill of rights and responsibilities.--
                The Council shall assess the implementation of this Act 
                with attention to the following areas:
                            (i) Information disclosure.
                            (ii) Choice of providers and plans.
                            (iii) Access to emergency services.
                            (iv) Participation in treatment decisions.
                            (v) Respect and nondiscrimination.
                            (vi) Confidentiality of health information.
                            (vii) Complaints and appeals.
                            (viii) Consumer responsibilities.
            (3) Comments on certain secretarial reports.--If the 
        Secretary of Health and Human Service (referred to in this 
        section as the ``Secretary'') submits to Congress (or a 
        committee of Congress) a report that is required by law, and 
        that relates to health care quality, including the National 
        Healthcare Quality Report and the National Healthcare 
        Disparities Report, the Secretary shall transmit a copy of the 
        report to the Council. The Council shall review the report and, 
        not later than 6 months after the date on which such report is 
        transmitted to the Council, shall submit to the appropriate 
        committees of Congress written comments on such report. Such 
        comments may include such recommendations as the Council 
        determines appropriate.
            (4) Agenda and additional reviews.--The Council shall 
        consult periodically with the chairmen and ranking minority 
        members of the appropriate committees of Congress concerning 
        the Council's agenda and progress towards achieving the agenda. 
        The Council may conduct additional reviews and submit 
        additional reports to the appropriate committees of Congress, 
        from time to time, on such topics relating to the program under 
        this title as may be requested by such chairperson and members 
        and as the Council determines appropriate.
            (5) Availability of reports.--The Council shall transmit to 
        the Secretary a copy of each report submitted under this 
        subsection and shall make such reports available to the public.
            (6) Appropriate committees of congress.--In this section, 
        the term ``appropriate committees of Congress'' means the 
        Committee on Ways and Means and the Committee on Energy and 
        Commerce of the House of Representatives and the Committee on 
        Health, Education, Labor, and Pensions and the Committee on 
        Finance of the Senate.
    (d) Director; Staff; Experts; Consultants.--Subject to such review 
as the Comptroller General determines necessary to ensure the efficient 
administration of the Council, the Council may--
            (1) employ and fix the compensation of an Executive 
        Director (subject to the approval of the Comptroller General) 
        and such other personnel as may be necessary to carry out its 
        duties (without regard to the provision of title 5, United 
        States Code, governing appointments in the competitive 
        service);
            (2) seek such assistance and support as may be required in 
        the performance of its duties from appropriate Federal 
        departments and agencies;
            (3) enter into contracts or make other arrangements, as may 
        be necessary for the conduct of the work of the Council 
        (without regard to section 3709 of the Revised Statutes (41 
        U.S.C. 5));
            (4) make advance, progress, and other payments which relate 
        to the work of the Council;
            (5) provide transportation and subsistence for persons 
        serving without compensation; and
            (6) prescribe such rules and regulations as the Council 
        determines necessary with respects to the internal organization 
        and operation of the Council.
    (e) Powers.--
            (1) Obtaining official data.--The Council may secure 
        directly from any department or agency of the United States 
        information necessary to enable it to carry out this section. 
        Upon request of the Chairperson, the head of such a department 
        or agency shall furnish such information to the Council on an 
        agreed upon schedule.
            (2) Data collection.--In order to carry out its functions, 
        the Council shall--
                    (A) utilize existing information, both published 
                and unpublished, where possible, collected and assessed 
                either by the staff of the Council or under other 
                arrangements made in accordance with this section;
                    (B) carry out, or award grants or contracts for, 
                original research and experimentation, where existing 
                information is inadequate; and
                    (C) adopt procedures allowing any interested party 
                to submit information for the Council's use in making 
                reports and recommendations.
            (3) Access of gao to information.--The Comptroller General 
        shall have unrestricted access to all deliberations, records, 
        and nonproprietary data of the Council, immediately upon 
        request.
            (4) Periodic audit.--The Council shall be subject to 
        periodic audit by the Comptroller General.
    (f) Authorization of Appropriations.--
            (1) In general.--The Council shall submit requests for 
        appropriations in the same manner as the Comptroller General 
        submits requests for appropriations, but amounts appropriated 
        for the Council shall be separate from amounts appropriated for 
        the Comptroller General.
            (2) Authorization.--There are authorized to be appropriated 
        such sums as may be necessary to carry out this section.

