[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3014 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 3014

 To improve the health of minority individuals, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 12, 2007

  Ms. Solis (for herself, Mr. Abercrombie, Mr. Baca, Mr. Becerra, Mr. 
  Bishop of Georgia, Ms. Bordallo, Ms. Corrine Brown of Florida, Mr. 
Butterfield, Mr. Cardoza, Ms. Carson, Ms. Castor, Mrs. Christensen, Ms. 
Clarke, Mr. Clay, Mr. Cleaver, Mr. Clyburn, Mr. Conyers, Mr. Costa, Mr. 
Crowley, Mr. Cuellar, Mr. Cummings, Mr. Davis of Alabama, Mr. Davis of 
Illinois, Mr. Ellison, Mr. Johnson of Georgia, Mrs. Jones of Ohio, Mr. 
Kildee, Ms. Kilpatrick, Ms. Lee, Ms. Jackson-Lee of Texas, Mr. Lewis of 
 Georgia, Ms. Matsui, Mr. Meek of Florida, Mr. Meeks of New York, Ms. 
Moore of Wisconsin, Mrs. Napolitano, Ms. Norton, Mr. Ortiz, Mr. Pastor, 
  Mr. Payne, Mr. Rangel, Mr. Reyes, Mr. Rush, Mr. Rodriguez, Ms. Ros-
Lehtinen, Ms. Roybal-Allard, Mr. Salazar, Mr. Fattah, Mr. Fortuno, Mr. 
Gonzalez, Mr. Al Green of Texas, Mr. Gene Green of Texas, Mr. Grijalva, 
   Mr. Hastings of Florida, Mr. Hinojosa, Mr. Honda, Mr. Hoyer, Mr. 
Jackson of Illinois, Mr. Jefferson, Ms. Eddie Bernice Johnson of Texas, 
 Mr. Scott of Georgia, Mr. Scott of Virginia, Mr. Serrano, Mr. Sires, 
Mr. Thompson of Mississippi, Mr. Towns, Ms. Velazquez, Ms. Waters, Ms. 
 Watson, Mr. Watt, and Mr. Wynn) introduced the following bill; which 
 was referred to the Committee on Energy and Commerce, and in addition 
   to the Committees on Ways and Means, Education and Labor, Natural 
     Resources, and the Judiciary, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To improve the health of minority individuals, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Equity and Accountability Act 
of 2007''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
     TITLE I--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE

Sec. 101. Amendment to the Public Health Service Act.
Sec. 102. Standards for language access services.
Sec. 103. Federal reimbursement for culturally and linguistically 
                            appropriate services under the Medicare, 
                            Medicaid and State Children's Health 
                            Insurance Program.
Sec. 104. Increasing understanding of and improving health literacy.
Sec. 105. Report on Federal efforts to provide culturally and 
                            linguistically appropriate health care 
                            services.
Sec. 106. Definitions.
Sec. 107. Treatment of the Medicare part B program under title VI of 
                            the Civil Rights Act of 1964.
                  TITLE II--HEALTH WORKFORCE DIVERSITY

Sec. 201. Amendment to the Public Health Service Act.
Sec. 202. Health Careers Opportunity Program.
Sec. 203. Program of Excellence in Health Professions Education for 
                            Underrepresented Minorities.
Sec. 204. Minority-Serving Institutions and Hispanic-serving health 
                            professions schools.
Sec. 205. Health Professions Student Loan fund; authorizations of 
                            appropriations regarding students from 
                            underrepresented minority communities.
Sec. 206. National Health Service Corps; training programs.
Sec. 207. Loan Repayment Program of the Centers for Disease Control and 
                            Prevention.
Sec. 208. Strengthening and expanding rural health provider networks.
Sec. 209. McNair Postbaccalaureate Achievement program.
Sec. 210. Ensuring proportional representation of interests of rural 
                            areas on MedPAC.
                TITLE III--DATA COLLECTION AND REPORTING

Sec. 301. Amendment to the Public Health Service Act.
Sec. 302. Collection of race and ethnicity data by the Social Security 
                            Administration.
Sec. 303. Revision of HIPAA claims standards.
Sec. 304. National Center for Health Statistics.
Sec. 305. Geo-access study.
Sec. 306. Racial, ethnic, and linguistic data collected by the Federal 
                            Government.
Sec. 307. Health information technology grants.
Sec. 308. Study of health information technology in medically 
                            underserved communities.
Sec. 309. Health information technology in medically underserved 
                            communities.
Sec. 310. Data collection and analysis grants to minority-serving 
                            institutions.
Sec. 311. Health information technology grants for rural health care 
                            providers.
                TITLE IV--ACCOUNTABILITY AND EVALUATION

                     Subtitle A--General Provisions

Sec. 401. Federal agency plan to eliminate disparities and improve the 
                            health of minority populations.
Sec. 402. Accountability within the Department of Health and Human 
                            Services.
Sec. 403. Office of Minority Health.
Sec. 404. Establishment of the Indian Health Service as an agency of 
                            the Public Health Service.
Sec. 405. Establishment of individual offices of minority health within 
                            agencies of the Public Health Service.
Sec. 406. Office of Minority Health at the Centers for Medicare & 
                            Medicaid Services.
Sec. 407. Office of Minority Affairs at the Food and Drug 
                            Administration.
Sec. 408. Safety and effectiveness of drugs with respect to racial and 
                            ethnic background.
Sec. 409. United States Commission on Civil Rights.
Sec. 410. Sense of Congress concerning full funding of activities to 
                            eliminate racial and ethnic health 
                            disparities.
Sec. 411. Guidelines for disease screening for minority patients.
Sec. 412. National center for minority health and health disparities 
                            reauthorization.
              Subtitle B--Improving Environmental Justice

Sec. 421. Codification of executive order 12898.
Sec. 422. Implementation of recommendations by environmental protection 
                            agency.
Sec. 423. Grant program.
Sec. 424. Additional research on the relationship between the built 
                            environment and the health of community 
                            residents.
              TITLE V--IMPROVEMENT OF HEALTH CARE SERVICES

Sec. 501. Health empowerment zones.
Sec. 502. Amendment to the Public Health Service Act.
Sec. 503. Optional coverage of legal immigrants under the Medicaid 
                            program and SCHIP.
Sec. 504. Border health grants.
Sec. 505. Cancer prevention and treatment demonstration for ethnic and 
                            racial minorities.
Sec. 506. Grants to promote positive health behaviors in women and 
                            children.
Sec. 507. Exception for citizens of freely associated States.
Sec. 508. Medicare graduate medical education.
Sec. 509. HIV/AIDS reduction in racial and ethnic minority communities.
Sec. 510. Grants for racial and ethnic approaches to community health.
Sec. 511. Critical access hospital improvements.
Sec. 512. Coverage of marriage and family therapist services and mental 
                            health counselor services under part B of 
                            the Medicare program.
Sec. 513. Establishment of rural community hospital (RCH) program.
Sec. 514. Medicare remote monitoring pilot projects.
Sec. 515. Rural health quality advisory commission and demonstration 
                            projects.
Sec. 516. Rural health care services.
Sec. 517. Community health center collaborative access expansion.
Sec. 518. Facilitating the provision of telehealth services across 
                            State lines.

     TITLE I--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE

SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

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

   ``TITLE XXX--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE

``SEC. 3000. DEFINITIONS.

    ``In this title:
            ``(1) Appropriate health care services.--The term 
        `appropriate health care services' includes services or 
        treatments to address prevention and care of physical, mental, 
        oral, and behavioral disorders or syndromes.
            ``(2) Indian tribe.--The term `Indian tribe' means any 
        Indian tribe, band, nation, or other organized group or 
        community, including any Alaska Native village or group or 
        regional or village corporation as defined in or established 
        pursuant to the Alaska Native Claims Settlement Act (85 Stat. 
        688) (43 U.S.C. 1601 et seq.), which is recognized as eligible 
        for the special programs and services provided by the United 
        States to Indians because of their status as Indians.
            ``(3) Limited english proficient.--The term `limited 
        English proficient' with respect to an individual means an 
        individual who speaks a primary language other than English and 
        cannot speak, read, write, or understand the English language 
        at a level that permits them to effectively communicate with 
        clinical or nonclinical staff at a health care organization.
            ``(4) Minority.--
                    ``(A) In general.--The terms `minority' and 
                `minorities' refer to individuals from a minority 
                group.
                    ``(B) Populations.--The term `minority', with 
                respect to populations, refers to racial and ethnic 
                minority groups.
            ``(5) Minority group.--The term `minority group' has the 
        meaning given the term `racial and ethnic minority group'.
            ``(6) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' means American Indians and Alaska 
        Natives, African Americans (including Caribbean Blacks, 
        Africans and other Blacks), Asian Americans, Hispanics 
        (including Latinos), and Native Hawaiians and other Pacific 
        Islanders.
            ``(7) State.--The term `State' means each of the several 
        states, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Indian tribes, the Virgin Islands, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.

``SEC. 3001. 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 obtain 
        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 title, each Federal agency that carries 
        out health care-related activities shall prepare a plan to 
        improve access to the federally conducted health care-related 
        programs and activities of the agency by limited English 
        proficient individuals.
            ``(2) Plan requirement.--Each plan under paragraph (1) 
        shall be consistent with the standards set forth in section 102 
        of the Health Equity and Accountability Act of 2007, 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 title, each Federal agency providing 
        health care-related Federal financial assistance shall ensure 
        that the guidance for recipients of Federal financial 
        assistance developed by the agency to ensure compliance with 
        title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et 
        seq.) is specifically tailored to the recipients of such 
        assistance and is consistent with the standards described in 
        section 102 of the Health Equity and Accountability Act of 
        2007. Each agency shall send a copy of such guidance to the 
        Department of Justice which shall serve as the central 
        repository of the agencies' plans. After approval by the 
        Department of Justice, each agency shall publish its guidance 
        document in the Federal Register for public comment.
            ``(2) Requirements.--The agency-specific guidance developed 
        under paragraph (1) shall--
                    ``(A) detail how the general standards established 
                under section 102 of the Health Equity and 
                Accountability Act of 2007 will be applied to the 
                agency's recipients; and
                    ``(B) take into account the types of health care 
                services provided by the recipients, the individuals 
                served by the recipients, and other factors set out in 
                such standards.
            ``(3) Existing guidances.--A Federal agency that has 
        developed a guidance for purposes of title VI of the Civil 
        Rights Act of 1964 that the Department of Justice determines is 
        consistent with the standards described in section 102 of the 
        Health Equity and Accountability Act of 2007 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.--Each Federal agency described in 
        paragraph (1) shall evaluate the--
                    ``(A) particular needs of the limited English 
                proficient individuals served by the agency, and by a 
                recipient of assistance provided by the agency;
                    ``(B) burdens of compliance with the agency 
                guidance and its recipients of the requirements of this 
                section; and
                    ``(C) outcomes or effectiveness of services.

``SEC. 3002. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES IN HEALTH CARE.

    ``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 health care 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 trained 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, particularly minor 
        children, 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, if such materials exist for non-limited English 
        proficient patients, 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 
        assessments of culturally and linguistically appropriate 
        services-related activities and integrate valid 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) if requested, 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. 3003. ROBERT T. MATSUI CENTER FOR CULTURAL AND LINGUISTIC 
              COMPETENCE IN HEALTH CARE.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Office of Minority Health Disparity Elimination, shall establish 
and support a center to be known as the `Robert T. Matsui Center for 
Cultural and Linguistic Competence in Health Care' (referred to in this 
section as the `Center') to carry out the following activities:
            ``(1) Remote medical interpreting.--The Center shall 
        provide remote medical interpreting, directly or through 
        contracts, to health care providers who otherwise would be 
        unable to provide language interpreting services, at reasonable 
        or no cost as determined appropriate by the Director of the 
        Center. Methods of interpretation may include remote, 
        simultaneous or consecutive interpreting through telephonic 
        systems, video conferencing, and other methods determined 
        appropriate by the Secretary for patients with limited English 
        proficiency. The quality of such interpreting shall be 
        monitored and reported publicly. Nothing in this paragraph 
        shall be construed to limit the ability of health care 
        providers or organizations to provide medical interpreting 
        services directly and obtain reimbursement for such services as 
        provided for under the Medicare, Medicaid, or SCHIP programs 
        under titles XVIII, XIX, or XXI of the Social Security Act.
            ``(2) Model language assistance programs.--The Center shall 
        provide for the collection and dissemination of information on 
        current model language assistance programs and strategies to 
        improve language access to health care for individuals with 
        limited English proficiency, including case studies using de-
        identified patient information, program summaries, and program 
        evaluations.
            ``(3) Internet health clearinghouse.--The Center shall 
        develop and maintain an Internet clearinghouse to reduce 
        medical errors and improve medical outcomes and reduce health 
        care costs caused by miscommunication with individuals with 
        limited English proficiency or low functional health literacy 
        and reduce or eliminate the duplication of effort to translate 
        materials by--
                    ``(A) developing and making available templates for 
                standard documents that are necessary for patients and 
                consumers to access and make educated decisions about 
                their health care, including--
                            ``(i) administrative and legal documents 
                        such as informed consent, advanced directives, 
                        and waivers of rights;
                            ``(ii) clinical information such as how to 
                        take medications, how to prevent transmission 
                        of a contagious disease, and other prevention 
                        and treatment instructions;
                            ``(iii) patient education and outreach 
                        materials such as immunization notices, health 
                        warnings, or screening notices; and
                            ``(iv) additional health or health care-
                        related materials as determined appropriate by 
                        the Director of the Center;
                    ``(B) ensuring that the documents posted in English 
                and non-English languages are culturally appropriate;
                    ``(C) allowing public review of the documents 
                before dissemination in order to ensure that the 
                documents are understandable and culturally appropriate 
                for the target populations;
                    ``(D) allowing health care providers to customize 
                the documents for their use;
                    ``(E) facilitating access to these documents;
                    ``(F) providing technical assistance with respect 
                to the access and use of such information; and
                    ``(G) carrying out any other activities the 
                Secretary determines to be useful to fulfill the 
                purposes of the Clearinghouse.
            ``(4) Provision of information.--The Center shall provide 
        information relating to culturally and linguistically competent 
        health care for minority populations residing in the United 
        States to all health care providers and health care 
        organizations at no cost. Such information shall include--
                    ``(A) tenets of culturally and linguistically 
                competent care;
                    ``(B) cultural and linguistic competence self-
                assessment tools;
                    ``(C) cultural and linguistic competence training 
                tools;
                    ``(D) strategic plans to increase cultural and 
                linguistic competence in different types of health care 
                organizations, including regional collaborations among 
                health care organizations; and
                    ``(E) resources for cultural and linguistic 
                competence information for educators, practitioners and 
                researchers.
    ``(b) Director.--The Center shall be headed by a Director who shall 
be appointed by, and who shall report to, the Deputy Assistant 
Secretary for Minority Health.
    ``(c) Availability of Language Access.--The Director shall 
collaborate with all agencies within the Department of Health and Human 
Services to notify health care providers and health care organizations 
about the availability of language access services by the Center.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2008 through 2012.

``SEC. 3004. INNOVATIONS IN CULTURAL AND LINGUISTIC COMPETENCE GRANTS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Centers for Medicare & Medicaid Services, the Administrator of 
the Health Resources and Services Administration, the Secretary of 
Education, and the Deputy Assistant Secretary for Minority Health, 
shall award grants to eligible entities to enable such entities to 
design, implement, and evaluate innovative, cost-effective programs to 
improve cultural and linguistic competence in 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 and other 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 cultural competence and 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 and 
        culturally competent providers;
            ``(4) provide staff language training instruction which 
        shall include information on the practical limitations of such 
        instruction for non-native speakers; and
            ``(5) 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 
culturally competent and 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 Robert T. 
Matsui Center for Cultural and Linguistic Competence in Health Care 
established under section 3003.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2008 through 2012.

``SEC. 3005. RESEARCH ON CULTURAL AND LANGUAGE COMPETENCE.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Deputy Assistant 
Secretary for Minority Health, shall expand research concerning--
            ``(1) the barriers to health care services including mental 
        and behavioral services that are faced by limited English 
        proficient individuals;
            ``(2) the impact of cultural and language barriers on the 
        quality of health care and the health status of limited English 
        proficient individuals and populations;
            ``(3) health care providers' and health administrators' 
        attitudes, knowledge, and awareness of the barriers described 
        in paragraphs (1) and (2);
            ``(4) the means by which language access services are 
        provided to limited English proficient individuals and how such 
        services are effective in improving the quality of care;
            ``(5) the cost-effectiveness of providing language access; 
        and
            ``(6) optimal approaches for delivering language access.
    ``(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 2008 through 2012.

``SEC. 3006. INFORMATION ABOUT FEDERAL HEALTH PROGRAMS FOR LIMITED 
              ENGLISH PROFICIENT POPULATIONS.

    ``The Secretary shall provide for a means by which limited English 
proficient individuals who are seeking information about, or assistance 
with, Federal health care programs may obtain such information or 
assistance.''.

SEC. 102. STANDARDS FOR LANGUAGE ACCESS SERVICES.

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

SEC. 103. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID AND 
              STATE CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) Demonstration Project Promoting Access for Medicare 
Beneficiaries With Limited English Proficiency.--
            (1) In general.--The Secretary shall conduct a 
        demonstration project (in this subsection referred to as the 
        ``project'') to demonstrate the impact on costs and health 
        outcomes of providing reimbursement for interpreter services to 
        certain Medicare beneficiaries who are limited English 
        proficient in urban and rural areas.
            (2) Scope.--The Secretary shall carry out the project in 
        not less than 30 States or territories through contracts with--
                    (A) MA plans (under part C of title XVIII of the 
                Social Security Act);
                    (B) small providers;
                    (C) hospitals; and
                    (D) community-based clinics.
            (3) Duration.--Each contract entered into under the project 
        shall extend over a period of not longer than 2 years.
            (4) Report.--Upon completion of the project, the Secretary 
        shall submit a report to Congress on the project which shall 
        include recommendations regarding the extension of such project 
        to the entire Medicare program.
            (5) Evaluation.--The Director of the Agency for Healthcare 
        Research and Quality, in consultation with the Office of 
        Minority Health and the National Center on Minority Health and 
        Health Disparities, shall award grants to public and private 
        nonprofit entities that demonstrate experience and capability 
        with respect to cultural and linguistic competence, including 
        Historically Black Colleges and Universities, Hispanic-serving 
        institutions, and other entities directed by and serving 
        representatives of racial and ethnic minority groups, for the 
        evaluation of the project. Such evaluations shall focus on 
        access, utilization, efficiency, cost-effectiveness, patient 
        satisfaction, and select health outcomes.
    (b) Medicaid.--Section 1903(a)(3) of the Social Security Act (42 
U.S.C. 1396b(a)(3)) is amended--
            (1) in subparagraph (E), by striking ``plus'' at the end 
        and inserting ``and''; and
            (2) by adding at the end the following:
                    ``(F) 100 percent of the sums expended with respect 
                to costs incurred during such quarter as are 
                attributable to the provision of language services on 
                behalf of individuals with limited English proficiency 
                who apply for or receive medical assistance under the 
                State plan under this title (including any provisions 
                of the plan implemented pursuant to any waiver 
                authority of the Secretary) or child health assistance 
                under a State child health plan under title XXI; 
                plus''.
    (c) SCHIP.--Section 2105(c)(2)(A) of the Social Security Act (42 
U.S.C. 1397ee(c)(2)(A)) is amended by inserting before the period at 
the end the following: ``except that expenditures described in, and 
reimbursable under, section 1903(a)(3)(F) shall not count towards this 
total''.
    (d) Effective Date.--The amendments made by this section take 
effect on October 1, 2007.

SEC. 104. INCREASING UNDERSTANDING OF AND IMPROVING HEALTH LITERACY.