                  TITLE IV--PREVENTIVE HEALTH SERVICES

SEC. 401. INCREASING HEALTH INSURANCE COVERAGE FOR PREVENTION.

    (a) Application to Group Health Plans and Group Health Insurance 
Coverage Under the Public Health Service Act.--
            (1) In general.--Subpart 2 of part A of title XXVII of the 
        Public Health Service Act, as amended by section 121, is 
        further amended by adding at the end the following new section:

``SEC. 2708. STANDARDS RELATING TO BENEFITS FOR PREVENTIVE SERVICES.

    ``(a) Requirements for Coverage.--A group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, shall provide coverage for preventive health care 
items and services specified by the Secretary under section 401(c) of 
the Health Care Modernization, Cost Reduction, and Quality Improvement 
Act.
    ``(b) Application of Certain Provisions.--The provisions of 
subsections (b) (relating to notice), (c) (relating to prohibitions), 
(d) (relating to rules of construction), and (e) (relating to 
preemption) of section 713 of the Employee Retirement Income Security 
Act of 1974 shall apply to subsection (a) in the same manner as such 
subsections apply to subsection (a) of such section 713, except that 
the date provided for in subsection (b)(3) shall be January 1, 2005.''.
            (2) Conforming amendment.--Section 2721(b)(2)(A) of the 
        Public Health Service Act (42 U.S.C. 300gg-21(b)(2)(A)) is 
        amended by inserting ``(other than sections 2707 and 2708)'' 
        after ``requirements of such subparts''.
    (b) Application to Group Health Plans and Group Health Insurance 
Coverage Under the Employee Retirement Income Security Act of 1974.--
            (1) In general.--Subpart B of part 7 of subtitle B of title 
        I of the Employee Retirement Income Security Act of 1974, as 
        amended by section 123, is further amended by adding at the end 
        the following new section:

``SEC. 715. STANDARDS RELATING TO BENEFITS FOR PREVENTIVE SERVICES.

    ``(a) Requirements for Coverage.--A group health plan, and a health 
insurance issuer providing health insurance coverage in connection with 
a group health plan, shall provide coverage for preventive health care 
items and services specified by the Secretary under section 401(c) of 
the Health Care Modernization, Cost Reduction, and Quality Improvement 
Act.
    ``(b) Application of Certain Provisions.--The provisions of 
subsections (b) (relating to notice), (c) (relating to prohibitions), 
(d) (relating to rules of construction), and (e) (relating to 
preemption) of section 713 shall apply to subsection (a) in the same 
manner as such subsections apply to subsection (a) of such section 713, 
except that the date provided for in subsection (b)(3) shall be January 
1, 2005.''.
            (2) Conforming amendments.--
                    (A) In general.--Section 732(a) of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 
                1185(a)) is amended by striking ``section 711'' and 
                inserting ``sections 711, 714 and 715''.
                    (B) Table of contents.--The table of contents in 
                section 1 of the Employee Retirement Income Security 
                Act of 1974 is amended by inserting after the item 
relating to section 714 the following new item:

``Sec. 715. Standards relating to benefits for preventive services.''.
    (c) Preventive Health Care Items and Services.--Not later than 
January 1, 2005, the Secretary of Health and Human Services, in 
consultation with the United States Preventive Services Task Force, 
shall specify those preventive health care items and services to be 
covered by group health plans and health insurance issuers under the 
amendments made by this section. In specifying such items and services, 
the Secretary shall consider the cost and effectiveness of such items 
and services.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to group health plans and health insurance issuers 
for plan years beginning on or after January 1, 2005.

SEC. 402. ACTIVITIES RELATING TO NUTRITION AND PHYSICAL ACTIVITY.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 303, is further amended by adding at the end the 
following:

                    ``PART U--PREVENTIVE HEALTH CARE

``SEC. 399D. ENCOURAGING HEALTHY DIETS.