    (a) In General.--The Secretary, acting through the Director of the 
Agency for Healthcare Research and Quality and the Administrator of the 
Health Resources and Services Administration, in consultation with the 
Office of Minority Health, shall award grants to eligible entities to 
improve health care for patient populations that have low functional 
health literacy.
    (b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            (1) be a hospital, health center or clinic, health plan, or 
        other health entity (including a nonprofit minority health 
        organization or association); and
            (2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    (c) Use of Funds.--
            (1) Agency for healthcare research and quality.--Grants 
        awarded under subsection (a) through the Agency for Healthcare 
        Research and Quality shall be used--
                    (A) to define and increase the understanding of 
                health literacy;
                    (B) to investigate the correlation between low 
                health literacy and health and health care;
                    (C) to clarify which aspects of health literacy 
                have an effect on health outcomes; and
                    (D) for any other activity determined appropriate 
                by the Director of the Agency.
            (2) Health resources and services administration.--Grants 
        awarded under subsection (a) through the Health Resources and 
        Services Administration shall be used to conduct demonstration 
        projects for interventions for patients with low health 
        literacy that may include--
                    (A) the development of new disease management 
                programs for patients with low health literacy;
                    (B) the tailoring of existing disease management 
                programs addressing mental, physical, oral, and 
                behavioral health conditions for patients with low 
                health literacy;
                    (C) the translation of written health materials for 
                patients with low health literacy;
                    (D) the identification, implementation, and testing 
                of low health literacy screening tools;
                    (E) the conduct of educational campaigns for 
                patients and providers about low health literacy; and
                    (F) other activities determined appropriate by the 
                Administrator of the Health Resources and Services 
                Administration.
    (d) Definitions.--In this section, the term ``low health literacy'' 
means the inability of an individual to obtain, process, and understand 
basic health information and services needed to make appropriate health 
decisions.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2012.

SEC. 105. 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 Act and 
annually thereafter, the Secretary of Health and Human Services shall 
enter into a contract with the Institute of Medicine for the 
preparation and publication of a report that describes Federal efforts 
to ensure that all individuals have meaningful access to culturally and 
linguistically appropriate health care services. Such report shall 
include--
            (1) a description and evaluation of the activities carried 
        out under this Act;
            (2) a description of best practices, model programs, 
        guidelines, and other effective strategies for providing access 
        to culturally and linguistically appropriate health care 
        services; and
            (3) an assessment of the implementation of the Department 
        of Health and Human Services National Standards on Culturally 
        and Linguistically Appropriate Services (CLAS) in Health Care, 
        in particular the implementation of CLAS mandates by recipients 
        of Federal funds.

SEC. 106. DEFINITIONS.

    In this title:
            (1) Incorporated definitions.--The definitions contained in 
        section 3000 of the Public Health Service Act, as added by 
        section 101, shall apply.
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

SEC. 107. TREATMENT OF THE MEDICARE PART B PROGRAM UNDER TITLE VI OF 
              THE CIVIL RIGHTS ACT OF 1964.

    A payment provider of services or physician or other supplier under 
part B of title XVIII of the Social Security Act shall be deemed a 
grant, and not a contract of insurance or guaranty, for the purposes of 
title VI of the Civil Rights Act of 1964.

                  TITLE II--HEALTH WORKFORCE DIVERSITY

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

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

          ``Subtitle A--Diversifying the Health Care Workplace

``SEC. 3011. REPORT ON WORKFORCE DIVERSITY.

    ``(a) In General.--Not later than July 1, 2008, and biannually 
thereafter, the Secretary, acting through the director of each entity 
within the Department of Health and Human Services, shall prepare and 
submit to the Committee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Commerce of the House of 
Representatives a report on health workforce diversity.
    ``(b) Requirement.--The report under subsection (a) shall contain 
the following information:
            ``(1) A description of any grant support that is provided 
        by each entity for workforce diversity initiatives with the 
        following information--
                    ``(A) the number of grants made;
                    ``(B) the purpose of the grants;
                    ``(C) the populations served through the grants;
                    ``(D) the organizations and institutions receiving 
                the grants, including specification of the number of 
                Hispanic health professions schools and minority-
                serving institutions; and
                    ``(E) the tracking efforts that were used to follow 
                the progress of participants.
            ``(2) A description of the entity's plan to achieve 
        workforce diversity goals that includes, to the extent relevant 
        to such entity--
                    ``(A) the number of underrepresented minority 
                health professionals that will be needed in various 
                disciplines over the next 10 years to achieve 
                population parity;
                    ``(B) the level of funding needed to fully expand 
                and adequately support health professions pipeline 
                programs;
                    ``(C) the impact such programs have had on the 
                admissions practices and policies of health professions 
                schools;
                    ``(D) the management strategy necessary to 
                effectively administer and institutionalize health 
                profession pipeline programs;
                    ``(E) the impact that the Government Performance 
                and Results Act (GPRA) has had on evaluating the 
                performance of grantees and whether the GPRA is the 
                best assessment tool for programs under titles VII and 
                VIII; and
                    ``(F) an examination of the role and support for 
                minority-serving institutions and Hispanic health 
                professions schools in training minority health 
                professionals and in increasing their representation at 
                all levels in the Department of Health and Human 
                Services.
            ``(3) A description of measurable objectives of each entity 
        relating to workforce diversity initiatives.
    ``(c) Public Availability.--The report under subsection (a) shall 
be made available for public review and comment.

``SEC. 3012. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Office of 
Minority Health, and in collaboration with the Bureau of Health 
Professions within the Health Resources and Services Administration, 
shall establish a technical clearinghouse on health workforce diversity 
within the Office of Minority Health and coordinate current and future 
clearinghouses.
    ``(b) Information and Services.--The clearinghouse established 
under subsection (a) shall offer the following information and 
services:
            ``(1) Information on the importance of health workforce 
        diversity.
            ``(2) Statistical information relating to underrepresented 
        minority representation in health and allied health professions 
        and occupations.
            ``(3) Model health workforce diversity practices and 
        programs.
            ``(4) Admissions policies that promote health workforce 
        diversity and are in compliance with Federal and State laws.
            ``(5) Lists of scholarship, loan repayment, and loan 
        cancellation grants as well as fellowship information for 
        underserved populations for health professions schools.
            ``(6) Foundation and other large organizational initiatives 
        relating to health workforce diversity.
    ``(c) Consultation.--In carrying out this section, the Secretary 
shall consult with non-Federal entities, which shall include minority 
health professional associations to help ensure thoroughness and 
accuracy of information.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3013. EVALUATION OF WORKFORCE DIVERSITY INITIATIVES.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions within the Health Resources and Services 
Administration, shall award grants to eligible entities for the conduct 
of an evaluation of current health workforce diversity initiatives 
funded by the Department of Health and Human Services.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a city, county, Indian tribe, State, territory, 
        community-based nonprofit organization, health center, 
        university, college, or other entity determined appropriate by 
        the Secretary;
            ``(2) with respect to an entity that is not an academic 
        medical center, university, or private research institution, 
        carry out activities under the grant in partnership with an 
        academic medical center, university, or private research 
        institution; and
            ``(3) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts awarded under a grant under subsection 
(a) shall be used to support the following evaluation activities:
            ``(1) Determinations of measures of health workforce 
        diversity success.
            ``(2) Assessments of the effects of health workforce 
        diversity on quality, including--
                    ``(A) language access;
                    ``(B) cultural competence;
                    ``(C) patient satisfaction;
                    ``(D) timeliness of care;
                    ``(E) safety of care;
                    ``(F) effectiveness of care;
                    ``(G) efficiency of care;
                    ``(H) patient outcomes;
                    ``(I) community engagement;
                    ``(J) resource allocation;
                    ``(K) organizational structure; and
                    ``(L) other topics determined appropriate by the 
                Secretary.
            ``(3) The short- and long-term tracking of participants in 
        health workforce diversity pipeline programs funded by the 
        Department of Health and Human Services.
            ``(4) Assessments of partnerships formed through activities 
        to increase health workforce diversity.
            ``(5) Assessments of barriers to health workforce 
        diversity.
            ``(6) Assessments of policy changes at the Federal, State, 
        and local levels.
            ``(7) Assessments of coordination within and between 
        Federal agencies and other institutions.
            ``(8) Other activities determined appropriate by the 
        Secretary.
    ``(d) Report.--Not later than 1 year after the date of enactment of 
this title, the Bureau of Health Professions within the Health 
Resources and Services Administration shall prepare and make available 
for public comment a report that summarizes the findings made by 
entities under grants under this section.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3014. DATA COLLECTION AND REPORTING BY HEALTH PROFESSIONAL 
              SCHOOLS.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions of the Health Resources and Services Administration 
and the Office of Minority Health, shall establish an aggregated 
database on health professional students.
    ``(b) Requirement To Collect Data.--Each health professional school 
(including medical, dental, and nursing schools) and allied health 
profession school and program that receives Federal funds shall collect 
race, ethnicity, and language proficiency data concerning those 
students enrolled at such schools or in such programs. In collecting 
such data, a school or program shall--
            ``(1) at a minimum, use the categories for race and 
        ethnicity described in the 1997 Office of Management and Budget 
        Standards for Maintaining, Collecting, and Presenting Federal 
        Data on Race and Ethnicity and available language standards; 
        and
            ``(2) if practicable, collect data on additional population 
        groups if such data can be aggregated into the minimum race and 
        ethnicity data categories.
    ``(c) Use of Data.--Data on race, ethnicity, and primary language 
collected under this section shall be reported to the database 
established under subsection (a) on an annual basis. Such data shall be 
available for public use.
    ``(d) Privacy.--The Secretary shall ensure that all data collected 
under this section is protected from inappropriate internal and 
external use by any entity that collects, stores, or receives the data 
and that such data is collected without personally identifiable 
information.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3015. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to eligible entities that demonstrate a commitment to health workforce 
diversity.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an educational institution or entity that 
        historically produces or trains meaningful numbers of 
        underrepresented minority health professionals, including--
                    ``(A) Historically Black Colleges and Universities;
                    ``(B) Hispanic-serving health professions schools;
                    ``(C) Hispanic-serving institutions;
                    ``(D) Tribal Colleges and Universities;
                    ``(E) Asian American and Pacific Islander-serving 
                institutions;
                    ``(F) institutions that have programs to recruit 
                and retain underrepresented minority health 
                professionals, in which a significant number of the 
                enrolled participants are underrepresented minorities;
                    ``(G) health professional associations, which may 
                include underrepresented minority health professional 
                associations; and
                    ``(H) institutions--
                            ``(i) located in communities with 
                        predominantly underrepresented minority 
                        populations;
                            ``(ii) with whom partnerships have been 
                        formed for the purpose of increasing workforce 
                        diversity; and
                            ``(iii) in which at least 20 percent of the 
                        enrolled participants are underrepresented 
                        minorities; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant under 
subsection (a) shall be used to expand existing workforce diversity 
programs, implement new workforce diversity programs, or evaluate 
existing or new workforce diversity programs, including with respect to 
mental as well as oral health care professions. Such programs shall 
enhance diversity by considering minority status as part of an 
individualized consideration of qualifications. Possible activities may 
include--
            ``(1) educational outreach programs relating to 
        opportunities in the health professions;
            ``(2) scholarship, fellowship, grant, and loan repayment 
        programs;
            ``(3) post-baccalaureate programs;
            ``(4) academic enrichment programs, particularly targeting 
        those who would not be competitive for health professions 
        schools;
            ``(5) kindergarten through 12th grade and other health 
        pipeline programs;
            ``(6) mentoring programs;
            ``(7) internship or rotation programs involving hospitals, 
        health systems, health plans and other health entities;
            ``(8) community partnership development for purposes 
        relating to workforce diversity; or
            ``(9) leadership training.
    ``(d) Reports.--Not later than 1 year after receiving a grant under 
this section, and annually for the term of the grant, a grantee shall 
submit to the Secretary a report that summarizes and evaluates all 
activities conducted under the grant.
    ``(e) Definition.--In this section, the term `Asian American and 
Pacific Islander-serving institutions' means institutions--
            ``(1) that are eligible institutions under section 312(b) 
        of the Higher Education Act of 1965; and
            ``(2) that, at the time of their application, have an 
        enrollment of undergraduate students that is made up of at 
        least 10 percent Asian American and Pacific Islander students.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $100,000,000 for each of fiscal 
years 2008 through 2013.

``SEC. 3016. CAREER DEVELOPMENT FOR SCIENTISTS AND RESEARCHERS.

    ``(a) In General.--The Secretary, acting through the Director of 
the National Institutes of Health, the Director of the Centers for 
Disease Control and Prevention, the Commissioner of Food and Drugs, and 
the Director of the Agency for Healthcare Research and Quality, shall 
award grants that expand existing opportunities for scientists and 
researchers and promote the inclusion of underrepresented minorities in 
the health professions.
    ``(b) Research Funding.--The head of each entity within the 
Department of Health and Human Services shall establish or expand 
existing programs to provide research funding to scientists and 
researchers in-training. Under such programs, the head of each such 
entity shall give priority in allocating research funding to support 
health research in traditionally underserved communities, including 
underrepresented minority communities, and research classified as 
community or participatory.
    ``(c) Data Collection.--The head of each entity within the 
Department of Health and Human Services shall collect data on the 
number (expressed as an absolute number and a percentage) of 
underrepresented minority and nonminority applicants who receive and 
are denied agency funding at every stage of review. Such data shall be 
reported annually to the Secretary and the appropriate committees of 
Congress.
    ``(d) Student Loan Reimbursement.--The Secretary shall establish a 
student loan reimbursement program to provide student loan 
reimbursement assistance to researchers who focus on racial and ethnic 
disparities in health. The Secretary shall promulgate regulations to 
define the scope and procedures for the program under this subsection.

``SEC. 3017. CAREER SUPPORT FOR NON-RESEARCH HEALTH PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, the Administrator of 
the Substance Abuse and Mental Health Services Administration, the 
Administrator of the Health Resources and Services Administration, and 
the Administrator of the Centers for Medicare & Medicaid Services shall 
establish a program to award grants to eligible individuals for career 
support, including leadership training, in non-research-related health 
care.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an individual shall--
            ``(1) be a student in a health professions school, a 
        graduate of such a school who is working in a health 
        profession, or a faculty member of such a school; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--An individual shall use amounts received under 
a grant under this section to--
            ``(1) support the individual's health activities or 
        projects that involve underserved communities, including rural 
        communities and racial and ethnic minority communities;
            ``(2) support health-related career advancement activities; 
        and
            ``(3) to pay, or as reimbursement for payments of, student 
        loans for individuals who are health professionals and are 
        focused on health issues affecting underserved communities, 
        including rural communities and racial and ethnic minority 
        communities.
    ``(d) Definition.--In this section, the term `career in non-
research-related health care' means employment or intended employment 
in the field of public health, health policy, health management, health 
administration, medicine, nursing, pharmacy, allied health, community 
health, or other fields determined appropriate by the Secretary, other 
than in a position that involves research.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3018. CULTURAL COMPETENCE TRAINING FOR HEALTH CARE 
              PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, the Deputy 
Assistant Secretary for Minority Health, and the Director of the 
National Center for Minority Health and Health Disparities, shall award 
grants to eligible entities to test, implement, and evaluate models of 
cultural competence training, including continuing education, for 
health care providers.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an academic medical center, a health center or 
        clinic, a hospital, a health plan, a health system, or a health 
        care professional guild (including a mental health care 
        professional guild);
            ``(2) partner with a minority-serving institution, minority 
        health professional association, or community-based 
        organization representing minority populations, in addition to 
        a research institution to carry out activities under this 
        grant; and
            ``(3) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3019. REGIONAL MINORITY CENTERS OF EXCELLENCE PROGRAMS.

    ``(a) Establishment.--The Office of Minority Health, in 
collaboration with the Health Resources and Services Administration and 
the National Center on Minority Health and Health Disparities, shall 
establish and jointly fund Regional Minority Centers of Excellence 
Programs in medically underserved regions through the award of major 
funded, long-term cooperative agreements to eligible minority 
community-based organizations, school districts, and health professions 
organizations.
    ``(b) Use of Funds.--The Office of Minority Health shall not award 
a cooperative agreement to an entity for a Regional Minority Centers of 
Excellence Program under subsection (a) unless the entity agrees that 
its program will include--
            ``(1) recruitment of minority students and faculty; and
            ``(2) development of curriculum on minority health for 
        health professions students, allied health students, and other 
        health professionals.
    ``(c) Eligibility.--To be eligible to receive a cooperative 
agreement under subsection (a), a minority community-based 
organization, school district, or profession organization must be 
recognized for its demonstrated ability to engage minority community 
involvement in health care programs.
    ``(d) Priority.--In awarding cooperative agreements under 
subsection (a), the Office of Minority Health shall give priority to 
entities that--
            ``(1) will use the agreement in a geographic area that has 
        a large medically underserved minority population; and
            ``(2) will use a regional approach through partnerships 
        with other health professions schools, private sector entities, 
        school districts, and community-based organizations that serve 
        the area.''.

SEC. 202. HEALTH CAREERS OPPORTUNITY PROGRAM.

    (a) Purpose.--It is the purpose of this section to diversify the 
health care workforce by increasing the number of individuals from 
disadvantaged backgrounds in the health and allied health professions 
by enhancing the academic skills of students from disadvantaged 
backgrounds and supporting them in successfully competing, entering, 
and graduating from health professions training programs.
    (b) Authorization of Appropriations.--Section 740(c) of the Public 
Health Service Act (42 U.S.C. 293d(c)) is amended by striking 
``$29,400,000'' and all that follows through ``2002'' and inserting 
``$50,000,000 for fiscal year 2008, and such sums as may be necessary 
for each of fiscal years 2009 through 2013''.

SEC. 203. PROGRAM OF EXCELLENCE IN HEALTH PROFESSIONS EDUCATION FOR 
              UNDERREPRESENTED MINORITIES.

    (a) Purpose.--It is the purpose of this section to diversify the 
health care workforce by supporting programs of excellence in 
designated health professions schools with a demonstrated set of 
effective policies, criteria, programs, performance standards, and 
measures that document commitment and capacity to underrepresented 
minority populations with a focus on minority health issues, cultural 
and linguistic competence, and eliminating racial and ethnic 
disparities in health and health care.
    (b) Authorization of Appropriation.--Section 736(h)(1) of the 
Public Health Service Act (42 U.S.C. 293(h)(1)) is amended to read as 
follows:
            ``(1) Authorization of appropriations.--For the purpose of 
        making grants under subsection (a), there are authorized to be 
        appropriated $50,000,000 for fiscal year 2008, and such sums as 
        may be necessary for each of the fiscal years 2009 through 
        2013.''.

SEC. 204. MINORITY-SERVING INSTITUTIONS AND HISPANIC-SERVING HEALTH 
              PROFESSIONS SCHOOLS.

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

``SEC. 742. MINORITY-SERVING INSTITUTIONS AND HISPANIC-SERVING HEALTH 
              PROFESSIONS SCHOOLS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to minority-serving institutions and Hispanic-serving health 
professions schools for the purpose of carrying out programs to recruit 
underrepresented individuals to enroll in and graduate from such 
schools, which may include providing scholarships and other financial 
assistance as appropriate.
    ``(b) Definitions.--In this section:
            ``(1) The term `Hispanic-serving health professions school' 
        means an entity that--
                    ``(A) is a school or program under section 799B;
                    ``(B) has an enrollment of full-time equivalent 
                students that is made up of at least 9 percent Hispanic 
                students;
                    ``(C) has been effective in carrying out programs 
                to recruit Hispanic individuals to enroll in and 
                graduate from the school;
                    ``(D) has been effective in recruiting and 
                retaining Hispanic faculty members; and
                    ``(E) has a significant number of graduates who are 
                providing health services to medically underserved 
                populations or to individuals in health professional 
                shortage areas.
            ``(2) The term `historically Black college or university' 
        means a part B institution (as defined in section 322(2) of the 
        Higher Education Act of 1965).
            ``(3) The term `minority-serving institution' means an 
        entity that is--
                    ``(A) an historically Black college or university;
                    ``(B) an Hispanic-serving institution (as defined 
                in section 502(a)(5) of the Higher Education Act of 
                1965);
                    ``(C) a tribally controlled college or university 
                (as defined in section 2(a)(4) of the Tribally 
                Controlled College or University Assistance Act of 
                1978);
                    ``(D) an Alaska Native-serving institution (as 
                defined in section 317(b)(2) of the Higher Education 
                Act of 1965); or
                    ``(E) a Native Hawaiian-serving institution (as 
                defined in section 317(b)(4) of the Higher Education 
                Act of 1965).''.