    ``(a) In General.--The Secretary, in collaboration with the 
Director of the Centers for Disease Control and Prevention, the 
Secretary of Education, and the Secretary of Agriculture, shall 
establish and implement activities to encourage health dietary choices 
(such as fruits and vegetables, and foods that are low in fat, sugar, 
and salt) in schools, worksites, and communities.
    ``(b) Schools.--The Secretary, in collaboration with the Director 
of the Centers for Disease Control and Prevention, the Secretary of 
Agriculture, and the Secretary of Education, shall require elementary 
and secondary schools that receive Federal funds to--
            ``(1) ban soft drinks or other foods of minimal nutritional 
        value from vending machines;
            ``(2) maintain a minimum number of functioning water 
        fountains in school buildings;
            ``(3) prohibit advertisements in schools and on school 
        grounds for foods of minimal nutritional value such as fast 
        foods, beverages, and snack foods of which greater than 50 
        percent of the calories are derived from fat or simple sugars; 
        and
            ``(4) integrate into school curricula education about 
        lifelong healthy eating.
    ``(c) Worksites.--The Secretary, in collaboration with the Director 
of the Centers for Disease Control and Prevention, the Secretary of 
Agriculture, and the Secretary of Labor, shall--
            ``(1) ensure the availability of meal selections in 
        cafeterias, snack stands, and vending machines in Federal 
        Government buildings that meet the recommendations of the 
        Secretary for nutritional content and portion size;
            ``(2) require clear and effective labeling of calories, 
        fat, trans fat, sugar, sodium, and portion size for meal 
        selections served in cafeterias and all foods and beverages 
        sold in vending machines, and at snack stands in Federal 
        Government buildings, as determined appropriate by the 
        Secretary;
            ``(3) work with unions, employee associations, and employer 
        associations to provide technical assistance for the 
        establishment of employee incentive programs to increase 
        participation in worksite health promotion programs that 
        encourage diets in accordance with national standards 
        promulgated by the Secretary; and
            ``(4) establish incentive programs to enable employers to 
        partner with local farmers, farmers markets, grocers, and 
        restaurants to increase accessibility and availability of fresh 
        fruits and vegetables through worksite cafeterias, snack bars, 
        and vending machines.
    ``(d) Communities.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall award grants for 
projects that--
            ``(1) implement campaigns, in communities at risk for poor 
        nutrition, that are designed to promote the intake of foods 
        consistent with established dietary guidelines through the use 
        of different types of media including television, radio, 
        newspapers, movie theaters, billboards, and mailings;
            ``(2) implement campaigns, in communities at risk for poor 
        nutrition, that promote water as the main daily drink choice 
        through the use of different types of media including 
        television, radio, newspapers, movie theaters, billboards, and 
        mailings;
            ``(3) conduct outreach to commercial food establishments, 
        grocery stores, and other food suppliers, to increase the 
        availability and accessibility of healthy foods and beverages;
            ``(4) partner with national programs that provide parents 
        and mentors with the skills to help guide and influence healthy 
        meals and snack selections for children and adolescents; or
            ``(5) partner with national afterschool and summer programs 
        that provide children with the education and skills needed to 
        make healthy meal and snack selections.
    ``(e) Health Professionals.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall award grants to--
            ``(1) support the development, implementation, and 
        evaluation of curricula to educate and train health 
        professionals about effective nutrition education and 
        counseling strategies for obese individuals and parents of 
        overweight children, with emphasis on the Dietary Guidelines 
        for Americans or other nationally accepted standards; or
            ``(2) use web-based and related technologies to develop, 
        implement, and evaluate the effectiveness of dietary counseling 
        in health care settings.
    ``(f) Evaluation.--Not later than 12 months after the date on which 
a grant is awarded under this section, the grantee shall submit to the 
Director of the Centers for Disease Control and Prevention a report 
that describes the activities carried out with funds received under the 
grant and the effectiveness of such activities in improving the intake 
of nutritional foods.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.

``SEC. 399D-1. INCREASING PHYSICAL ACTIVITY.