SEC. 205. HEALTH PROFESSIONS STUDENT LOAN FUND; AUTHORIZATIONS OF 
              APPROPRIATIONS REGARDING STUDENTS FROM UNDERREPRESENTED 
              MINORITY COMMUNITIES.

    Section 724(f) of the Public Health Service Act (42 U.S.C. 292t(f)) 
is amended by inserting before paragraph (2) the following:
            ``(1) In general.--With respect to making Federal capital 
        contributions to student loan funds for purposes of subsection 
        (a), there is authorized to be appropriated $50,000,000 for 
        fiscal year 2008, and such sums as may be necessary for each of 
        the fiscal years 2009 through 2013.''.

SEC. 206. NATIONAL HEALTH SERVICE CORPS; TRAINING PROGRAMS.

    (a) In General.--Section 331(b) of the Public Health Service Act 
(42 U.S.C. 254d(b)) is amended by adding at the end the following:
    ``(3) The Secretary shall ensure that the individuals with respect 
to whom activities under paragraphs (1) and (2) are carried out include 
individuals from disadvantaged backgrounds, including activities 
carried out to provide health professions students with information on 
the Scholarship and Repayment Programs.''.
    (b) Assignment of Corps Personnel.--
            (1) In general.--Section 333(a)(3) of the Public Health 
        Service Corps (42 U.S.C. 254f(a)(3)) is amended to read as 
        follows:
            ``(3)(A) In approving applications for assignment of 
        members of the Corps the Secretary shall not discriminate 
        against application from entities which are not receiving 
        Federal financial assistance under this Act.
            ``(B) In approving such applications, the Secretary shall--
                    ``(i) give preference to applications in which a 
                nonprofit entity or public entity shall provide a site 
                to which Corps members may be assigned; and
                    ``(ii) give highest preference to applications--
                            ``(I) from entities described in clause (i) 
                        that are federally qualified health centers as 
                        defined in section 1905(l)(2)(B) of the Social 
                        Security Act; and
                            ``(II) from entities described in clause 
                        (i) that primarily serve rural communities, 
                        racial and ethnic minorities, and other health 
                        disparity populations with annual incomes at or 
                        below twice those set forth in the most recent 
                        poverty guidelines issued by the Secretary 
                        pursuant to section 673(2) of the Community 
                        Services Block Grant Act (42 U.S.C. 
                        9902(2)).''.
            (2) Priorities in assignment of corps personnel.--Section 
        333A of the Public Health Service Act (42 U.S.C. 254f-1) is 
        amended--
                    (A) in subsection (a)--
                            (i) by redesignating paragraphs (1), (2), 
                        and (3) as paragraphs (2), (3), and (4), 
                        respectively; and
                            (ii) by striking ``shall--'' and inserting 
                        ``shall--
            ``(1) give preference to applications as set forth in 
        subsection (a)(3) of section 333;'';
                    (B) in subsection (b)(1), by striking ``subsection 
                (a)(1)(A)'' and inserting ``subsection (a)(2)(A)''; and
                    (C) by striking ``subsection (a)(1)'' each place it 
                appears and inserting ``subsection (a)(2)''.
            (3) Conforming amendment.--Section 338I(c)(3)(B)(ii) of the 
        Public Health Service Act (42 U.S.C. 254q-1(c)(3)(B)(ii)) is 
        amended by striking ``section 333A(a)(1)'' and inserting 
        ``section 333A(a)(2)''.
    (c) Reauthorization of National Health Service Corps Scholarship 
Program and Loan Repayment Program.--
            (1) Reauthorization of appropriations.--Section 338H(a) of 
        the Public Health Service Act (42 U.S.C. 254q(a)) is amended by 
        striking ``$146,250,000'' and all that follows through the 
        period and inserting ``$300,000,000 for each of fiscal years 
        2008 through 2012.''.
            (2) Scholarships for medical students.--Section 338H of 
        such Act is further amended by adding at the end the following:
    ``(d) Scholarships for Medical Students.--For contracts for 
scholarships under this subpart to individuals who are accepted for 
enrollment, or enrolled, in a course of study or program described in 
section 338A(b)(1)(B) that leads to a degree in medicine, osteopathic 
medicine, dentistry, or mental health services, the Secretary shall, of 
the amounts appropriated under subsection (a) for a fiscal year, 
obligate the greater of 10 percent or such amount as necessary to fund 
ongoing activities related to such contracts.''.
    (d) Reauthorization of Certain Programs Providing Grants for Health 
Professions Training for Diversity.--
            (1) Grants for centers of excellence.--Section 736(h)(1) of 
        the Public Health Service Act (42 U.S.C. 293(h)(1)) is amended 
        by striking ``$26,000,000'' and all that follows through 
        ``2002'' and inserting ``$50,000,000 for each of fiscal years 
        2008 through 2012''.
            (2) Educational assistance for individuals from 
        disadvantaged backgrounds.--Section 740(c) of such Act (42 
        U.S.C. 293d(c)) is amended by striking ``$29,400,000'' and all 
        that follows through ``1999 through 2002.'' and inserting 
        ``$50,000,000 for each of fiscal years 2008 through 2012.''.
    (e) Expansion of Residency Training Programs and Primary Care 
Services Offered by Community Health Centers.--Part C of title VII of 
the Public Health Service Act (42 U.S.C. 293k et seq.) is amended--
            (1) by adding before section 747 the following:

                     ``Subpart I--In General''; and

            (2) by adding after section 748 the following:

                   ``Subpart II--Additional Programs

``SEC. 749. GRANTS TO EXPAND MEDICAL RESIDENCY TRAINING PROGRAMS AT 
              COMMUNITY HEALTH CENTERS.

    ``(a) Program Authorized.--The Secretary may make grants to 
community health centers--
            ``(1) to establish, at the centers, new or alternative-
        campus accredited medical residency training programs 
        affiliated with a hospital or other health care facility; or
            ``(2) to fund new residency positions within existing 
        accredited medical residency training programs at the centers 
        and their affiliated partners.
    ``(b) Use of Funds.--Amounts from a grant under this section shall 
be used to cover the costs of establishing or expanding a medical 
residency training program described in subsection (a), including costs 
associated with--
            ``(1) curriculum development;
            ``(2) equipment acquisition;
            ``(3) recruitment, training, and retention of residents and 
        faculty; and
            ``(4) residency stipends.
    ``(c) Applications.--A community health center seeking a grant 
under this section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    ``(d) Preference.--In selecting recipients for a grant under this 
section, the Secretary shall give preference to funding medical 
residency training programs focusing on primary health care.
    ``(e) Definitions.--In this section:
            ``(1) The term `accredited', as applied to a new or 
        alternative-campus medical residency training program, means a 
        program that is accredited by a recognized body or bodies 
        approved for such purpose by the Accreditation Council for 
        Graduate Medical Education, except that a new medical residency 
        training program that, by reason of an insufficient period of 
        operation, is not eligible for accreditation on or before the 
        date of submission of an application under subsection (c) shall 
        be deemed accredited if the Accreditation Council for Graduate 
        Medical Education finds, after consultation with the 
        appropriate accreditation body or bodies, that there is 
        reasonable assurance that the program will meet the 
        accreditation standards of such body or bodies prior to the 
        date of graduation of the first entering class in that program.
            ``(2) The term `community health center' means a health 
        center as defined in section 330.

``SEC. 749A. GRANTS TO IMPROVE DELIVERY OF PRIMARY CARE SERVICES IN 
              COMMUNITY HEALTH CENTERS.

    ``(a) Primary Care Access Grants.--
            ``(1) Program authorized.--The Secretary, acting through 
        the Administrator of the Health Resources and Services 
        Administration, may make grants to community health centers for 
        the purpose of increasing the number of medical service 
        providers associated with such centers.
            ``(2) Grants.--A recipient of a grant under this subsection 
        shall be eligible to receive such grants for a total of 5 
        fiscal years.
            ``(3) Use of funds.--A recipient of a grant under this 
        subsection shall use amounts from the grant for one or more of 
        the following activities:
                    ``(A) To recruit residents for medical residency 
                training programs at the community health center.
                    ``(B) To establish a multi-community physician 
                mentoring program to encourage upper level residents to 
                remain in the State or Territory in which the community 
                health center and medical residency training program 
                are located.
                    ``(C) To enter into contracts for technical 
                assistance for the purpose of recruiting or retaining 
                primary health care staff.
                    ``(D) To enter into contracts for technical 
                assistance in preparing contracts with local providers 
                of primary health care to provide services for 
                medically underserved communities.
                    ``(E) To enter into contracts for the development 
                and implementation of strategies to identify and retain 
                health care professionals and specialists, including 
                oral and mental health providers, who are willing and 
                able to provide direct actual service to the community 
                health center on a referral basis.
            ``(4) Application.--A community health center seeking a 
        grant under this subsection shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may require.
    ``(b) Grants for Primary Care Facility Capital Expenditures.--
            ``(1) Program authorized.--The Secretary, acting through 
        the Administrator of the Health Resources and Services 
        Administration, may make grants to community health centers for 
        the purpose of increasing primary health care capabilities 
        through the construction, expansion, or renovation of 
        facilities.
            ``(2) Grants.--A recipient of a grant under this subsection 
        shall be eligible to receive such grants for a total of 5 
        fiscal years.
            ``(3) Use of funds.--A recipient of a grant under this 
        subsection shall use amounts from the grant for one or more of 
        the following activities:
                    ``(A) To acquire or lease facilities.
                    ``(B) To construct new facilities.
                    ``(C) To repair or modernize existing facilities.
                    ``(D) To purchase or lease medical equipment.
    ``(c) Definition.--The term `community health center' means a 
health center as defined in section 330.

``SEC. 749B. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated $200,000,000 for fiscal 
year 2008 and such sums as may be necessary for each fiscal year 
thereafter to carry out this subpart.''.
    (f) Interdisciplinary, Community-Based Programs.--
            (1) Area health education centers.--Section 751(a) of the 
        Public Health Service Act (42 U.S.C. 294a(a)) is amended--
                    (A) in paragraph (1)(A)--
                            (i) in clause (i), by inserting at the end 
                        before the semicolon the following: ``, with an 
                        emphasis on such personnel who focus on primary 
                        care'';
                            (ii) by redesignating clauses (ii) through 
                        (vii) as clauses (iii) through (viii), 
                        respectively; and
                            (iii) by inserting after clause (i) the 
                        following:
                            ``(ii) foster and provide community-based 
                        training and education for health professions 
                        students in underserved communities and among 
                        underserved populations, including but not 
                        limited to the National Health Service Corps, 
                        community and migrant health centers, rural 
                        health clinics, critical access hospitals, 
                        tribal health clinics, and public health 
                        departments;''; and
                    (B) by adding at the end the following:
            ``(3) Point of service enhancement grants.--
                    ``(A) In general.--The Secretary may award grants 
                to entities receiving an award under paragraph (1) or 
                (2) to improve the effectiveness of the programs 
                operated by such entities or to enable the entities to 
                respond to changes affecting such entities arising 
                since the date of the receipt of the award under 
                paragraph (1) or (2).
                    ``(B) Application.--To receive an award under this 
                paragraph, an entity described under subparagraph (A) 
                shall submit to the Secretary an application at such 
                time, in such manner, and containing such information 
                as the Secretary may require, including an explanation 
                of the changes affecting such entity arising since the 
                date of the receipt by the entity of the award under 
                paragraph (1) or (2), such as changes in the 
                demographics of the area served, the needs of the 
                population served, and the situations encountered by 
                such population and such entity.''.
            (2) Authorization of appropriations.--Section 757 of the 
        Public Health Service Act (42 U.S.C. 294g) is amended--
                    (A) in subsection (a), by striking ``$55,600,000'' 
                and all that follows through ``2002'' and inserting 
                ``$125,000,000 for fiscal year 2008 and such sums as 
                may be necessary for each of fiscal years 2009 through 
                2012'';
                    (B) by striking subsection (b) and inserting the 
                following:
    ``(b) Allocation.--
            ``(1) In general.--Of the amounts appropriated under 
        subsection (a) that the Secretary makes available for each 
        fiscal year to carry out section 751, the Secretary shall 
        obligate--
                    ``(A) for awards under paragraph (1) of section 
                751(a), not more than 25 percent of such amounts in 
                each fiscal year; and
                    ``(B) for awards under paragraphs (2) and (3) of 
                section 751(a), not less than 60 percent of such 
                amounts in each fiscal year.''; and
                    (C) in subsection (c), by--
                            (i) striking the subsection designation and 
                        heading and inserting the following:
    ``(c) Sense of the Congress.--It is the sense of the Congress 
that--''.
                            (ii) striking paragraph (1); and
                            (iii) in paragraph (2), by--
                                    (I) striking the paragraph 
                                designation and all that follows 
                                through ``Congress that--''; and
                                    (II) redesignating subparagraphs 
                                (A) and (B) as paragraphs (1) and (2) 
                                and indenting appropriately.

SEC. 207. LOAN REPAYMENT PROGRAM OF THE CENTERS FOR DISEASE CONTROL AND 
              PREVENTION.

    Section 317F(c) of the Public Health Service Act (42 U.S.C. 247b-
7(c)) is amended--
            (1) by striking ``and'' after ``1994,''; and
            (2) by inserting before the period the following: 
        ``$750,000 for fiscal year 2008, and such sums as may be 
        necessary for each of the fiscal years 2009 through 2013.''.

SEC. 208. STRENGTHENING AND EXPANDING RURAL HEALTH PROVIDER NETWORKS.

    Section 330A of the Public Health Service Act (42 U.S.C. 254c) is 
amended--
            (1) in subsection (h), by adding at the end the following:
            ``(4) Rural minority, border, and indian populations.--In 
        making grants under this section, the Director of the Office of 
        Rural Health Policy of the Health Resources and Services 
        Administration, in coordination with the Director of the Indian 
        Health Service and the Deputy Assistant Secretary for Minority 
        Health, shall make grants to entities that serve rural 
        minority, border, and Indian populations.
            ``(5) Diversity health training programs.--The Director of 
        the Office of Rural Health Policy of the Health Resources and 
        Services Administration, in coordination with the Director of 
        the Indian Health Service and the Deputy Assistant Secretary 
        for Minority Health, shall coordinate the awarding of grants 
        under this section with the awarding of grants and contracts 
        under section 765 to connect and integrate diversity health 
        training programs.''; and
            (2) in subsection (j), by striking ``and such sums as may 
        be necessary for each of fiscal years 2003 through 2006'' and 
        inserting ``, such sums as may be necessary for each of fiscal 
        years 2008 through 2010, and $60,000,000 for each of fiscal 
        years 2011 through 2015''.

SEC. 209. MCNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM.

    Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a-
15) is amended by striking subsection (f) and inserting the following:
    ``(f) Collaboration in Health Profession Diversity Training 
Programs.--The Secretary of Education shall coordinate with the 
Secretary of Health and Human Services to ensure that there is 
collaboration between the goals of the program under this section and 
programs of the Health Resources and Services Administration that 
promote health workforce diversity. The Secretary of Education shall 
take such measures as may be necessary to encourage participants in 
programs under this section to consider health profession careers.
    ``(g) Funding.--From amounts appropriated pursuant to the authority 
of section 402A(f), the Secretary shall, to the extent practicable, 
allocate funds for projects authorized by this section in an amount 
which is not less than $31,000,000 for each of the fiscal years 2008 
through 2014.''.

SEC. 210. ENSURING PROPORTIONAL REPRESENTATION OF INTERESTS OF RURAL 
              AREAS ON MEDPAC.

    (a) In General.--Section 1805(c)(2) of the Social Security Act (42 
U.S.C. 1395b-6(c)(2)) is amended--
            (1) in subparagraph (A), by inserting ``consistent with 
        subparagraph (E)'' after ``rural representatives''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Proportional representation of interests of 
                rural areas.--In order to provide a balance between 
                urban and rural representatives under subparagraph (A), 
                the proportion of members who represent the interests 
                of health care providers and Medicare beneficiaries 
                located in rural areas shall be no less than the 
                proportion, of the total number of Medicare 
                beneficiaries, who reside in rural areas.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to appointments made to the Medicare Payment 
Advisory Commission after the date of the enactment of this Act.

                TITLE III--DATA COLLECTION AND REPORTING

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

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

 ``Subtitle B--Strengthening Data Collection, Improving Data Analysis, 
                      and Expanding Data Reporting

``SEC. 3031. DATA ON RACE, ETHNICITY, AND PRIMARY LANGUAGE.

    ``(a) Requirements.--
            ``(1) In general.--Each health-related program operated by 
        or that receives funding or reimbursement, in whole or in part, 
        either directly or indirectly from the Department of Health and 
        Human Services shall--
                    ``(A) require the collection, by the agency or 
                program involved, of data on the race, ethnicity, and 
                primary language of each applicant for and recipient of 
                health-related assistance under such program--
                            ``(i) using, at a minimum, the categories 
                        for race and ethnicity described in the 1997 
                        Office of Management and Budget Standards for 
                        Maintaining, Collecting, and Presenting Federal 
                        Data on Race and Ethnicity;
                            ``(ii) using the standards developed under 
                        subsection (e) for the collection of language 
                        data;
                            ``(iii) collecting data for additional 
                        population groups if such groups can be 
                        aggregated into the minimum race and ethnicity 
                        categories; and
                            ``(iv) where practicable, through self-
                        report;
                    ``(B) with respect to the collection of the data 
                described in subparagraph (A) for applicants and 
                recipients who are minors or otherwise legally 
                incapacitated, require that--
                            ``(i) such data be collected from the 
                        parent or legal guardian of such an applicant 
                        or recipient; and
                            ``(ii) the preferred language of the parent 
                        or legal guardian of such an applicant or 
                        recipient be collected;
                    ``(C) systematically analyze such data using the 
                smallest appropriate units of analysis feasible to 
                detect racial and ethnic disparities in health and 
                health care and when appropriate, for men and women 
                separately, and report the results of such analysis to 
                the Secretary, the Director of the Office for Civil 
                Rights, the Committee on Health, Education, Labor, and 
                Pensions and the Committee on Finance of the Senate, 
                and the Committee on Energy and Commerce and the 
                Committee on Ways and Means of the House of 
                Representatives;
                    ``(D) provide such data to the Secretary on at 
                least an annual basis; and
                    ``(E) ensure that the provision of assistance to an 
                applicant or recipient of assistance is not denied or 
                otherwise adversely affected because of the failure of 
                the applicant or recipient to provide race, ethnicity, 
                and primary language data.
            ``(2) Rules of construction.--Nothing in this subsection 
        shall be construed to--
                    ``(A) permit the use of information collected under 
                this subsection in a manner that would adversely affect 
                any individual providing any such information; and
                    ``(B) require health care providers to collect 
                data.
    ``(b) Protection of Data.--The Secretary shall ensure (through the 
promulgation of regulations or otherwise) that all data collected 
pursuant to subsection (a) is protected--
            ``(1) under the same privacy protections as the Secretary 
        applies to other health data under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) 
        relating to the privacy of individually identifiable health 
        information and other protections; and
            ``(2) from all inappropriate internal use by any entity 
        that collects, stores, or receives the data, including use of 
        such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from other inappropriate 
        uses, as defined by the Secretary.
    ``(c) National Plan of the Data Council.--The Secretary shall 
develop and implement a national plan to ensure the collection of data 
in a culturally appropriate and competent manner, and to improve the 
collection, analysis, and reporting of racial, ethnic, and primary 
language data at the Federal, State, territorial, Tribal, and local 
levels, including data to be collected under subsection (a). The Data 
Council of the Department of Health and Human Services, in consultation 
with the National Committee on Vital Health Statistics, the Office of 
Minority Health, and other appropriate public and private entities, 
shall make recommendations to the Secretary concerning the development, 
implementation, and revision of the national plan. Such plan shall 
include recommendations on how to--
            ``(1) implement subsection (a) while minimizing the cost 
        and administrative burdens of data collection and reporting;
            ``(2) expand awareness among Federal agencies, States, 
        territories, Indian tribes, health providers, health plans, 
        health insurance issuers, and the general public that data 
        collection, analysis, and reporting by race, ethnicity, and 
        primary language is legal and necessary to assure equity and 
        non-discrimination in the quality of health care services;
            ``(3) ensure that future patient record systems have data 
        code sets for racial, ethnic, and primary language identifiers 
        and that such identifiers can be retrieved from clinical 
        records, including records transmitted electronically;
            ``(4) improve health and health care data collection and 
        analysis for more population groups if such groups can be 
        aggregated into the minimum race and ethnicity categories, 
        including exploring the feasibility of enhancing collection 
        efforts in States for racial and ethnic groups that comprise a 
        significant proportion of the population of the State;
            ``(5) provide researchers with greater access to racial, 
        ethnic, and primary language data, subject to privacy and 
        confidentiality regulations; and
            ``(6) safeguard and prevent the misuse of data collected 
        under subsection (a).
    ``(d) Compliance With Standards.--Data collected under subsection 
(a) shall be obtained, maintained, and presented (including for 
reporting purposes) in accordance with the 1997 Office of Management 
and Budget Standards for Maintaining, Collecting, and Presenting 
Federal Data on Race and Ethnicity (at a minimum).
    ``(e) Language Collection Standards.--Not later than 1 year after 
the date of enactment of this title, the Deputy Assistant Secretary for 
Minority Health, in consultation with the Office for Civil Rights of 
the Department of Health and Human Services, shall develop and 
disseminate Standards for the Classification of Federal Data on 
Preferred Written and Spoken Language.
    ``(f) Technical Assistance for the Collection and Reporting of 
Data.--
            ``(1) In general.--The Secretary may, either directly or 
        through grant or contract, provide technical assistance to 
        enable a health care program or an entity operating under such 
        program to comply with the requirements of this section.
            ``(2) Types of assistance.--Assistance provided under this 
        subsection may include assistance to--
                    ``(A) enhance or upgrade computer technology that 
                will facilitate racial, ethnic, and primary language 
                data collection and analysis;
                    ``(B) improve methods for health data collection 
                and analysis including additional population groups 
                beyond the Office of Management and Budget categories 
                if such groups can be aggregated into the minimum race 
                and ethnicity categories;
                    ``(C) develop mechanisms for submitting collected 
                data subject to existing privacy and confidentiality 
                regulations; and
                    ``(D) develop educational programs to inform health 
                insurance issuers, health plans, health providers, 
                health-related agencies, and the general public that 
                data collection and reporting by race, ethnicity, and 
                preferred language are legal and essential for 
                eliminating health and health care disparities.
    ``(g) Analysis of Racial and Ethnic Data.--The Secretary, acting 
through the Director of the Agency for Healthcare Research and Quality 
and in coordination with the Administrator of the Centers for Medicare 
& Medicaid Services, shall provide technical assistance to agencies of 
the Department of Health and Human Services in meeting Federal 
standards for race, ethnicity, and primary language data collection and 
analysis of racial and ethnic disparities in health and health care in 
public programs by--
            ``(1) identifying appropriate quality assurance mechanisms 
        to monitor for health disparities;
            ``(2) specifying the clinical, diagnostic, or therapeutic 
        measures which should be monitored;
            ``(3) developing new quality measures relating to racial 
        and ethnic disparities in health and health care;
            ``(4) identifying the level at which data analysis should 
        be conducted; and
            ``(5) sharing data with external organizations for research 
        and quality improvement purposes.
    ``(h) Report.--Not later than 2 years after the date of enactment 
of this title, and biennially thereafter, the Secretary shall submit to 
the appropriate committees of Congress a report on the effectiveness of 
data collection, analysis, and reporting on race, ethnicity, and 
primary language under the programs and activities of the Department of 
Health and Human Services and under other Federal data collection 
systems with which the Department interacts to collect relevant data on 
race and ethnicity. The report shall evaluate the progress made in the 
Department with respect to the national plan under subsection (c) or 
subsequent revisions thereto.
    ``(i) Definition.--In this section, the term `health-related 
program' mean a program--
            ``(1) under the Social Security Act (42 U.S.C. 301 et seq.) 
        that pay for health care and services; and
            ``(2) under this Act that provide Federal financial 
        assistance for health care, biomedical research, health 
        services research, and programs designed to improve the 
        public's health.
    ``(j) 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 2008 through 2013.

``SEC. 3032. PROVISIONS RELATING TO NATIVE AMERICANS.

    ``(a) Establishment of Epidemiology Centers.--The Secretary shall 
establish an epidemiology center in each service area to carry out the 
functions described in subsection (b). Any new center established after 
the date of the enactment of the Health Equity and Accountability Act 
of 2007 may be operated under a grant authorized by subsection (d), but 
funding under such a grant shall not be divisible.
    ``(b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, each service area epidemiology center established under 
this subsection shall, with respect to such service area--
            ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in the service area;
            ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in identifying their highest priority 
        health status objectives and the services needed to achieve 
        such objectives, based on epidemiological data;
            ``(4) make recommendations for the targeting of services 
        needed by the populations served;
            ``(5) make recommendations to improve health care delivery 
        systems for Indians and Urban Indians;
            ``(6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
            ``(7) provide disease surveillance and assist Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        promote public health.
    ``(c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical assistance to 
the centers in carrying out the requirements of this subsection.
    ``(d) Grants for Studies.--
            ``(1) In general.--The Secretary may make grants to Indian 
        Tribes, Tribal Organizations, Urban Indian Organizations, and 
        eligible intertribal consortia to conduct epidemiological 
        studies of Indian communities.
            ``(2) Eligible intertribal consortia.--An intertribal 
        consortium is eligible to receive a grant under this subsection 
        if--
                    ``(A) the intertribal consortium is incorporated 
                for the primary purpose of improving Indian health; and
                    ``(B) the intertribal consortium is representative 
                of the Indian Tribes or urban Indian communities in 
                which the intertribal consortium is located.
            ``(3) Applications.--An application for a grant under this 
        subsection shall be submitted in such manner and at such time 
        as the Secretary shall prescribe.
            ``(4) Requirements.--An applicant for a grant under this 
        subsection shall--
                    ``(A) demonstrate the technical, administrative, 
                and financial expertise necessary to carry out the 
                functions described in paragraph (5);
                    ``(B) consult and cooperate with providers of 
                related health and social services in order to avoid 
                duplication of existing services; and
                    ``(C) demonstrate cooperation from Indian tribes or 
                Urban Indian Organizations in the area to be served.
            ``(5) Use of funds.--A grant awarded under paragraph (1) 
        may be used--
                    ``(A) to carry out the functions described in 
                subsection (b);
                    ``(B) to provide information to and consult with 
                tribal leaders, urban Indian community leaders, and 
                related health staff on health care and health service 
                management issues; and
                    ``(C) in collaboration with Indian Tribes, Tribal 
                Organizations, and urban Indian communities, to provide 
                the Service with information regarding ways to improve 
                the health status of Indians.
    ``(e) Access to Information.--An epidemiology center operated by a 
grantee pursuant to a grant awarded under subsection (d) shall be 
treated as a public health authority for purposes of the Health 
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191; 110 Stat. 2033), as such entities are defined in part 164.501 of 
title 45, Code of Federal Regulations (or a successor regulation). The 
Secretary shall grant such grantees access to and use of data, data 
sets, monitoring systems, delivery systems, and other protected health 
information in the possession of the Secretary.''.

SEC. 302. COLLECTION OF RACE AND ETHNICITY DATA BY THE SOCIAL SECURITY 
              ADMINISTRATION.

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

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

    ``(a) Requirement.--The Commissioner of Social Security, in 
consultation with the Administrator of the Centers for Medicare & 
Medicaid Services, shall--
            ``(1) require the collection of data on the race, 
        ethnicity, and primary language of all applicants for social 
        security account numbers or benefits under title II or part A 
        of title XVIII and all individuals with respect to whom the 
        Commissioner maintains records of wages and self-employment 
        income in accordance with reports received by the Commissioner 
        or the Secretary of the Treasury--
                    ``(A) using, at a minimum, the categories for race 
                and ethnicity described in the 1997 Office of 
                Management and Budget Standards for Maintaining, 
                Collecting, and Presenting Federal Data on Race and 
                Ethnicity and available language standards; and
                    ``(B) where practicable, collecting data for 
                additional population groups if such groups can be 
                aggregated into the minimum race and ethnicity 
                categories;
            ``(2) with respect to the collection of the data described 
        in paragraph (1) for applicants who are under 18 years of age 
        or otherwise legally incapacitated, require that--
                    ``(A) such data be collected from the parent or 
                legal guardian of such an applicant; and
                    ``(B) the primary language of the parent or legal 
                guardian of such an applicant or recipient be used;
            ``(3) require that such data be uniformly analyzed and 
        reported at least annually to the Commissioner of Social 
        Security;
            ``(4) be responsible for storing the data reported under 
        paragraph (3);
            ``(5) ensure transmission to the Centers for Medicare & 
        Medicaid Services and other Federal health agencies;
            ``(6) provide such data to the Secretary on at least an 
        annual basis; and
            ``(7) ensure that the provision of assistance to an 
        applicant is not denied or otherwise adversely affected because 
        of the failure of the applicant to provide race, ethnicity, and 
        primary language data.
    ``(b) Protection of Data.--The Commissioner of Social Security 
shall ensure (through the promulgation of regulations or otherwise) 
that all data collected pursuant subsection (a) is protected--
            ``(1) under the same privacy protections as the Secretary 
        applies to health data under the regulations promulgated under 
        section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (Public Law 104-191; 110 Stat. 2033) 
        relating to the privacy of individually identifiable health 
        information and other protections; and
            ``(2) from all inappropriate internal use by any entity 
        that collects, stores, or receives the data, including use of 
        such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from other inappropriate 
        uses, as defined by the Secretary.
    ``(c) Rule of Construction.--Nothing in this section shall be 
construed to permit the use of information collected under this section 
in a manner that would adversely affect any individual providing any 
such information.
    ``(d) Technical Assistance.--The Secretary may, either directly or 
by grant or contract, provide technical assistance to enable any health 
entity to comply with the requirements of this section.
    ``(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 2008 through 2013.''.

SEC. 303. REVISION OF HIPAA CLAIMS STANDARDS.

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

SEC. 304. NATIONAL CENTER FOR HEALTH STATISTICS.

    Section 306(n) of the Public Health Service Act (42 U.S.C. 242k(n)) 
is amended--
            (1) in paragraph (1), by striking ``2003'' and inserting 
        ``2012'';
            (2) in paragraph (2), in the first sentence, by striking 
        ``2003'' and inserting ``2012''; and
            (3) in paragraph (3), by striking ``2002'' and inserting 
        ``2012''.

SEC. 305. GEO-ACCESS STUDY.

    The Administrator of the Substance Abuse and Mental Health Services 
Administration shall--
            (1) conduct a study to--
                    (A) determine which geographic areas of the United 
                States have shortages of specialty mental health 
                providers; and
                    (B) assess the preparedness of speciality mental 
                health providers to deliver culturally and 
                linguistically appropriate services; and
            (2) submit a report to the Congress on the results of such 
        study.

SEC. 306. RACIAL, ETHNIC, AND LINGUISTIC DATA COLLECTED BY THE FEDERAL 
              GOVERNMENT.

    (a) Collection; Submission.--Not later than 90 days after the date 
of the enactment of this Act, and January 31st of each year thereafter, 
each department, agency, and office of the Federal Government that has 
collected racial, ethnic, or linguistic data during the preceding 
calendar year shall submit such data to the Secretary of Health and 
Human Services.
    (b) Analysis; Public Availability; Reporting.--Not later than April 
30, 2008, and each April 30th thereafter, the Secretary of Health and 
Human Services, acting through the Director of the National Center on 
Minority Health and Health Disparities and the Deputy Assistant 
Secretary for Minority Health, shall--
            (1) collect and analyze the racial, ethnic, and linguistic 
        data submitted under subsection (a) for the preceding calendar 
        year;
            (2) make publicly available such data and the results of 
        such analysis; and
            (3) submit a report to the Congress on such data and 
        analysis.

SEC. 307. HEALTH INFORMATION TECHNOLOGY GRANTS.

    (a) Authority.--The Deputy Assistant Secretary for Minority Health, 
in coordination with the Office of the National Coordinator for Health 
Information Technology, the Health Resources and Services 
Administration, the Substance Abuse and Mental Health Services 
Administration, and the National Center on Minority Health and Health 
Disparities, may award grants to appropriate entities for the purpose 
of ensuring appropriate and best practices to collect appropriate data 
and documents on the reduction of health disparities.
    (b) Use of Funds.--A grant received under subsection (a) shall be 
used to achieve the purpose described in such subsection through one or 
more of the following:
            (1) Purchasing new, or enhancing existing, health 
        information technology.
            (2) Providing support and training to providers concerning 
        such technology.
            (3) Conducting outreach and education on health information 
        technology and its benefits to patients, physicians, allied 
        health professionals, and advocacy groups in medically 
        underserved communities (as defined in section 799B of the 
        Public Health Service Act (42 U.S.C. 295p)).
    (c) Authorization of Appropriations.--To carry out this section, 
there are authorized to be appropriated $20,000,000 for each of fiscal 
years 2008 through 2013.

SEC. 308. STUDY OF HEALTH INFORMATION TECHNOLOGY IN MEDICALLY 
              UNDERSERVED COMMUNITIES.

    (a) Study.--The National Coordinator for Health Information 
Technology shall conduct a study on the development and implementation 
of health information technology in medically underserved communities. 
The study shall--
            (1) identify barriers to successful implementation of 
        health information technology in these communities;
            (2) examine the impact of health information technology on 
        providing quality care and reducing the cost of care to these 
        communities;
            (3) examine urban and rural community health systems and 
        determine the impact that health information technology may 
        have on the capacity of primary health providers; and
            (4) assess the feasibility and the costs of associated with 
        the use of health information technology in these communities.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the National Coordinator for Health Information 
Technology shall submit to the Congress a report on the study conducted 
under subsection (a) and shall include in such report such 
recommendations for legislation or administrative action as the 
Coordinator determines appropriate.

SEC. 309. HEALTH INFORMATION TECHNOLOGY IN MEDICALLY UNDERSERVED 
              COMMUNITIES.

    The National Coordinator for Health Information Technology shall--
            (1) identify sources of funds that will be made available 
        to promote and support the planning and adoption of health 
        information technology in medically underserved communities (as 
        defined in section 799B of the Public Health Service Act (42 
        U.S.C. 295p)), including in urban and rural areas, either 
        through grants or technical assistance;
            (2) coordinate with the funding sources to help such 
        communities connect to identified funding; and
            (3) collaborate with the Agency for Healthcare Research and 
        Quality, the Health Resources and Services Administration, and 
        other Federal agencies to support technical assistance, 
        knowledge dissemination, and resource development, to such 
        communities seeking to plan for and adopt technology and 
        establish electronic health information networks across 
        providers.

SEC. 310. DATA COLLECTION AND ANALYSIS GRANTS TO MINORITY-SERVING 
              INSTITUTIONS.

    (a) Authority.--The Secretary of Health and Human Services, acting 
through the Center on Minority Health and Health Disparities and the 
Office of Minority Health, may award grants to access and analyze 
racial and ethnic, and where possible, primary language data to monitor 
and report on progress to reduce and eliminate racial and ethnic 
disparities in health and health care.
    (b) Eligible Entity.--In this section, the term ``eligible entity'' 
means a historically Black college or university, an Hispanic-serving 
institution, a tribal college or university, or an Asian American and 
Pacific Islander-serving institution with an accredited public health, 
health policy, or health services research program.

SEC. 311. HEALTH INFORMATION TECHNOLOGY GRANTS FOR RURAL HEALTH CARE 
              PROVIDERS.

    Title II of the Public Health Service Act is amended by adding at 
the end the following new part:

             ``PART D--HEALTH INFORMATION TECHNOLOGY GRANTS

``SEC. 271. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF 
              INTEROPERABLE HEALTH INFORMATION TECHNOLOGY IN RURAL 
              AREAS.

    ``(a) Competitive Grants to Eligible Entities in Rural Areas.--
            ``(1) In general.--The Secretary may award competitive 
        grants to eligible entities in rural areas to facilitate the 
        purchase and enhance the utilization of qualified health 
        information technology systems to improve the quality and 
        efficiency of health care.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1) an entity shall--
                    ``(A) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require;
                    ``(B) submit to the Secretary a strategic plan for 
                the implementation of data sharing and interoperability 
                measures;
                    ``(C) be a rural health care provider;
                    ``(D) adopt any applicable core interoperability 
                guidelines (endorsed under other provisions of law);
                    ``(E) agree to notify patients if their 
                individually identifiable health information is 
                wrongfully disclosed;
                    ``(F) demonstrate significant financial need; and
                    ``(G) provide matching funds in accordance with 
                paragraph (4).
            ``(3) Use of funds.--Amounts received under a grant under 
        this subsection shall be used to facilitate the purchase and 
        enhance the utilization of qualified health information 
        technology systems and training personnel in the use of such 
        technology.
            ``(4) Matching requirement.--To be eligible for a grant 
        under this subsection an entity shall contribute non-Federal 
        contributions to the costs of carrying out the activities for 
        which the grant is awarded in an amount equal to $1 for each $3 
        of Federal funds provided under the grant.
            ``(5) Limit on grant amount.--In no case shall the payment 
        amount under this subsection with respect to the purchase or 
        enhanced utilization of qualified health information technology 
        for a rural health care provider, in addition to the amount of 
        any loan made to the provider from a grant to a State under 
        subsection (b) for such purpose, exceed 100 percent of the 
        provider's costs for such purchase or enhanced utilization 
        (taking into account costs for training, implementation, and 
        maintenance).
            ``(6) Preference in awarding grants.--In awarding grants to 
        eligible entities under this subsection, the Secretary shall 
        give preference to each of the following types of applicants:
                    ``(A) An entity that is located in a frontier or 
                other rural underserved area as determined by the 
                Secretary.
                    ``(B) An entity that will link, to the extent 
                practicable, the qualified health information system to 
                a local or regional health information plan or plans.
                    ``(C) A rural health care provider that is a 
                nonprofit hospital or a Federally qualified health 
                center.
                    ``(D) A rural health care provider that is an 
                individual practice or group practice.
    ``(b) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out this 
        section, there is authorized to be appropriated $20,000,000 for 
        fiscal year 2008, $30,000,000 for fiscal year 2009, and such 
        sums as may be necessary, but not to exceed $30,000,000 for 
        each of fiscal years 2010 through 2012.
            ``(2) Availability.--Amounts appropriated under paragraph 
        (1) shall remain available through fiscal year 2011.
    ``(c) Definitions.--In this section:
            ``(1) Federally qualified health center.--The term 
        `Federally qualified health center' has the meaning given that 
        term in section 1861(aa)(4) of the Social Security Act (42 
        U.S.C. 1395x(aa)(4)).
            ``(2) Group practice.--The term `group practice' has the 
        meaning given that term in section 1877(h)(4) of the Social 
        Security Act (42 U.S.C. 1395nn(h)(4)).
            ``(3) Health care provider.--The term `health care 
        provider' means a hospital, skilled nursing facility, home 
        health agency (as defined in subsection (o) of section 1861 of 
        the Social Security Act, 42 U.S.C. 1395x), health care clinic, 
        rural health clinic, Federally qualified health center, group 
        practice, a pharmacist, a pharmacy, a laboratory, a physician 
        (as defined in subsection (r) of such section), a practitioner 
        (as defined in section 1842(b)(18)(CC) of such Act, 42 U.S.C. 
        1395u(b)(18)(CC)), a health facility operated by or pursuant to 
        a contract with the Indian Health Service, and any other 
        category of facility or clinician determined appropriate by the 
        Secretary.
            ``(4) Health information; individually identifiable health 
        information.--The terms `health information' and `individually 
        identifiable health information' have the meanings given those 
        terms in paragraphs (4) and (6), respectively, of section 1171 
        of the Social Security Act (42 U.S.C. 1320d).
            ``(5) Laboratory.--The term `laboratory' has the meaning 
        given that term in section 353.
            ``(6) Pharmacist.--The term `pharmacist' has the meaning 
        given that term in section 804(a)(2) of the Federal Food, Drug, 
        and Cosmetic Act (21 U.S.C. 384(a)(2)).
            ``(7) Qualified health information technology.--The term 
        `qualified health information technology' means a system or 
        components of health information technology that meet any 
        applicable core interoperability guidelines (endorsed under 
        applicable provisions of law) when in use or that use interface 
        software that allows for interoperability in accordance with 
        such guidelines.
            ``(8) Rural area.--The term `rural area' has the meaning 
        given such term for purposes of section 1886(d)(2)(D) of the 
        Social Security Act (42 U.S.C. 1395ww(d)(2)(D)).
            ``(9) Rural health care provider.--The term `rural health 
        care provider' means a health care provider that is located in 
        a rural area.''.