    ``(a) In General.--The Secretary, in collaboration with the 
Director of the Centers for Disease Control and Prevention, the 
Secretary of Education, the Secretary of Labor, and the Director of the 
Federal Highway Administration, shall establish and implement 
activities for the purpose of increasing physical activity in schools, 
worksites, and communities.
    ``(b) Schools.--The Director of the Centers for Disease Control and 
Prevention, in collaboration with the Secretary of Education shall 
award grants to public elementary and secondary schools for programs 
that support--
            ``(1) the provision of daily physical education for 
        students in kindergarten through grade 12 through programs that 
        are consistent with the Guidelines for Physical Activity as 
        reported by the Centers for Disease Control and Prevention and 
        the American College of Sports Medicine and National Physical 
        Education Standards;
            ``(2) the implementation of comprehensive school curricula 
        and school-based physical activity programs that provide 
        education about lifelong physical activity;
            ``(3) training for school personnel that provides the 
        knowledge and skills needed to effectively teach lifelong 
        physical activity; or
            ``(4) evaluations of school physical education programs and 
        facilities at annual intervals to determine the extent to which 
        national guidelines described in paragraph (1) are met.
    ``(c) Worksites.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Secretary, and the Secretary 
of Labor, shall award grants to eligible entities as determined by the 
Director, which may include labor organizations, trade associations, 
trade groups, and businesses for the establishment of projects that 
include--
            ``(1) the development of activity friendly worksites (which 
        may include the provision of facilities for physical activity, 
        accessible and attractive stairwells, walking trails, and 
        supportive management practices) that encourage employee 
        participation in physical activity;
            ``(2) the development of worksite wellness programs that 
        improve physical activity by increasing the knowledge, 
        attitudes, skills, and behaviors of employees; and
            ``(3) the development of employee incentive programs (such 
        as cafeteria discounts, health club memberships, small cash 
        bonuses, and time off) to increase the participation of 
        employees in worksite health promotion programs that increase 
        physical activity.
    ``(d) Communities.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Secretary, the Secretary of 
Transportation, and Secretary of the Interior, shall award grants for 
the implementation and evaluation of activities that may include--
            ``(1) projects to design pedestrian zones and construct 
        safe walkways and cycling paths;
            ``(2) projects that create greenways and open-space areas 
        linking parks, nature preserves, and cultural or historic sites 
        with each other and with populated areas such as residential 
        communities and business locations;
            ``(3) initiatives to increase the use of walking and 
        bicycling as a transportation mode by creating or enhancing 
        informational outreach to parks or community recreation 
        centers; and
            ``(4) community-wide campaigns designed to increase 
        physical activity as part of multicomponent efforts that 
        include strategies such as support of self help groups, 
        physical activity counseling, risk factor screening and 
        education, and environmental or policy changes such as the 
        creation of walking trails.
    ``(e) Evaluation.--Not later than 2 years after the date on which a 
grant is awarded under this section, the grantee shall submit to the 
Director of the Centers for Disease Control and Prevention a report 
that describes the activities carried out with funds receive under the 
grant and the effectiveness of such activities in increasing physical 
activity.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2010.''.

SEC. 403. IMPROVING IMMUNIZATION.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 402, is further amended by adding at the end the 
following:

                    ``PART V--IMPROVING IMMUNIZATION

``SEC. 399E. PROGRAMS TO IMPROVE THE RATE OF IMMUNIZATION IN ADULTS AND 
              ADOLESCENTS.