                TITLE IV--ACCOUNTABILITY AND EVALUATION

                     Subtitle A--General Provisions

SEC. 401. FEDERAL AGENCY PLAN TO ELIMINATE DISPARITIES AND IMPROVE THE 
              HEALTH OF MINORITY POPULATIONS.

    (a) In General.--Not later than September 1, 2008, each Federal 
health agency shall develop and implement a national strategic action 
plan to eliminate disparities on the basis of race, ethnicity, and 
primary language and improve the health and health care of minority 
populations, through programs relevant to the mission of the agency.
    (b) Publication.--Each action plan described in paragraph (1) 
shall--
            (1) be publicly reported in draft form for public review 
        and comment;
            (2) include a response to the review and comment described 
        in paragraph (1) in the final plan;
            (3) include the agency response to the 2002 Institute of 
        Medicine report, Unequal Treatment--Confronting Racial and 
        Ethnic Disparities in Healthcare;
            (4) respond to data and analyses presented in the National 
        Healthcare Disparities Report and the National Healthcare 
        Quality Report published annually by the Agency for Healthcare 
        Research and Quality;
            (5) demonstrate progress in meeting the Healthy People 2010 
        objectives; and
            (6) be updated, including progress reports, for inclusion 
        in an annual report to Congress.

SEC. 402. ACCOUNTABILITY WITHIN THE DEPARTMENT OF HEALTH AND HUMAN 
              SERVICES.

    Title XXX of the Public Health Service Act, as amended by titles II 
and III of this Act, is further amended by adding at the end the 
following:

               ``Subtitle C--Strengthening Accountability

``SEC. 3041. ELEVATION OF THE OFFICE OF CIVIL RIGHTS.

    ``(a) In General.--The Secretary shall establish within the Office 
for Civil Rights an Office of Health Disparities, which shall be headed 
by a director to be appointed by the Secretary.
    ``(b) Purpose.--The Office of Health Disparities shall ensure that 
the health programs, activities, and operations of health entities 
which receive Federal financial assistance are in compliance with title 
VI of the Civil Rights Act, which prohibits discrimination on the basis 
of race, color, or national origin. The activities of the Office shall 
include the following:
            ``(1) The development and implementation of an action plan 
        to address racial and ethnic health care disparities, which 
        shall address concerns relating to the Office for Civil Rights 
        as released by the United States Commission on Civil Rights in 
        the report entitled `Health Care Challenge: Acknowledging 
        Disparity, Confronting Discrimination, and Ensuring Equity' 
        (September, 1999) in conjunction with the reports by the 
        Institute of Medicine entitled `Unequal Treatment: Confronting 
        Racial and Ethnic Disparities in Health Care', `Crossing the 
        Quality Chasm: A New Health System for the 21st Century', and 
        `In the Nation's Compelling Interest: Ensuring Diversity in the 
        Health Care Workforce' and other related reports by the 
        Institute of Medicine. This plan shall be publicly disclosed 
        for review and comment and the final plan shall address any 
        comments or concerns that are received by the Office.
            ``(2) Investigative and enforcement actions against 
        intentional discrimination and policies and practices that have 
        a disparate impact on minorities.
            ``(3) The review of racial, ethnic, and primary language 
        health data collected by Federal health agencies to assess 
        health care disparities related to intentional discrimination 
        and policies and practices that have a disparate impact on 
        minorities.
            ``(4) Outreach and education activities relating to 
        compliance with title VI of the Civil Rights Act.
            ``(5) The provision of technical assistance for health 
        entities to facilitate compliance with title VI of the Civil 
        Rights Act.
            ``(6) Coordination and oversight of activities of the civil 
        rights compliance offices established under section 3042.
            ``(7) Ensuring compliance with the 1997 Office of 
        Management and Budget Standards for Maintaining, Collecting, 
        and Presenting Federal Data on Race, Ethnicity and the 
        available language standards.
    ``(c) Funding and Staff.--The Secretary shall ensure the 
effectiveness of the Office of Health Disparities by ensuring that the 
Office is provided with--
            ``(1) adequate funding to enable the Office to carry out 
        its duties under this section; and
            ``(2) staff with expertise in--
                    ``(A) epidemiology;
                    ``(B) statistics;
                    ``(C) health quality assurance;
                    ``(D) minority health and health disparities;
                    ``(E) cultural and linguistic competency; and
                    ``(F) civil rights.
    ``(d) Report.--Not later than December 31, 2008, and annually 
thereafter, the Secretary, in collaboration with the Director of the 
Office for Civil Rights and the Director of the Office of Minority 
Health, shall submit a report to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives that includes--
            ``(1) the number of cases filed, broken down by category;
            ``(2) the number of cases investigated and closed by the 
        office;
            ``(3) the outcomes of cases investigated;
            ``(4) the staffing levels of the office including staff 
        credentials;
            ``(5) the number of other lingering and emerging cases in 
        which civil rights inequities can be demonstrated; and
            ``(6) the number of cases remaining open and an explanation 
        for their open status.
    ``(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 2008 through 2013.

``SEC. 3042. ESTABLISHMENT OF HEALTH PROGRAM OFFICES FOR CIVIL RIGHTS 
              WITHIN FEDERAL HEALTH AND HUMAN SERVICES AGENCIES.

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

SEC. 403. OFFICE OF MINORITY HEALTH.

    Section 1707 of the Public Health Service Act (42 U.S.C. 300u-6) is 
amended--
            (1) by striking subsection (b) and inserting the following:
    ``(b) Duties.--With respect to improving the health of racial and 
ethnic minority groups, the Secretary, acting through the Deputy 
Assistant Secretary for Minority Health (in this section referred to as 
the `Deputy Assistant Secretary'), shall carry out the following:
            ``(1) Establish, implement, monitor, and evaluate short-
        range and long-range goals and objectives and oversee all other 
        activities within the Public Health Service that relate to 
        disease prevention, health promotion, service delivery, and 
        research concerning minority groups. The heads of each of the 
        agencies of the Service shall consult with the Deputy Assistant 
        Secretary to ensure the coordination of such activities.
            ``(2) Oversee all activities within the Department of 
        Health and Human Services that relate to reducing or 
        eliminating disparities in health and health care in racial and 
        ethnic minority populations and in rural and underserved 
        communities, including coordinating--
                    ``(A) the design of programs, support for programs, 
                and the evaluation of programs;
                    ``(B) the monitoring of trends in health and health 
                care;
                    ``(C) research efforts;
                    ``(D) the training of health providers; and
                    ``(E) information and education programs and 
                campaigns.
            ``(3) Enter into interagency and intra-agency agreements 
        with other agencies of the Public Health Service.
            ``(4) Ensure that the Federal health agencies and the 
        National Center for Health Statistics collect data on the 
        health status and health care of each minority group, using at 
        a minimum the categories specified in the 1997 OMB Standards 
        for Maintaining, Collecting, and Presenting Federal Data on 
        Race and Ethnicity as required under subtitle B and available 
        language standards.
            ``(5) Provide technical assistance to States, local 
        agencies, territories, Indian tribes, and entities for 
        activities relating to the elimination of racial and ethnic 
        disparities in health and health care.
            ``(6) Support a national minority health resource center to 
        carry out the following:
                    ``(A) Facilitate the exchange of information 
                regarding matters relating to health information, 
                health promotion and wellness, preventive health 
                services, clinical trials, health information 
                technology, and education in the appropriate use of 
                health services.
                    ``(B) Facilitate timely access to culturally and 
                linguistically appropriate information.
                    ``(C) Assist in the analysis of such information.
                    ``(D) Provide technical assistance with respect to 
                the exchange of such information (including 
                facilitating the development of materials for such 
                technical assistance).
            ``(7) Carry out programs to improve access to health care 
        services for individuals with limited English proficiency, 
        including developing and carrying out programs to provide 
        bilingual or interpretive services through the development and 
        support of the Robert T. Matsui Center for Cultural and 
        Linguistic Competence in Health Care as provided for in section 
        3003.
            ``(8) Carry out programs to improve access to health care 
        services and to improve the quality of health care services for 
        individuals with low functional health literacy. As used in the 
        preceding sentence, the term `functional health literacy' means 
        the ability to obtain, process, and understand basic health 
        information and services needed to make appropriate health 
        decisions.
            ``(9) Advise in matters related to the development, 
        implementation, and evaluation of health professions education 
        on decreasing disparities in health care outcomes, with focus 
        on cultural competency as a method of eliminating disparities 
        in health and health care in racial and ethnic minority 
        populations.
            ``(10) Assist health care professionals, community and 
        advocacy organizations, academic centers and public health 
        departments in the design and implementation of programs that 
        will improve the quality of health outcomes by strengthening 
        the provider-patient relationship.'';
            (2) by redesignating subsections (f) through (h) as 
        subsections (g) through (i) , respectively;
            (3) by inserting after subsection (d) the following:
    ``(f) Preparation of Health Professionals to Provide Health Care to 
Minority Populations.--The Secretary, in collaboration with the 
Director of the Bureau of Health Professions and the Deputy Assistant 
Secretary for Minority Health, shall require that health professional 
schools that receive Federal funds train future health professionals to 
provide culturally and linguistically appropriate health care to 
diverse populations.''; and
            (4) by striking subsection (i) (as so redesignated) and 
        inserting the following:
    ``(i) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $100,000,000 
for fiscal year 2008, and such sums as may be necessary for each of 
fiscal years 2009 through 2013.''.

SEC. 404. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
              THE PUBLIC HEALTH SERVICE.

    (a) Establishment.--
            (1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, authorities, and 
        functions of the United States to provide health care services 
        to Indians and Indian tribes, as are or may be hereafter 
        provided by Federal statute or treaties, there is established 
        within the Public Health Service of the Department of Health 
        and Human Services the Indian Health Service.
            (2) Assistant secretary of indian health.--The Service 
        shall be administered by an Assistant Secretary of Indian 
        Health, who shall be appointed by the President, by and with 
        the advice and consent of the Senate. The Assistant Secretary 
        shall report to the Secretary. Effective with respect to an 
        individual appointed by the President, by and with the advice 
        and consent of the Senate the term of service of the Assistant 
        Secretary shall be 4 years. An Assistant Secretary may serve 
        more than 1 term.
    (b) Agency.--The Service shall be an agency within the Public 
Health Service of the Department, and shall not be an office, 
component, or unit of any other agency of the Department.
    (c) Functions and Duties.--The Secretary shall carry out through 
the Assistant Secretary of the Service--
            (1) all functions which were, on the day before the date of 
        enactment of the Indian Health Care Amendments of 1988, carried 
        out by or under the direction of the individual serving as 
        Director of the Service on such day;
            (2) all functions of the Secretary relating to the 
        maintenance and operation of hospital and health facilities for 
        Indians and the planning for, and provision and utilization of, 
        health services for Indians;
            (3) all health programs under which health care is provided 
        to Indians based upon their status as Indians which are 
        administered by the Secretary, including programs under--
                    (A) the Indian Health Care Improvement Act;
                    (B) the Act of November 2, 1921 (25 U.S.C. 13);
                    (C) the Act of August 5, 1954 (42 U.S.C. 2001, et 
                seq.);
                    (D) the Act of August 16, 1957 (42 U.S.C. 2005 et 
                seq.);
                    (E) the Indian Self-Determination Act (25 U.S.C. 
                450f, et seq.); and
                    (F) title XXX of the Public Health Service Act, as 
                added by this Act; and
            (4) all scholarship and loan functions carried out under 
        title I of the Indian Health Care Improvement Act.
    (d) Authority.--
            (1) In general.--The Secretary, acting through the 
        Assistant Secretary, shall have the authority--
                    (A) except to the extent provided for in paragraph 
                (2), to appoint and compensate employees for the 
                Service in accordance with title 5, United States Code;
                    (B) to enter into contracts for the procurement of 
                goods and services to carry out the functions of the 
                Service; and
                    (C) to manage, expend, and obligate all funds 
                appropriated for the Service.
            (2) Personnel actions.--Notwithstanding any other provision 
        of law, the provisions of section 12 of the Act of June 18, 
        1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all 
        personnel actions taken with respect to new positions created 
        within the Service as a result of its establishment under 
        subsection (a).
    (e) Rate of Pay.--
            (1) Positions at level iv.--Section 5315 of title 5, United 
        States Code, is amended by striking the following: ``Assistant 
        Secretaries of Health and Human Services (6).'' and inserting 
        ``Assistant Secretaries of Health and Human Services (7).''.
            (2) Positions at level v.--Section 5316 of such title is 
        amended by striking the following: ``Director, Indian Health 
        Service, Department of Health and Human Services.''.
    (f) Duties of Assistant Secretary for Indian Health.--Section 601 
of the Indian Health Care Improvement Act (25 U.S.C. 1661) is amended 
in subsection (a)--
            (1) by inserting ``(1)'' after ``(a)'';
            (2) in the second sentence of paragraph (1), as so 
        designated, by striking ``a Director,'' and inserting ``the 
        Assistant Secretary for Indian Health,'';
            (3) by striking the third sentence of paragraph (1), as so 
        designated, and all that follows through the end of the 
        subsection (a) of such section and inserting the following: 
        ``The Assistant Secretary for Indian Health shall carry out the 
        duties specified in paragraph (2).''; and
            (4) by adding after paragraph (1) the following:
            ``(2) The Assistant Secretary for Indian Health shall--
                    ``(A) report directly to the secretary concerning 
                all policy and budget-related matters affecting Indian 
                health;
                    ``(B) collaborate with the Assistant Secretary for 
                Health concerning appropriate matters of Indian health 
                that affect the agencies of the Public Health Service;
                    ``(C) advise each Assistant Secretary of the 
                Department of Health and Human Services concerning 
                matters of Indian health with respect to which that 
                Assistant Secretary has authority and responsibility;
                    ``(D) advise the heads of other agencies and 
                programs of the Department of Health and Human Services 
                concerning matters of Indian health with respect to 
                which those heads have authority and responsibility; 
                and
                    ``(E) coordinate the activities of the Department 
                of Health and Human Services concerning matters of 
                Indian health.''.
    (g) Continued Service by Incumbent.--The individual serving in the 
position of Director of the Indian Health Service on the date preceding 
the date of enactment of this Act may serve as Assistant Secretary for 
Indian Health, at the pleasure of the President after the date of 
enactment of this Act.
    (h) Conforming Amendments.--
            (1) Amendments to indian health care improvement act.--The 
        Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is 
        amended--
                    (A) in section 601--
                            (i) in subsection (c), by striking 
                        ``Director of the Indian Health Service'' both 
                        places it appears and inserting ``Assistant 
                        Secretary for Indian Health''; and
                            (ii) in subsection (d), by striking 
                        ``Director of the Indian Health Service'' and 
                        inserting ``Assistant Secretary for Indian 
                        Health''; and
                    (B) in section 816(c)(1), by striking ``Director of 
                the Indian Health Service'' and inserting ``Assistant 
                Secretary for Indian Health''.
            (2) Amendments to other provisions of law.--The following 
        provisions are each amended by striking ``Director of the 
        Indian Health Service'' each place it appears and inserting 
        ``Assistant Secretary for Indian Health'':
                    (A) Section 203(a)(1) of the Rehabilitation Act of 
                1973 (29 U.S.C. 763(a)(1)).
                    (B) Subsections (b) and (e) of section 518 of the 
                Federal Water Pollution Control Act (33 U.S.C. 1377 (b) 
                and (e)).
                    (C) Section 803B(d)(1) of the Native American 
                Programs Act of 1974 (42 U.S.C. 2991b-2(d)(1)).
    (i) References.--Reference in any other Federal law, Executive 
order, rule, regulation, or delegation of authority, or any document of 
or relating to the Director of the Indian Health Service shall be 
deemed to refer to the Assistant Secretary for Indian Health.
    (j) Definitions.--For purposes of this section, the definitions 
contained in section 4 of the Indian Health Care Improvement Act shall 
apply.

SEC. 405. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN 
              AGENCIES OF THE PUBLIC HEALTH SERVICE.

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

  ``individual offices of minority health within public health service

    ``Sec. 1707A. 
    ``(a) In General.--The head of each agency specified in subsection 
(b)(1) shall establish within the agency an office to be known as the 
Office of Minority Health. Each such Office shall be headed by a 
director, who shall be appointed by the head of the agency within which 
the Office is established, and who shall report directly to the head of 
the agency. The head of such agency shall carry out this section (as 
this section relates to the agency) acting through such Director.
    ``(b) Specified Agencies.--
            ``(1) In general.--The agencies referred to in subsection 
        (a) are the following:
                    ``(A) The Centers for Disease Control and 
                Prevention.
                    ``(B) The Health Resources and Services 
                Administration.
                    ``(C) The Substance Abuse and Mental Health 
                Services Administration; and
                    ``(D) The Administration on Aging.
    ``(c) Composition.--The head of each specified agency shall ensure 
that the officers and employees of the minority health office of the 
agency are, collectively, experienced in carrying out community-based 
health programs for each of the various racial and ethnic minority 
groups that are present in significant numbers in the United States.
    ``(d) Duties.--Each Director of a minority health office shall 
establish and monitor the programs of the specified agency of such 
office in order to carry out the following:
            ``(1) Determine the extent to which the purposes of the 
        programs are being carried out with respect to racial and 
        ethnic minority groups;
            ``(2) Determine the extent to which members of such groups 
        are represented among the Federal officers and employees who 
        administer the programs; and
            ``(3) Make recommendations to the head of such agency on 
        carrying out the programs with respect to such groups. In the 
        case of programs that provide services, such recommendations 
        shall include recommendations toward ensuring that--
                    ``(A) the services are equitably delivered with 
                respect to racial and ethnic minority groups;
                    ``(B) the programs provide the services in the 
                language and cultural context that is most appropriate 
                for the individuals for whom the services are intended; 
                and
                    ``(C) the programs utilize racial and ethnic 
                minority community-based organizations to deliver 
                services.
    ``(e) Biennial Reports to Secretary.--The head of each specified 
agency shall submit to the Secretary for inclusion in each biennial 
report describing--
            ``(1) the extent to which the minority health office of the 
        agency employs individuals who are members of racial and ethnic 
        minority groups, including a specification by minority group of 
        the number of such individuals employed by such office.
    ``(f) Funding.--
            ``(1) Allocations.--Of the amounts appropriated for a 
        specified agency for a fiscal year, the Secretary must 
        designate an appropriate amount of funds for the purpose of 
        carrying out activities under this section through the minority 
        health office of the agency. In reserving an amount under the 
        preceding sentence for a minority health office for a fiscal 
        year, the Secretary shall reduce, by substantially the same 
        percentage, the amount that otherwise would be available for 
        each of the programs of the designated agency involved.
            ``(2) Availability of funds for staffing.--The purposes for 
        which amounts made available under paragraph may be expended by 
        a minority health office include the costs of employing staff 
        for such office.''.

SEC. 406. OFFICE OF MINORITY HEALTH AT THE CENTERS FOR MEDICARE & 
              MEDICAID SERVICES.

    (a) In General.--Not later than 60 days after the date of enactment 
of this Act, the Secretary of Health and Human Services shall establish 
within the Centers for Medicare & Medicaid Services an Office of 
Minority Health (referred to in this section as the ``Office'').
    (b) Duties.--The Office shall be responsible for the coordination 
and facilitation of activities of the Centers for Medicare & Medicaid 
Services to improve minority health and health care and to reduce 
racial and ethnic disparities in health and health care, which shall 
include--
            (1) creating a strategic plan, which shall be made 
        available for public review, to improve the health and health 
        care of Medicare, Medicaid, and SCHIP beneficiaries;
            (2) promoting agency-wide policies relating to health care 
        delivery and financing that could have a beneficial impact on 
        the health and health care of minority populations;
            (3) assisting health plans, hospitals, and other health 
        entities in providing culturally and linguistically appropriate 
        health care services;
            (4) increasing awareness and outreach activities for 
        minority health care consumers and providers about the causes 
        and remedies for health and health care disparities;
            (5) developing grant programs and demonstration projects to 
        identify, implement and evaluate innovative approaches to 
        improving the health and health care of minority beneficiaries 
        in the Medicare, Medicaid, and SCHIP programs;
            (6) considering incentive programs relating to 
        reimbursement that would reward health entities for providing 
        quality health care for minority populations using established 
        benchmarks for quality of care;
            (7) collaborating with the compliance office to ensure 
        compliance with the anti-discrimination provisions under title 
        VI of the Civil Rights Act of 1964;
            (8) identifying barriers to enrollment in public programs 
        under the jurisdiction of the Centers for Medicare & Medicaid 
        Services;
            (9) monitoring and evaluating on a regular basis the 
        success of minority health programs and initiatives;
            (10) publishing an annual report about the activities of 
        the Centers for Medicare & Medicaid Services relating to 
        minority health improvement; and
            (11) other activities determined appropriate by the 
        Secretary of Health and Human Services.
    (c) Staff.--The staff at the Office shall include--
            (1) one or more individuals with expertise in minority 
        health and racial and ethnic health disparities; and
            (2) one or more individuals with expertise in health care 
        financing and delivery in underserved communities.
    (d) Coordination.--In carrying out its duties under this section, 
the Office shall coordinate with--
            (1) the Office of Minority Health in the Office of the 
        Secretary of Health and Human Services;
            (2) the National Centers for Minority Health and Health 
        Disparities in the National Institutes of Health; and
            (3) the Office of Minority Health in the Centers for 
        Disease Control and Prevention.
    (e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $10,000,000 
for fiscal year 2008, and such sums may be necessary for each of fiscal 
years 2009 through 2014.

SEC. 407. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND DRUG 
              ADMINISTRATION.

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

``SEC. 910. OFFICE OF MINORITY AFFAIRS.

    ``(a) In General.--Not later than 60 days after the date of 
enactment of this section, the Secretary shall establish within the 
Office of the Commissioner of Food and Drugs an Office of Minority 
Affairs (referred to in this section as the `Office').
    ``(b) Duties.--The Office shall be responsible for the coordination 
and facilitation of activities of the Food and Drug Administration to 
improve minority health and health care and to reduce racial and ethnic 
disparities in health and health care, which shall include--
            ``(1) promoting policies in the development and review of 
        medical products that reduce racial and ethnic disparities in 
        health and health care;
            ``(2) encouraging appropriate data collection, analysis, 
        and dissemination of racial and ethnic differences using, at a 
        minimum, the categories described in the 1997 Office of 
        Management and Budget standards, in response to different 
        therapies in both adult and pediatric populations;
            ``(3) providing, in coordination with other appropriate 
        government agencies, education, training, and support to 
        increase participation of minority patients and physicians in 
        clinical trials;
            ``(4) collecting and analyzing data using, at a minimum, 
        the categories described in the 1997 Office of Management and 
        Budget standards, on the number of participants from minority 
        racial and ethnic backgrounds in clinical trials used to 
        support medical product approvals;
            ``(5) the identification of methods to reduce language and 
        literacy barriers; and
            ``(6) publishing an annual report about the activities of 
        the Food and Drug Administration pertaining to minority health.
    ``(c) Staff.--The staff of the Office shall include--
            ``(1) one or more individuals with expertise in the design 
        and conduct of clinical trials of drugs, biological products, 
        and medical devices; and
            ``(2) one or more individuals with expertise in therapeutic 
        classes or disease states for which medical evidence suggests a 
        difference based on race or ethnicity.
    ``(d) Coordination.--In carrying out its duties under this section, 
the Office shall coordinate with--
            ``(1) the Office of Minority Health in the Office of the 
        Secretary of Health and Human Services;
            ``(2) the National Center for Minority Health and Health 
        Disparities in the National Institutes of Health; and
            ``(3) the Office of Minority Health in the Centers for 
        Disease Control and Prevention.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 2008 through 2013.''.

SEC. 408. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL AND 
              ETHNIC BACKGROUND.

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

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

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

SEC. 409. UNITED STATES COMMISSION ON CIVIL RIGHTS.

    (a) Coordination Within Department of Justice of Activities 
Regarding Health Disparities.--Section 3 of the Civil Rights Commission 
Act of 1983 (42 U.S.C. 1975a) is amended--
            (1) in paragraph (1)(B), by striking ``and'' at the end;
            (2) in paragraph (2), in the matter after and below 
        subparagraph (D), by striking the period and inserting ``; 
        and''; and
            (3) by adding at the end the following:
            ``(3) shall, with respect to activities carried out in 
        health care and correctional facilities toward the goal of 
        eliminating health disparities between the general population 
        and members of racial or ethnic minority groups, coordinate 
        such activities of--
                    ``(A) the Office for Civil Rights within the 
                Department of Justice;
                    ``(B) the Office of Justice Programs within the 
                Department of Justice;
                    ``(C) the Office for Civil Rights within the 
                Department of Health and Human Services; and
                    ``(D) the Office of Minority Health within the 
                Department of Health and Human Services (headed by the 
                Deputy Assistant Secretary for Minority Health).''.
    (b) Authorization of Appropriations.--Section 5 of the Civil Rights 
Commission Act of 1983 (42 U.S.C. 1975c) is amended by striking the 
first sentence and inserting the following: ``For the purpose of 
carrying out this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2008, and such sums as may be necessary for 
each of the fiscal years 2009 through 2013.''.

SEC. 410. SENSE OF CONGRESS CONCERNING FULL FUNDING OF ACTIVITIES TO 
              ELIMINATE RACIAL AND ETHNIC HEALTH DISPARITIES.

    (a) Findings.--Congress makes the following findings:
            (1) The health status of the American populace is declining 
        and the United States currently ranks below most industrialized 
        nations in health status measured by longevity, sickness, and 
        mortality.
            (2) Racial and ethnic minority populations tend have the 
        poorest health status and face substantial cultural, social, 
        and economic barriers to obtaining quality health care.
            (3) Efforts to improve minority health have been limited by 
        inadequate resources (funding, staffing, and stewardship) and 
        accountability.
    (b) Sense of Congress.--It is the sense of Congress that--
            (1) funding should be doubled by fiscal year 2008 for the 
        National Center for Minority Health Disparities, the Office of 
        Civil Rights in the Department of Health and Human Services, 
        the National Institute of Nursing Research, and the Office of 
        Minority Health;
            (2) adequate funding by fiscal year 2008, and subsequent 
        funding increases, should be provided for health professions 
        training programs, the Racial and Ethnic Approaches to 
        Community Health (REACH) at the Center for Disease Control and 
        Prevention, the Minority HIV/AIDS Initiative, and the 
        Excellence Centers to Eliminate Ethnic/Racial Disparities 
        (EXCEED) Program at the Agency for Healthcare Research and 
        Quality;
            (3) current and newly-created health disparity elimination 
        incentives, programs, agencies, and departments under this Act 
        (and the amendments made by this Act) should receive adequate 
        staffing and funding by fiscal year 2008; and
            (4) stewardship and accountability should be provided to 
        Congress and the President for measurable and sustainable 
        progress toward health disparity elimination.

SEC. 411. GUIDELINES FOR DISEASE SCREENING FOR MINORITY PATIENTS.

    (a) In General.--The Secretary, acting through the Director of the 
Agency for Healthcare Research and Quality, shall convene a series of 
meetings to develop guidelines for disease screening for minority 
patient populations which have a higher than average risk for many 
chronic diseases and cancers.
    (b) Participants.--In convening meetings under subsection (a), the 
Secretary shall ensure that meeting participants include 
representatives of--
            (1) professional societies and associations;
            (2) minority health organizations;
            (3) health care researchers and providers, including those 
        with expertise in minority health;
            (4) Federal health agencies, including the Office of 
        Minority Health and the National Institutes of Health; and
            (5) other experts determined appropriate by the Secretary.
    (c) Diseases.--Screening guidelines for minority populations shall 
be developed under subsection (a) for--
            (1) hypertension;
            (2) hypercholesterolemia;
            (3) diabetes;
            (4) cardiovascular disease;
            (5) cancers, including breast, prostate, colon, cervical, 
        and lung cancer;
            (6) asthma;
            (7) diabetes;
            (8) kidney diseases;
            (9) eye diseases and disorders, including glaucoma;
            (10) HIV/AIDS and sexually transmitted diseases;
            (11) uterine fibroids;
            (12) autoimmune disease;
            (13) mental health conditions;
            (14) dental health conditions and oral diseases;
            (15) environmental and related health illnesses and 
        conditions;
            (16) Sickle cell disease;
            (17) violence and injury prevention and control;
            (18) genetic and related conditions;
            (19) heart disease and stroke;
            (20) tuberculosis;
            (21) chronic obstructive pulmonary disease; and
            (22) other diseases determined appropriate by the 
        Secretary.
    (d) Dissemination.--Not later than 24 months after the date of 
enactment of this title, the Secretary shall publish and disseminate to 
health care provider organizations the guidelines developed under 
subsection (a).
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, sums as may be necessary for 
each of fiscal years 2008 through 2013.

SEC. 412. NATIONAL CENTER FOR MINORITY HEALTH AND HEALTH DISPARITIES 
              REAUTHORIZATION.

    (a) In General.--Section 485E of the Public Health Service Act (42 
U.S.C. 287c-31) is amended--
            (1) by striking subsection (e) and inserting the following:
    ``(e) Duties of the Director.--
            ``(1) Interagency coordination of minority health and 
        health disparities activities.--With respect to minority health 
        and health disparities, the Director of the Center shall plan, 
        coordinate, and evaluate research and other activities 
        conducted or supported by the agencies of the National 
        Institutes of Health. In carrying out the preceding sentence, 
        the Director of the Center shall evaluate the minority health 
        and health disparity activities of each of such agencies and 
        shall provide for the timely periodic re-evaluation of such 
        activities.
            ``(2) Consultations.--The Director of the Center shall 
        carry out this subpart (including developing and revising the 
        plan and budget required in subsection (f)) in consultation 
        with the Directors of the agencies (or a designee of the 
        Directors) of the National Institutes of Health, with the 
        advisory councils of the agencies, and with the advisory 
        council established under section (j).
            ``(3) Coordination of activities.--The Director of the 
        Center shall act as the primary Federal official with 
        responsibility for coordinating all minority health disparities 
        research and other health disparities research conducted or 
        supported by the National Institutes of Health and shall--
                    ``(A) represent the health disparities research 
                program of the National Institutes of Health including 
                the minority health disparities research program at all 
                relevant executive branch task forces, committees, and 
                planning activities;
                    ``(B) maintain communications with all relevant 
                Public Health Service agencies, including the Indian 
                Health Service and various other departments of the 
                Federal Government, to ensure the timely transmission 
                of information concerning advances in minority health 
                disparities research and other health disparities 
                research between these various agencies for 
                dissemination to affected communities and health care 
                providers;
                    ``(C) undertake research to further refine and 
                develop the conceptual, definitional, and 
                methodological issues involved in health disparities 
                research and to further the understanding of the cause 
                of disparities; and
                    ``(D) engage with national and community-based 
                organizations and health provider groups, led by and 
                serving racial and ethnic minorities, to--
                            ``(i) increase education, awareness, and 
                        participation with respect to the Center's 
                        activities and areas of research focus; and
                            ``(ii) accelerate the translation of 
                        research findings into programs including those 
                        carried out by community-based 
                        organizations.'';
            (2) in subsection (f)--
                    (A) by striking the subsection heading and 
                inserting the following: ``Comprehensive Plan for 
                Research; Budget Estimate; Allocation of 
                Appropriations.--'';
                    (B) in paragraph (1)--
                            (i) by striking the paragraph designation, 
                        the paragraph heading, the matter preceding 
                        subparagraph (A), and subparagraph (A) and 
                        inserting the following:
            ``(1) In general.--Subject to the provisions of this 
        section and other applicable law, the Director of the Center, 
        in consultation with the Director of NIH, the Directors of the 
        other agencies of the National Institutes of Health, and the 
        advisory council established under subsection (j) shall--
                    ``(A) annually review and revise a comprehensive 
                plan (referred to in this section as `the plan') and 
                budget for the conduct and support of all minority 
                health and health disparities research and other health 
                disparities research activities of the agencies of the 
                National Institutes of Health that includes time-based 
                targeted objectives with measurable outcomes and assure 
                that the annual review and revision of the plan uses an 
                established trans-NIH process subject to timely review, 
                approval, and dissemination;'';
                            (ii) in subparagraph (D), by striking ``, 
                        with respect to amounts appropriated for 
                        activities of the Center,'';
                            (iii) by striking subparagraph (F) and 
                        inserting the following:
                    ``(F) ensure that the plan and budget are presented 
                to and considered by the Director in a clear and timely 
                process during the formulation of the overall annual 
                budget for the National Institutes of Health;'';
                            (iv) by redesignating subparagraphs (G) and 
                        (H) as subparagraphs (I) and (J), respectively; 
                        and
                            (v) by inserting after subparagraph (F), 
                        the following:
                    ``(G) annually submit to the Congress a report on 
                the progress made with respect to the plan;
                    ``(H) create and implement a plan for the 
                systematic review of research activities supported by 
                the National Institutes of Health that are within the 
                mission of both the Center and other agencies of the 
                National Institutes of Health, by establishing 
                mechanisms for--
                            ``(i) tracking minority health and health 
                        disparity research conducted within the 
                        agencies and assessing the appropriateness of 
                        this research with regard to the overall goals 
                        and objectives of the plan;
                            ``(ii) the early identification of 
                        applications and proposals for grants, 
                        contracts, and cooperative agreements 
                        supporting extramural training, research, and 
                        development, that are submitted to the agencies 
                        and that are within the mission of the Center;
                            ``(iii) providing the Center with the 
                        written descriptions and scientific peer review 
                        results of such applications and proposals;
                            ``(iv) enabling the agencies to consult 
                        with the Director of the Center prior to final 
                        approval of such applications and proposals; 
                        and
                            ``(v) reporting to the Director of the 
                        Center all such applications and proposals that 
                        are approved for funding by the agencies;''; 
                        and
                    (C) in paragraph (2)--
                            (i) in subparagraph (D), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (E), by striking the 
                        period and inserting ``; and''; and
                            (iii) by adding at the end the following:
                    ``(F) the number and type of personnel needs of the 
                Center.'';
            (3) in subsection (h)--
                    (A) in paragraph (1), by striking ``endowments at 
                centers of excellence under section 736.'' and 
                inserting the following: ``endowments at--
                    ``(A) centers of excellence under section 736; and
                    ``(B) centers of excellence under section 485F.''; 
                and
                    (B) in paragraph (2)(A), by striking ``average'' 
                and inserting ``median''; and
            (4) by inserting after subsection (j), the following:
    ``(k) Representation of Minorities Among Researchers.--The 
Secretary, in collaboration with the Director of the Center, shall 
determine, by means of the collection and reporting of aggregated and 
disaggregated data, the extent to which racial and ethnic minority 
groups are represented among senior physicians and scientists of the 
national research institutes and among physicians and scientists 
conducting research with funds provided by such institutes, and as 
appropriate, carry out activities to increase the extent of such 
representation, including developing a pipeline of minority researchers 
interested in the study of health and health disparities, as well as 
attracting minority scientists in social and behavioral science fields 
who can bring their expertise to the study of health disparities.
    ``(l) Cancer Research.--The Secretary, in collaboration with the 
Director of the Center, shall designate and support a cancer 
prevention, control, and population science center to address the 
significantly elevated rate of morbidity and mortality from cancer in 
racial and ethnic minority populations. Such designated center shall be 
housed within an existing, stand-alone cancer center at a minority-
serving institution that has a demonstrable commitment to and expertise 
in cancer research in the basic, clinical, and population sciences.''.
    (b) Authorization of Appropriations.--
            (1) In general.--To carry out section 485E of the Public 
        Health Service Act (42 U.S.C.287c-31), as amended by subsection 
        (a), there are authorized to be appropriated $240,000,000 for 
        fiscal year 2008 and such sums as may be necessary for each of 
        fiscal years 2009 through 2012.
            (2) Expenditure.--The Director of the National Center on 
        Minority Health and Health Disparities shall expend amounts 
        appropriated for activities under such section 485E in 
        accordance with such section and other applicable law and in 
        collaboration with the Director of National Institutes of 
        Health and the directors of other institutes and centers of the 
        National Institutes of Health.
            (3) Management.--All amounts expended for minority health 
        and health disparities research activities under this 
        subsection shall be reported programmatically to and approved 
        by the Director of the National Center on Minority Health and 
        Health Disparities under such section 485E, in accordance with 
        the plan described under subsection (f)(1)(A) of such section 
        485E.

              Subtitle B--Improving Environmental Justice

SEC. 421. CODIFICATION OF EXECUTIVE ORDER 12898.

    (a) In General.--The President of the United States is authorized 
and directed to execute, administer, and enforce as a matter of Federal 
law the provisions of Executive Order 12898, dated February 11, 1994, 
(``Federal Actions To Address Environmental Justice In Minority 
Populations and Low-Income Populations'') with such modifications as 
are provided in this section.
    (b) Definition of Environmental Justice.--For purposes of carrying 
out the provisions of Executive Order 12898, the following definitions 
shall apply:
            (1) The term ``environmental justice'' means the fair 
        treatment and meaningful involvement of all people regardless 
        of race, color, national origin, educational level, or income 
        with respect to the development, implementation, and 
        enforcement of environmental laws and regulations in order to 
        ensure that--
                    (A) minority and low-income communities have access 
                to public information relating to human health and 
                environmental planning, regulations, and enforcement; 
                and
                    (B) no minority or low-income population is forced 
                to shoulder a disproportionate burden of the negative 
                human health and environmental impacts of pollution or 
                other environmental hazard.
            (2) The term ``fair treatment'' means policies and 
        practices that ensure that no group of people, including 
        racial, ethnic, or socioeconomic groups bear disproportionately 
        high and adverse human health or environmental effects 
        resulting from Federal agency programs, policies, and 
        activities.
    (c) Judicial Review and Rights of Action.--The provisions of 
section 6-609 of Executive Order 12898 shall not apply for purposes of 
this Act.

SEC. 422. IMPLEMENTATION OF RECOMMENDATIONS BY ENVIRONMENTAL PROTECTION 
              AGENCY.