    ``(a) Demonstration Projects.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall award 
supplemental grants under section 317 to eligible entities for the 
development, implementation, and evaluation of evidence-based programs 
that improve the rate of immunization of adults and adolescents.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section an entity shall--
            ``(1) be--
                    ``(A) a hospital;
                    ``(B) an academic institution;
                    ``(C) a nonprofit community based organization;
                    ``(D) a health center; or
                    ``(E) any other public or private nonprofit entity 
                determined appropriate by the Director of the Centers 
                for Disease Control and Prevention;
            ``(2) establish a partnership with a State or local 
        government for purposes of carrying out activities under this 
        section; and
            ``(3) prepare and submit to the Director of the Centers for 
        Disease Control and Prevention an application at such time, in 
        such manner, and containing such information as the Director 
        may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to conduct projects to carry out activities 
consistent with evidence-based strategies recommended by the Advisory 
Committee on Immunization Practices and the Task Force on Community 
Preventive Services, including--
            ``(1) the conduct of public information and education 
        campaigns that will promote adult and adolescent immunizations 
        recommended by the Advisory Committee on Immunization 
        Practices, through the development and dissemination to 
        targeted audiences of appropriate messages about the risks and 
        benefits of immunizations;
            ``(2) the conduct of programs to offer vaccines to 
        underimmunized adult and adolescent populations in settings 
        that have not previously or routinely provided these services, 
        such as family planning, HIV, sexually transmitted disease, and 
        drug treatment centers, emergency departments, pharmacies, home 
        care agencies, senior citizen homes, and correctional 
        facilities;
            ``(3) the conduct of provider-based interventions to 
        promote adult and adolescent vaccinations recommended by the 
        Advisory Committee on Immunization Practices, which shall 
        include--
                    ``(A) the development and implementation of 
                reminder or recall systems that align with State and 
                local immunization information systems and inform 
                health care providers when adult and adolescent 
                patients are due or overdue for specific vaccinations; 
                and
                    ``(B) the establishment of standing orders in which 
                non-physician medical personnel deliver adult and 
                adolescent vaccinations without direct physician 
                involvement at the time of the visit; and
            ``(4) the conduct of programs to identify other 
        interventions and to translate interventions into practice.
    ``(d) Dissemination.--The Director of the Centers for Disease 
Control and Prevention shall publish and disseminate findings made as a 
result of activities conducted under this section to the public in 
coordination with the heads of other appropriate Federal agencies.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399E-1. CURRICULUM DEVELOPMENT.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention shall award competitive cooperative agreements for the 
development of innovative curricula for health care provider training 
and continuing education for practicing professionals concerning the 
assessment, monitoring, improvement, and delivery of immunizations for 
adults, adolescents, and children.
    ``(b) Eligibility.--To be eligible to receive a cooperative 
agreement under this section an entity shall--
            ``(1) be--
                    ``(A) an academic institution, such as a school of 
                medicine, nursing, or pharmacy; or
                    ``(B) any other public or private nonprofit entity 
                determined to be appropriate by the Director of the 
                Centers for Disease Control and Prevention; and
            ``(2) prepare and submit to the Director of the Centers for 
        Disease Control and Prevention an application at such time, in 
        such manner, and containing such information as the Director of 
        the Centers for Disease Control may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
cooperative agreement under this section to develop, implement, and 
evaluate curricula for health care providers that use innovative 
educational methods, to promote the awareness and implementation of 
immunizations for adults, adolescents, and children. Such curricula may 
include distance learning courses and CD-Rom and web-based educational 
programs.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399E-2. ASSURING ADEQUATE SUPPLY OF VACCINES FOR ADULT AND 
              ADOLESCENT IMMUNIZATION PROGRAMS.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention shall award competitive supplemental grants to 
immunization grantees under section 317 to ensure that there is an 
adequate supply of vaccines for adults and adolescents.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be an entity determined appropriate by the Director 
        of the Centers for Disease Control and Prevention; and
            ``(2) prepare and submit to the Director of the Centers for 
        Disease Control and Prevention an application at such time, in 
        such manner, and containing such information as the Director 
        may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to ensure the availability of vaccines and 
related supplies to support the implementation of programs to improve 
the rate of immunization in adults and adolescents.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399E-3. RESEARCH ON IMMUNIZATION PROGRAMS.

    ``(a) Efficacy Research Projects.--The Secretary, acting through 
the Director of the Centers for Disease Control and Prevention, shall 
award cooperative agreements to eligible entities for the conduct of 
research and other activities to improve immunization program's for 
adults and adolescents.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section an entity shall--
            ``(1) be--
                    ``(A) an academic institution;
                    ``(B) a nonprofit community based organization;
                    ``(C) a State or local health agency; or
                    ``(D) any other public or private nonprofit entity 
                determined to be appropriate by the Director of the 
                Centers for Disease Control and Prevention; and
            ``(2) prepare and submit to the Director of the Centers for 
        Disease Control and Prevention an application at such time, in 
        such manner, and containing such information as the Director 
        may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to conduct prospective and other research 
projects on the effect of immunization programs in high-risk and 
underimmunized populations on the rates of immunization, incidence of 
influenza, pneumococcal disease, hepatitis A, hepatitis B, and other 
vaccine-preventable diseases and related complications.
    ``(d) Dissemination.--The Director of the Centers for Disease 
Control and Prevention shall disseminate findings made as a result of 
activities conducted under this section to the public in coordination 
with the heads of other appropriate Federal agencies.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399E-4. DEFINITION.

    ``In this part, the term `State' has the meaning given such term in 
section 2, and includes Indian tribes.''.

SEC. 404. IMPROVING ORAL HEALTH.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.), 
as amended by section 403, is further amended by adding at the end the 
following:

                    ``PART W--IMPROVING ORAL HEALTH

``SEC. 399F. PUBLIC EDUCATION.