    (a) Inspector General Recommendations.--The Administrator of the 
Environmental Protection Agency shall, as promptly as practicable, 
carry out each of the following recommendations of the Inspector 
General of the agency as set forth in Report No. 2006-P-00034 entitled 
``EPA needs to conduct environmental justice reviews of its programs, 
policies and activities'':
            (1) The recommendation that the Agency's program and 
        regional offices identify which programs, policies, and 
        activities need environmental justice reviews and require these 
        offices to establish a plan to complete the necessary reviews.
            (2) The recommendation that the Administrator of the Agency 
        ensure that these reviews determine whether the programs, 
        policies, and activities may have a disproportionately high and 
        adverse health or environmental impact on minority and low-
        income populations.
            (3) The recommendation that each program and regional 
        office develop specific environmental justice review guidance 
        for conducting environmental justice reviews.
            (4) The recommendation that the Administrator designate a 
        responsible office to compile results of environmental justice 
        reviews and recommend appropriate actions.
    (b) Gao Recommendations.--In developing rules under laws 
administered by the Environmental Protection Agency, the Administrator 
of the Agency shall, as promptly as practicable, carry out each of the 
following recommendations of the Comptroller General of the United 
States as set forth in GAO Report numbered GAO-05-289 entitled ``EPA 
Should Devote More Attention to Environmental Justice when Developing 
Clean Air Rules'':
            (1) The recommendation that the Administrator ensure that 
        workgroups involved in developing a rule devote attention to 
        environmental justice while drafting and finalizing the rule.
            (2) The recommendation that the Administrator enhance the 
        ability of such workgroups to identify potential environmental 
        justice issues through such steps as providing workgroup 
        members with guidance and training to helping them identify 
        potential environmental justice problems and involving 
        environmental justice coordinators in the workgroups when 
        appropriate.
            (3) The recommendation that the Administrator improve 
        assessments of potential environmental justice impacts in 
        economic reviews by identifying the data and developing the 
        modeling techniques needed to assess such impacts.
            (4) The recommendation that the Administrator direct 
        appropriate Agency officers and employees to respond fully when 
        feasible to public comments on environmental justice, including 
        improving the Agency's explanation of the basis for its 
        conclusions, together with supporting data.
    (c) 2004 Inspector General Report.--The Administrator of the 
Environmental Protection Agency shall, as promptly as practicable, 
carry out each of the following recommendations of the Inspector 
General of the Agency as set forth in the report entitled ``EPA Needs 
to Consistently Implement the Intent of the Executive Order on 
Environmental Justice'' (Report No. 2004-P-00007):
            (1) The recommendation that the Agency clearly define the 
        mission of the Office of Environmental Justice (OEJ) and 
        provide Agency staff with an understanding of the roles and 
        responsibilities of the Office.
            (2) The recommendation that the Agency establish (through 
        issuing guidance or a policy statement from the Administrator) 
        specific time frames for the development of definitions, goals, 
        and measurements regarding environmental justice and provide 
        the regions and program offices a standard and consistent 
        definition for a minority and low-income community, with 
        instructions on how the Agency will implement and 
        operationalize environmental justice into the Agency's daily 
        activities.
            (3) The recommendation that the Agency ensure the 
        comprehensive training program currently under development 
        includes standard and consistent definitions of the key 
        environmental justice concepts (such as ``low-income'', 
        ``minority'', and ``disproportionately impacted'') and 
        instructions for implementation of those concepts.
    (d) Report.--The Administrator shall submit an initial report to 
Congress within 6 months after the enactment of this Act regarding the 
Administrator's strategy for implementing the recommendations referred 
to in subsections (a), (b), and (c). Thereafter, the Administrator 
shall provide semi-annual reports to Congress regarding the 
Administrator's progress in implementing such recommendations and 
modifying the Administrator's emergency management procedures to 
incorporate environmental justice in the Agency's Incident Command 
Structure (in accordance with the December 18, 2006, letter from the 
Deputy Administrator to the Acting Inspector General of the agency).

SEC. 423. GRANT PROGRAM.

    (a) Definitions.--In this section:
            (1) Director.--The term ``Director'' means the Director of 
        the Centers for Disease Control and Prevention, acting in 
        collaboration with the Administrator of the Environmental 
        Protection Agency and the Director of the National Institute of 
        Environmental Health Sciences.
            (2) Eligible entity.--The term ``eligible entity'' means a 
        State or local community that--
                    (A) bears a disproportionate burden of exposure to 
                environmental health hazards;
                    (B) has established a coalition--
                            (i) with not less than 1 community-based 
                        organization; and
                            (ii) with not less than 1--
                                    (I) public health entity;
                                    (II) health care provider 
                                organization; or
                                    (III) academic institution, 
                                including any minority-serving 
                                institution (including an Hispanic-
                                serving institution, a historically 
                                Black college or university, and a 
                                tribal college or university);
                    (C) ensures planned activities and funding streams 
                are coordinated to improve community health; and
                    (D) submits an application in accordance with 
                subsection (c).
    (b) Establishment.--The Director shall establish a grant program 
under which eligible entities shall receive grants to conduct 
environmental health improvement activities.
    (c) Application.--To receive a grant under this section, an 
eligible entity shall submit an application to the Director at such 
time, in such manner, and accompanied by such information as the 
Director may require.
    (d) Cooperative Agreements.--An eligible entity may use a grant 
under this section--
            (1) to promote environmental health; and
            (2) to address environmental health disparities.
    (e) Amount of Cooperative Agreement.--
            (1) In general.--The Director shall award grants to 
        eligible entities at the 2 different funding levels described 
        in this subsection.
            (2) Level 1 cooperative agreements.--
                    (A) In general.--An eligible entity awarded a grant 
                under this paragraph shall use the funds to identify 
                environmental health problems and solutions by--
                            (i) establishing a planning and 
                        prioritizing council in accordance with 
                        subparagraph (B); and
                            (ii) conducting an environmental health 
                        assessment in accordance with subparagraph (C).
                    (B) Planning and prioritizing council.--
                            (i) In general.--A prioritizing and 
                        planning council established under subparagraph 
                        (A)(i) (referred to in this paragraph as a 
                        ``PPC'') shall assist the environmental health 
                        assessment process and environmental health 
                        promotion activities of the eligible entity.
                            (ii) Membership.--Membership of a PPC shall 
                        consist of representatives from various 
                        organizations within public health, planning, 
                        development, and environmental services and 
                        shall include stakeholders from vulnerable 
                        groups such as children, the elderly, disabled, 
                        and minority ethnic groups that are often not 
                        actively involved in democratic or decision-
                        making processes.
                            (iii) Duties.--A PPC shall--
                                    (I) identify key stakeholders and 
                                engage and coordinate potential 
                                partners in the planning process;
                                    (II) establish a formal advisory 
                                group to plan for the establishment of 
                                services;
                                    (III) conduct an in-depth review of 
                                the nature and extent of the need for 
                                an environmental health assessment, 
                                including a local epidemiological 
                                profile, an evaluation of the service 
                                provider capacity of the community, and 
                                a profile of any target populations; 
                                and
                                    (IV) define the components of care 
                                and form essential programmatic 
                                linkages with related providers in the 
                                community.
                    (C) Environmental health assessment.--
                            (i) In general.--A PPC shall carry out an 
                        environmental health assessment to identify 
                        environmental health concerns.
                            (ii) Assessment process.--The PPC shall--
                                    (I) define the goals of the 
                                assessment;
                                    (II) generate the environmental 
                                health issue list;
                                    (III) analyze issues with a systems 
                                framework;
                                    (IV) develop appropriate community 
                                environmental health indicators;
                                    (V) rank the environmental health 
                                issues;
                                    (VI) set priorities for action;
                                    (VII) develop an action plan;
                                    (VIII) implement the plan; and
                                    (IX) evaluate progress and planning 
                                for the future.
                    (D) Evaluation.--Each eligible entity that receives 
                a grant under this paragraph shall evaluate, report, 
                and disseminate program findings and outcomes.
                    (E) Technical assistance.--The Director may provide 
                such technical and other non-financial assistance to 
                eligible entities as the Director determines to be 
                necessary.
            (3) Level 2 cooperative agreements.--
                    (A) Eligibility.--
                            (i) In general.--The Director shall award 
                        grants under this paragraph to eligible 
                        entities that have already--
                                    (I) established broad-based 
                                collaborative partnerships; and
                                    (II) completed environmental 
                                assessments.
                            (ii) No level 1 requirement.--To be 
                        eligible to receive a grant under this 
                        paragraph, an eligible entity is not required 
                        to have successfully completed a Level 1 
                        Cooperative Agreement (as described in 
                        paragraph (2).
                    (B) Use of grant funds.--An eligible entity awarded 
                a grant under this paragraph shall use the funds to 
                further activities to carry out environmental health 
                improvement activities, including--
                            (i) addressing community environmental 
                        health priorities in accordance with paragraph 
                        (2)(C)(ii), including--
                                    (I) air quality;
                                    (II) water quality;
                                    (III) solid waste;
                                    (IV) land use;
                                    (V) housing;
                                    (VI) food safety;
                                    (VII) crime;
                                    (VIII) injuries; and
                                    (IX) healthcare services;
                            (ii) building partnerships between 
                        planning, public health, and other sectors, to 
                        address how the built environment impacts food 
                        availability and access and physical activity 
                        to promote healthy behaviors and lifestyles and 
                        reduce overweight and obesity, asthma, 
                        respiratory conditions, dental, oral and mental 
                        health conditions, and related co-morbidities;
                            (iii) establishing programs to address--
                                    (I) how environmental and social 
                                conditions of work and living choices 
                                influence physical activity and dietary 
                                intake; or
                                    (II) how those conditions influence 
                                the concerns and needs of people who 
                                have impaired mobility and use 
                                assistance devices, including 
                                wheelchairs and lower limb prostheses; 
                                and
                            (iv) convening intervention programs that 
                        examine the role of the social environment in 
                        connection with the physical and chemical 
                        environment in--
                                    (I) determining access to 
                                nutritional food; and
                                    (II) improving physical activity to 
                                reduce morbidity and increase quality 
                                of life.
    (f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            (1) $25,000,000 for fiscal year 2008; and
            (2) such sums as may be necessary for fiscal years 2009 
        through 2012.

SEC. 424. ADDITIONAL RESEARCH ON THE RELATIONSHIP BETWEEN THE BUILT 
              ENVIRONMENT AND THE HEALTH OF COMMUNITY RESIDENTS.

    (a) Definition of Eligible Institution.--In this section, the term 
``eligible institution'' means a public or private nonprofit 
institution that submits to the Secretary of Health and Human Services 
(in this section referred to as the ``Secretary'') and the 
Administrator of the Environmental Protection Agency (in this section 
referred to as the ``Administrator'') an application for a grant under 
the grant program authorized under subsection (b)(2) at such time, in 
such manner, and containing such agreements, assurances, and 
information as the Secretary and Administrator may require.
    (b) Research Grant Program.--
            (1) Definition of health.--In this section, the term 
        ``health'' includes--
                    (A) levels of physical activity;
                    (B) consumption of nutritional foods;
                    (C) rates of crime;
                    (D) air, water, and soil quality;
                    (E) risk of injury;
                    (F) accessibility to healthcare services; and
                    (G) other indicators as determined appropriate by 
                the Secretary.
            (2) Grants.--The Secretary, in collaboration with the 
        Administrator, shall provide grants to eligible institutions to 
        conduct and coordinate research on the built environment and 
        its influence on individual and population-based health.
            (3) Research.--The Secretary shall support research that--
                    (A) investigates and defines the causal links 
                between all aspects of the built environment and the 
                health of residents;
                    (B) examines--
                            (i) the extent of the impact of the built 
                        environment (including the various 
                        characteristics of the built environment) on 
                        the health of residents;
                            (ii) the variance in the health of 
                        residents by--
                                    (I) location (such as inner cities, 
                                inner suburbs, and outer suburbs); and
                                    (II) population subgroup (such as 
                                children, the elderly, the 
                                disadvantaged); or
                            (iii) the importance of the built 
                        environment to the total health of residents, 
                        which is the primary variable of interest from 
                        a public health perspective;
                    (C) is used to develop--
                            (i) measures to address health and the 
                        connection of health to the built environment; 
                        and
                            (ii) efforts to link the measures to travel 
                        and health databases; and
                    (D) distinguishes carefully between personal 
                attitudes and choices and external influences on 
                observed behavior to determine how much an observed 
                association between the built environment and the 
                health of residents, versus the lifestyle preferences 
                of the people that choose to live in the neighborhood, 
                reflects the physical characteristics of the 
                neighborhood; and
                    (E)(i) identifies or develops effective 
                intervention strategies to promote better health among 
                residents with a focus on behavioral interventions and 
                enhancements of the built environment that promote 
                increased use by residents; and
                    (ii) in developing the intervention strategies 
                under clause (i), ensures that the intervention 
                strategies will reach out to high-risk populations, 
                including racial and ethnic minorities and low-income 
                urban and rural communities.
            (4) Priority.--In providing assistance under the grant 
        program authorized under paragraph (2), the Secretary and the 
        Administrator shall give priority to research that 
        incorporates--
                    (A) Minority-serving institutions as grantees;
                    (B) interdisciplinary approaches; or
                    (C) the expertise of the public health, physical 
                activity, urban planning, and transportation research 
                communities in the United States and abroad.

              TITLE V--IMPROVEMENT OF HEALTH CARE SERVICES

SEC. 501. HEALTH EMPOWERMENT ZONES.

    (a) Health Empowerment Zone Programs.--
            (1) Grants.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and the Deputy Assistant Secretary for Minority 
        Health, and in cooperation with the Director of the Office of 
        Community Services and the Director of the National Center for 
        Minority Health and Health Disparities, shall make grants to 
        partnerships of private and public entities to establish health 
        empowerment zone programs in communities that 
        disproportionately experience disparities in health status and 
        health care for the purpose described in paragraph (2).
            (2) Use of funds.--
                    (A) In general.--Subject to subparagraph (B), the 
                purpose of a health empowerment zone program under this 
                section shall be to assist individuals, businesses, 
                schools, minority health associations, non-profit 
                organizations, community-based organizations, 
                hospitals, health care clinics, foundations, and other 
                entities in communities that disproportionately 
                experience disparities in health status and health care 
                which are seeking--
                            (i) to improve the health or environment of 
                        minority individuals in the community and to 
                        reduce disparities in health status and health 
                        care by assisting individuals in accessing 
                        Federal programs;
                            (ii) to coordinate the efforts of 
                        governmental and private entities regarding the 
                        elimination of racial and ethnic disparities in 
                        health status and health care; and
                            (iii) to increase the adoption and use of 
                        health information technology by providers in 
                        racial and ethnic minority and rural 
                        communities to improve quality of care; enhance 
                        minority and rural consumer awareness; 
                        understand, adopt, and use health information 
                        technology to improve health literacy and 
                        health self-management; and foster improved 
                        coordination of health services and care 
                        quality.
                    (B) Medicare and medicaid.--A health empowerment 
                zone program under this section shall not provide any 
                assistance (other than referral and follow-up services) 
                that is duplicative of programs under title XVIII or 
                XIX of the Social Security Act (42 U.S.C. 1395 and 1396 
                et seq.).
            (3) Distribution.--The Secretary shall make at least 1 
        grant per Health and Human Services region under this section 
        to a partnership for a health empowerment zone program in 
        communities that disproportionately experience disparities in 
        health status and health care that is located in a territory or 
        possession of the United States.
            (4) Application.--To obtain a grant under this section, a 
        partnership shall submit to the Secretary an application in 
        such form and in such manner as the Secretary may require. An 
        application under this paragraph shall--
                    (A) demonstrate that the communities to be served 
                by the health empowerment zone program are those that 
                disproportionately experience disparities in health 
                status and health care;
                    (B) set forth a strategic plan for accomplishing 
                the purpose described in paragraph (2), by--
                            (i) describing the coordinated health, 
                        economic, human, community, and physical 
                        development plan and related activities 
                        proposed for the community;
                            (ii) describing the extent to which local 
                        institutions and organizations have contributed 
                        and will contribute to the planning process and 
                        implementation;
                            (iii) identifying the projected amount of 
                        Federal, State, local, and private resources 
                        that will be available in the area and the 
                        private and public partnerships to be used 
                        (including any participation by or cooperation 
                        with universities, colleges, foundations, non-
                        profit organizations, medical centers, 
                        hospitals, health clinics, school districts, or 
                        other private and public entities);
                            (iv) identifying the funding requested 
                        under any Federal program in support of the 
                        proposed activities;
                            (v) identifying benchmarks for measuring 
                        the success of carrying out the strategic plan;
                            (vi) demonstrating the ability to reach and 
                        service the targeted underserved minority 
                        community populations in a culturally 
                        appropriate and linguistically responsive 
                        manner; and
                            (vii) demonstrating a capacity and 
                        infrastructure to provide long-term community 
                        response that is culturally appropriate and 
                        linguistically responsive to communities that 
                        disproportionately experience disparities in 
                        health and health care; and
                    (C) include such other information as the Secretary 
                may require.
            (5) Preference.--In awarding grants under this subsection, 
        the Secretary shall give preference to proposals from 
        indigenous community entities that have an expertise in 
        providing culturally appropriate and linguistically responsive 
        services to communities that disproportionately experience 
        disparities in health and health care.
    (b) Federal Assistance for Health Empowerment Zone Grant 
Programs.--The Secretary, the Administrator of the Small Business 
Administration, the Secretary of Agriculture, the Secretary of 
Education, the Secretary of Labor, and the Secretary of Housing and 
Urban Development shall each--
            (1) where appropriate, provide entity-specific technical 
        assistance and evidence-based strategies to communities that 
        disproportionately experience disparities in health status and 
        health care to further the purposes served by a health 
        empowerment zone program established with a grant under 
        subsection (a);
            (2) identify all programs administered by the Department of 
        Health and Human Services, Small Business Administration, 
        Department of Agriculture, Department of Education, Department 
        of Labor, and the Department of Housing and Urban Development, 
        respectively, that may be used to further the purpose of a 
        health empowerment zone program established with a grant under 
        subsection (a); and
            (3) in administering any program identified under paragraph 
        (2), consider the appropriateness of giving priority to any 
        individual or entity located in communities that 
        disproportionately experience disparities in health status and 
        health care served by a health empowerment zone program 
        established with a grant under subsection (a), if such priority 
        would further the purpose of the health empowerment zone 
        program.
    (c) Health Empowerment Zone Coordinating Committee.--
            (1) Establishment.--For each health empowerment zone 
        program established with a grant under subsection (a), the 
        Secretary acting through the Director of Office of Minority 
        Health and the Administrator of the Health Resources and 
        Services Administration shall establish a health empowerment 
        zone coordinating committee.
            (2) Duties.--Each coordinating committee established, in 
        coordination with the Deputy Assistant Secretary for Minority 
        Health and the Administrator of the Health Resources and 
        Services Administration, shall provide technical assistance and 
        evidence-based strategies to the grant recipient involved, 
        including providing guidance on research, strategies, health 
        outcomes, program goals, management, implementation, 
        monitoring, assessment, and evaluation processes.
            (3) Membership.--
                    (A) Appointment.--The Deputy Assistant Secretary 
                for Minority Health and the Administrator of the Health 
                Resources and Services Administration, in consultation 
                with the respective grant recipient shall appoint the 
                members of each coordinating committee.
                    (B) Composition.--The Deputy Assistant Secretary 
                for Minority Health, and the Administrator of the 
                Health Resources and Services Administration shall 
                ensure that each coordinating committee established--
                            (i) has not more than 20 members;
                            (ii) includes individuals from communities 
                        that disproportionately experience disparities 
                        in health status and health care;
                            (iii) includes community leaders and 
                        leaders of community-based organizations;
                            (iv) includes representatives of academia 
                        and lay and professional organizations and 
                        associations including those having expertise 
                        in medicine (including dental and oral 
                        medicine), technical, social, and behavioral 
                        science, health policy, health information 
                        technology, advocacy, cultural and linguistic 
                        competency, research management, and 
                        organization; and
                            (v) represents a reasonable cross-section 
                        of knowledge, views, and application of 
                        expertise on societal, ethical, behavioral, 
                        educational, policy, legal, cultural, 
                        linguistic, and technological workforce issues 
                        related to eliminating disparities in health 
                        and health care.
                    (C) Individual qualifications.--The Deputy 
                Assistant Secretary for Minority Health and the 
                Administrator of the Health Resources and Services 
                Administration may not appoint an individual to serve 
                on a coordinating committee unless the individual meets 
                the following qualifications:
                            (i) The individual is not employed by the 
                        Federal Government.
                            (ii) The individual has appropriate 
                        experience, including experience in the areas 
                        of community development, cultural and 
                        linguistic competency, reducing and eliminating 
                        racial and ethnic disparities in health and 
                        health care, or minority health.
                    (D) Selection.--In selecting individuals to serve 
                on a coordinating committee, the Deputy Assistant 
                Secretary for Minority Health and the Administrator 
                Health Resources and Services Administration shall give 
                due consideration to the recommendations of the 
                Congress, industry leaders, the scientific community 
                (including the Institute of Medicine), academia, 
                community based non-profit organizations, minority 
                health and related organizations, the education 
                community, State and local governments, and other 
                appropriate organizations.
                    (E) Chairperson.--The Deputy Assistant Secretary 
                for Minority Health and the Administrator of the Health 
                Resources and Services Administration, in consultation 
                with the members of the coordinating committee 
                involved, shall designate a chairperson of the 
                coordinating committee, who shall serve for a term of 3 
                years and who may be reappointed at the expiration of 
                each such term.
                    (F) Terms.--Each member of a coordinating committee 
                shall be appointed for a term of 1 to 3 years in 
                overlapping staggered terms, as determined by the 
                Deputy Assistant Secretary for Minority Health and the 
                Administrator of the Health Resources and Services 
                Administration at the time of appointment, and may be 
                reappointed at the expiration of each such term.
                    (G) Vacancies.--A vacancy on a coordinating 
                committee shall be filled in the same manner in which 
                the original appointment was made.
            (4) Meetings.--A coordinating committee shall meet at least 
        twice each year, at the call of the coordinating committee's 
        chairperson and in consultation with the Deputy Assistant 
        Secretary for Minority Health and the Administrator Health 
        Resources and Services Administration.
            (5) Report.--Each coordinating committee shall transmit to 
        the Congress an annual report that, with respect to the health 
        empowerment zone program involved, includes the following:
                    (A) A review of the program's effectiveness in 
                achieving stated goals and outcomes.
                    (B) A review of the program's management and the 
                coordination of the entities involved, including the 
                representation and involvement of communities 
                experiencing health disparities.
                    (C) A review of the activities in the program's 
                portfolio and components.
                    (D) An identification of policy issues raised by 
                the program.
                    (E) An assessment of the program's capacity, 
                infrastructure, and number of underserved minority 
                communities engaged.
                    (F) Recommendations for new program goals, research 
                areas, enhanced approaches, partnerships, coordination 
                and management mechanisms, and projects to be 
                established to achieve the program's stated goals, to 
                improve outcomes, monitoring, and evaluation.
                    (G) A review of the degree of minority entity 
                participation in the program, and an identification of 
                a strategy to increase such participation.
                    (H) Any other reviews or recommendations determined 
                to be appropriate by the coordinating committee.
    (d) Report.--The Deputy Assistant Secretary for Minority Health and 
the Administrator of the Health Resources and Services Administration 
shall submit a joint annual report to the appropriate committees of 
Congress on the results of the implementation of programs under this 
section.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

SEC. 502. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title XXX of the Public Health Service Act, as amended by titles 
II, III, and IV of this Act, is further amended by adding at the end 
the following:

 ``Subtitle D--Reconstruction and Improvement Grants for Public Health 
    Care Facilities Serving Pacific Islanders and the Insular Areas

``SEC. 3051. GRANT SUPPORT FOR QUALITY IMPROVEMENT INITIATIVES.