    ``(a) Demonstration Projects.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall award 
competitive grants to eligible entities for the conduct of public 
education campaigns to raise public awareness concerning oral health.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be--
                    ``(A) a State health agency;
                    ``(B) an academic institution;
                    ``(C) a nonprofit or community organization; or
                    ``(D) any other public or private nonprofit entity 
                determined to be appropriate by the Director of the 
                Centers for Disease Control and Prevention; and
            ``(2) prepare and submit to the Director of the Centers for 
        Disease Control and Prevention an application at such time, in 
        such manner, and containing such information as the Director 
        may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to partner with a State to--
            ``(1) increase public awareness of oral health issues 
        through public outreach campaigns, particularly targeting adult 
        populations including those with intellectual disabilities, and 
        those with chronic diseases such as diabetes; and
            ``(2) develop, implement, and evaluate programs that 
        promote oral health in adults.
    ``(d) Dissemination.--The Director of the Centers for Disease 
Control and Prevention shall disseminate findings made as a result of 
activities conducted under this section to the public in coordination 
with the heads of other appropriate Federal agencies.
    ``(e) Evaluation.--A grantee under this section shall submit to the 
Director of the Centers for Disease Control and Prevention an 
evaluation that describes activities carried out with funds received 
under the grant and the effectiveness of such activities in improving 
oral health among adults including those with intellectual disabilities 
or with chronic disease.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399F-1. HEALTH CARE PROVIDER EDUCATION.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention shall award competitive grants to entities for the 
development of innovative curricula for health care providers 
concerning the delivery of oral care to adults, including adults with 
intellectual disabilities or with chronic disease.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be--
                    ``(A) an academic institution;
                    ``(B) a health center; or
                    ``(C) any other entity determined appropriate by 
                the Director of the Centers for Disease Control and 
                Prevention; and
            ``(2) prepare and submit to the Director of the Centers for 
        Disease Control and Prevention an application at such time, in 
        such manner, and containing such information as the Director 
        may require.
    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to develop, implement, and evaluate innovative 
curricula for health care providers that promotes oral health for 
adults, including adults with intellectual disabilities or with chronic 
disease.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399F-2. MONITORING AND EVALUATING THE QUALITY OF ORAL HEALTH.

    ``(a) Demonstration Projects.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall award 
competitive grants to States to expand the ability of States to improve 
the quality of oral health among adults including adults with 
intellectual disabilities or with chronic disease.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section a State shall prepare and submit to the Director of the Centers 
for Disease Control and Prevention an application at such time, in such 
manner, and containing such information as the Director may require.
    ``(c) Contracting Authority.--A State receiving a grant under this 
section may enter into contracts with academic institutions, and other 
entities determined to be appropriate by the Director, to carry out 
activities authorized under this section.
    ``(d) Use of Funds.--A State shall use amounts received under a 
grant under this section for activities to improve the oral health of 
adults, including adults with intellectual disabilities or chronic 
diseases. Such activities may include--
            ``(1) the collection of public health surveillance 
        information;
            ``(2) the analysis of data to determine the oral health 
        status of adults;
            ``(3) the development and implementation of interventions 
        to improve oral health;
            ``(4) the dissemination of evidence-based best practices; 
        and
            ``(5) the coordination of the sharing of oral health data 
        and evidence based practices between States.
    ``(e) Privacy.--A State receiving a grant, or an entity entering 
into a contract, under this section shall comply with appropriate 
security and privacy protocols (including protocols required under the 
regulations promulgated under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note)), 
if applicable, with respect to information collected under this 
section. Nothing in this section shall be construed to supersede 
applicable Federal or State privacy laws.
    ``(f) Evaluation.--A grantee under this section shall submit to the 
Director of the Centers for Disease Control and Prevention an 
evaluation that describes the activities conducted with funds received 
under the grant and the effectiveness of such activities in improving 
oral health among adults, including adults with intellectual 
disabilities or with chronic disease.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section and such sums as may be 
necessary for each of fiscal years 2005 through 2009.

``SEC. 399F-3. STUDIES AND REPORTS BY THE INSTITUTE OF MEDICINE.

    ``(a) Contract.--The Secretary shall enter into a contract with the 
Institute of Medicine to assess existing gaps in, and impediments to, 
quality oral health, including gaps in data, research and translation, 
and care provided to adult populations.
    ``(b) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2005 through 2009.

``SEC. 399F-4. DEFINITION.

    ``In this part, the term `State' has the meaning given such term in 
section 2, and includes Indian tribes.''.
                                 <all>