    ``(a) In General.--The Secretary, in collaboration with the 
Administrator of the Health Resources and Services Administration, the 
Director of the Agency for Healthcare Research and Quality, and the 
Administrator of the Centers for Medicare & Medicaid Services, shall 
award grants to eligible entities for the conduct of demonstration 
projects to improve the quality of and access to health care.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be a health center, hospital, health plan, health 
        system, community clinic. or other health entity determined 
        appropriate by the Secretary--
                    ``(A) that, by legal mandate or explicitly adopted 
                mission, provides patients with access to services 
                regardless of their ability to pay;
                    ``(B) that provides care or treatment for a 
                substantial number of patients who are uninsured, are 
                receiving assistance under a State program under title 
                XIX of the Social Security Act, or are members of 
                vulnerable populations, as determined by the Secretary; 
                and
                    ``(C)(i) with respect to which, not less than 50 
                percent of the entity's patient population is made up 
                of racial and ethnic minorities; or
                    ``(ii) that--
                            ``(I) serves a disproportionate percentage 
                        of local, minority racial and ethnic patients, 
                        or that has a patient population, at least 50 
                        percent of which is limited English proficient; 
                        and
                            ``(II) provides an assurance that amounts 
                        received under the grant will be used only to 
                        support quality improvement activities in the 
                        racial and ethnic population served; and
            ``(2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to applicants under subsection (b)(2) 
that--
            ``(1) demonstrate an intent to operate as part of a health 
        care partnership, network, collaborative, coalition, or 
        alliance where each member entity contributes to the design, 
        implementation, and evaluation of the proposed intervention; or
            ``(2) intend to use funds to carry out systemwide changes 
        with respect to health care quality improvement, including--
                    ``(A) improved systems for data collection and 
                reporting;
                    ``(B) innovative collaborative or similar 
                processes;
                    ``(C) group programs with behavioral or self-
                management interventions;
                    ``(D) case management services;
                    ``(E) physician or patient reminder systems;
                    ``(F) educational interventions; or
                    ``(G) other activities determined appropriate by 
                the Secretary.
    ``(d) Use of Funds.--An entity shall use amounts received under a 
grant under subsection (a) to support the implementation and evaluation 
of health care quality improvement activities or minority health and 
health care disparity reduction activities that include--
            ``(1) with respect to health care systems, activities 
        relating to improving--
                    ``(A) patient safety;
                    ``(B) timeliness of care;
                    ``(C) effectiveness of care;
                    ``(D) efficiency of care;
                    ``(E) patient centeredness; and
                    ``(F) health information technology; and
            ``(2) with respect to patients, activities relating to--
                    ``(A) staying healthy;
                    ``(B) getting well;
                    ``(C) living with illness or disability; and
                    ``(D) coping with end of life issues.
    ``(e) Common Data Systems.--The Secretary shall provide financial 
and other technical assistance to grantees under this section for the 
development of common data systems.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3052. CENTERS OF EXCELLENCE.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall designate 
centers of excellence at public hospitals, and other health systems 
serving large numbers of minority patients, that--
            ``(1) meet the requirements of section 3051(b)(1);
            ``(2) demonstrate excellence in providing care to minority 
        populations; and
            ``(3) demonstrate excellence in reducing disparities in 
        health and health care.
    ``(b) Requirements.--A hospital or health system that serves as a 
Center of Excellence under subsection (a) shall--
            ``(1) design, implement, and evaluate programs and policies 
        relating to the delivery of care in racially, ethnically, and 
        linguistically diverse populations;
            ``(2) provide training and technical assistance to other 
        hospitals and health systems relating to the provision of 
        quality health care to minority populations; and
            ``(3) develop activities for graduate or continuing medical 
        education that institutionalize a focus on cultural competence 
        training for health care providers.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2008 through 2013.

``SEC. 3053. RECONSTRUCTION AND IMPROVEMENT GRANTS FOR PUBLIC HEALTH 
              CARE FACILITIES SERVING PACIFIC ISLANDERS AND THE INSULAR 
              AREAS.

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

SEC. 503. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS UNDER THE MEDICAID 
              PROGRAM AND SCHIP.

    (a) Medicaid Program.--Section 1903(v) of the Social Security Act 
(42 U.S.C. 1396b(v)) is amended--
            (1) in paragraph (1), by striking ``paragraph (2)'' and 
        inserting ``paragraphs (2) and (4)''; and
            (2) by adding at the end the following new paragraph:
    ``(4)(A) A State may elect (in a plan amendment under this title) 
to provide medical assistance under this title, notwithstanding 
sections 401(a), 402(b), 403, and 421 of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996, for undocumented 
residents who are lawfully residing in the United States (including 
battered undocumented residents described in section 431(c) of such 
Act) and who are otherwise eligible for such assistance, within either 
or both of the following eligibility categories:
            ``(i) Pregnant women.--Women during pregnancy (and during 
        the 60-day period beginning on the last day of the pregnancy).
            ``(ii) Children.--Individuals under 21 years of age, 
        including optional targeted low-income children described in 
        section 1905(u)(2)(B).
    ``(B) In the case of a State that has elected to provide medical 
assistance to a category of undocumented residents under subparagraph 
(A), no debt shall accrue under an affidavit of support against any 
sponsor of such an undocumented resident on the basis of provision of 
assistance to such category and the cost of such assistance shall not 
be considered as an unreimbursed cost.''.
    (b) SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) 
is amended by redesignating subparagraphs (C) and (D) as subparagraph 
(D) and (E), respectively, and by inserting after subparagraph (B) the 
following new subparagraph:
                    ``(C) Section 1903(v)(4) (relating to optional 
                coverage of categories of lawfully residing immigrant 
                children), but only if the State has elected to apply 
                such section to the category of children under title 
                XIX.''.
    (c) Effective Date.--The amendments made by this section take 
effect on October 1, 2007, and apply to medical assistance and child 
health assistance furnished on or after such date.

SEC. 504. BORDER HEALTH GRANTS.

    (a) Eligible Entity Defined.--In this section, the term ``eligible 
entity'' means a State, public institution of higher education, local 
government, tribal government, nonprofit health organization, community 
health center, or community clinic receiving assistance under section 
330 of the Public Health Service Act (42 U.S.C. 254b), that is located 
in the border area.
    (b) Authorization.--From funds appropriated under subsection (f), 
the Secretary of Health and Human Services (in this section referred to 
as the ``Secretary''), acting through the United States members of the 
United States-Mexico Border Health Commission, shall award grants to 
eligible entities to address priorities and recommendations to improve 
the health of border area residents that are established by--
            (1) the United States members of the United States-Mexico 
        Border Health Commission;
            (2) the State border health offices; and
            (3) the Secretary.
    (c) Application.--An eligible entity that desires a grant under 
subsection (b) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the Secretary 
may require.
    (d) Use of Funds.--An eligible entity that receives a grant under 
subsection (b) shall use the grant funds for--
            (1) programs relating to--
                    (A) maternal and child health;
                    (B) primary care and preventative health;
                    (C) public health and public health infrastructure;
                    (D) health education and promotion;
                    (E) oral health;
                    (F) mental and behavioral health;
                    (G) substance abuse;
                    (H) health conditions that have a high prevalence 
                in the border area;
                    (I) medical and health services research;
                    (J) workforce training and development;
                    (K) community health workers or promotoras;
                    (L) health care infrastructure problems in the 
                border area (including planning and construction 
                grants);
                    (M) health disparities in the border area;
                    (N) environmental health; and
                    (O) outreach and enrollment services with respect 
                to Federal programs (including programs authorized 
                under titles XIX and XXI of the Social Security Act (42 
                U.S.C. 1396 and 1397aa)); and
            (2) other programs determined appropriate by the Secretary.
    (e) Supplement, Not Supplant.--Amounts provided to an eligible 
entity awarded a grant under subsection (b) shall be used to supplement 
and not supplant other funds available to the eligible entity to carry 
out the activities described in subsection (d).
    (f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $200,000,000 for fiscal year 
2008, and such sums as may be necessary for each succeeding fiscal 
year.

SEC. 505. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC AND 
              RACIAL MINORITIES.

    (a) Demonstration.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        conduct demonstration projects (in this section referred to as 
        ``demonstration projects'') for the purpose of developing 
        models and evaluating methods that--
                    (A) improve the quality of items and services 
                provided to target individuals in order to facilitate 
                reduced disparities in early detection and treatment of 
                cancer;
                    (B) improve clinical outcomes, satisfaction, 
                quality of life, and appropriate use of Medicare-
                covered services and referral patterns among those 
                target individuals with cancer;
                    (C) eliminate disparities in the rate of preventive 
                cancer screening measures, such as pap smears, prostate 
                cancer screenings, and CT scans for lung cancer among 
                target individuals; and
                    (D) promote collaboration with community-based 
                organizations to ensure cultural competency of health 
                care professionals and linguistic access for persons 
                with limited English proficiency.
            (2) Target individual defined.--In this section, the term 
        ``target individual'' means an individual of a racial and 
        ethnic minority group, as defined by section 1707 of the Public 
        Health Service Act (42 U.S.C. 300u-6) who is entitled to 
        benefits under part A, and enrolled under part B, of title 
        XVIII of the Social Security Act.
    (b) Program Design.--
            (1) Initial design.--Not later than 1 year after the date 
        of the enactment of this Act, the Secretary shall evaluate best 
        practices in the private sector, community programs, and 
        academic research of methods that reduce disparities among 
        individuals of racial and ethnic minority groups in the 
        prevention and treatment of cancer and shall design the 
        demonstration projects based on such evaluation.
            (2) Number and project areas.--Not later than 2 years after 
        the date of the enactment of this Act, the Secretary shall 
        implement at least nine demonstration projects, including the 
        following:
                    (A) Two projects for each of the four following 
                major racial and ethnic minority groups:
                            (i) American Indians and Alaska Natives, 
                        Eskimos and Aleuts.
                            (ii) Asian Americans.
                            (iii) Blacks/African Americans.
                            (iv) Hispanic/Latino Americans.
                            (v) Native Hawaiians and other Pacific 
                        Islanders.
                The two projects must target different ethnic 
                subpopulations.
                    (B) One project within the Pacific Islands or 
                United States insular areas.
                    (C) At least one project each in a rural area and 
                inner-city area.
            (3) Expansion of projects; implementation of demonstration 
        project results.--If the initial report under subsection (c) 
        contains an evaluation that demonstration projects--
                    (A) reduce expenditures under the Medicare program 
                under title XVIII of the Social Security Act; or
                    (B) do not increase expenditures under the Medicare 
                program and reduce racial and ethnic health disparities 
                in the quality of health care services provided to 
                target individuals and increase satisfaction of 
                beneficiaries and health care providers;
        the Secretary shall continue the existing demonstration 
        projects and may expand the number of demonstration projects.
    (c) Report to Congress.--
            (1) In general.--Not later than 2 years after the date the 
        Secretary implements the initial demonstration projects, and 
        biannually thereafter, the Secretary shall submit to Congress a 
        report regarding the demonstration projects.
            (2) Contents of report.--Each report under paragraph (1) 
        shall include the following:
                    (A) A description of the demonstration projects.
                    (B) An evaluation of--
                            (i) the cost-effectiveness of the 
                        demonstration projects;
                            (ii) the quality of the health care 
                        services provided to target individuals under 
                        the demonstration projects; and
                            (iii) beneficiary and health care provider 
                        satisfaction under the demonstration projects.
                    (C) Any other information regarding the 
                demonstration projects that the Secretary determines to 
                be appropriate.
    (d) Waiver Authority.--The Secretary shall waive compliance with 
the requirements of title XVIII of the Social Security Act to such 
extent and for such period as the Secretary determines is necessary to 
conduct demonstration projects.

SEC. 506. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN AND 
              CHILDREN.

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

``SEC. 399R. GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS IN WOMEN AND 
              CHILDREN.

    ``(a) Grants Authorized.--The Secretary, in collaboration with the 
Director of the Centers for Disease Control and Prevention and other 
Federal officials determined appropriate by the Secretary, is 
authorized to award grants to eligible entities to promote positive 
health behaviors for women and children in target populations, 
especially racial and ethnic minority women and children in medically 
underserved communities.
    ``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may 
be used to support community health workers--
            ``(1) to educate and provide outreach regarding enrollment 
        in health insurance including the State Children's Health 
        Insurance Program under title XXI of the Social Security Act, 
        Medicare under title XVIII of such Act, and Medicaid under 
        title XIX of such Act;
            ``(2) to educate, guide, and provide outreach in a 
        community setting regarding health problems prevalent among 
        women and children and especially among racial and ethnic 
        minority women and children;
            ``(3) to educate, guide, and provide experiential learning 
        opportunities that target behavioral risk factors including--
                    ``(A) poor nutrition;
                    ``(B) physical inactivity;
                    ``(C) being overweight or obese;
                    ``(D) tobacco use;
                    ``(E) alcohol and substance use;
                    ``(F) injury and violence;
                    ``(G) risky sexual behavior;
                    ``(H) mental health problems;
                    ``(I) dental and oral health problems; and
                    ``(J) understanding informed consent;
            ``(4) to educate and guide regarding effective strategies 
        to promote positive health behaviors within the family;
            ``(5) to promote community wellness and awareness; and
            ``(6) to educate and refer target populations to 
        appropriate health care agencies and community-based programs 
        and organizations in order to increase access to quality health 
        care services, including preventive health services.
    ``(c) Application.--
            ``(1) In general.--Each eligible entity that desires to 
        receive a grant under subsection (a) shall submit an 
        application to the Secretary, at such time, in such manner, and 
        accompanied by such additional information as the Secretary may 
        require.
            ``(2) Contents.--Each application submitted pursuant to 
        paragraph (1) shall--
                    ``(A) describe the activities for which assistance 
                under this section is sought;
                    ``(B) contain an assurance that with respect to 
                each community health worker program receiving funds 
                under the grant awarded, such program provides training 
                and supervision to community health workers to enable 
                such workers to provide authorized program services;
                    ``(C) contain an assurance that the applicant will 
                evaluate the effectiveness of community health worker 
                programs receiving funds under the grant;
                    ``(D) contain an assurance that each community 
                health worker program receiving funds under the grant 
                will provide services in the cultural context most 
                appropriate for the individuals served by the program;
                    ``(E) contain a plan to document and disseminate 
                project description and results to other States and 
                organizations as identified by the Secretary; and
                    ``(F) describe plans to enhance the capacity of 
                individuals to utilize health services and health-
                related social services under Federal, State, and local 
                programs by--
                            ``(i) assisting individuals in establishing 
                        eligibility under the programs and in receiving 
                        the services or other benefits of the programs; 
                        and
                            ``(ii) providing other services as the 
                        Secretary determines to be appropriate, that 
                        may include transportation and translation 
                        services.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Secretary shall give priority to those applicants--
            ``(1) who propose to target geographic areas--
                    ``(A) with a high percentage of residents who are 
                eligible for health insurance but are uninsured or 
                underinsured; and
                    ``(B) with a high percentage of families for whom 
                English is not their primary language.
            ``(2) with experience in providing health or health-related 
        social services to individuals who are underserved with respect 
        to such services; and
            ``(3) with documented community activity and experience 
        with community health workers.
    ``(e) Collaboration With Academic Institutions.--The Secretary 
shall encourage community health worker programs receiving funds under 
this section to collaborate with academic institutions, including 
minority-serving institutions. Nothing in this section shall be 
construed to require such collaboration.
    ``(f) Quality Assurance and Cost-Effectiveness.--The Secretary 
shall establish guidelines for assuring the quality of the training and 
supervision of community health workers under the programs funded under 
this section and for assuring the cost-effectiveness of such programs.
    ``(g) Monitoring.--The Secretary shall monitor community health 
worker programs identified in approved applications and shall determine 
whether such programs are in compliance with the guidelines established 
under subsection (f).
    ``(h) Technical Assistance.--The Secretary may provide technical 
assistance to community health worker programs identified in approved 
applications with respect to planning, developing, and operating 
programs under the grant.
    ``(i) Report to Congress.--
            ``(1) In general.--Not later than 4 years after the date on 
        which the Secretary first awards grants under subsection (a), 
        the Secretary shall submit to Congress a report regarding the 
        grant project.
            ``(2) Contents.--The report required under paragraph (1) 
        shall include the following:
                    ``(A) A description of the programs for which grant 
                funds were used.
                    ``(B) The number of individuals served.
                    ``(C) An evaluation of--
                            ``(i) the effectiveness of these programs;
                            ``(ii) the cost of these programs; and
                            ``(iii) the impact of the project on the 
                        health outcomes of the community residents.
                    ``(D) Recommendations for sustaining the community 
                health worker programs developed or assisted under this 
                section.
                    ``(E) Recommendations regarding training to enhance 
                career opportunities for community health workers.
    ``(j) Definitions.--In this section:
            ``(1) Community health worker.--The term `community health 
        worker' means an individual who promotes health or nutrition 
        within the community in which the individual resides--
                    ``(A) by serving as a liaison between communities 
                and health care agencies;
                    ``(B) by providing guidance and social assistance 
                to community residents;
                    ``(C) by enhancing community residents' ability to 
                effectively communicate with health care providers;
                    ``(D) by providing culturally and linguistically 
                appropriate health or nutrition education;
                    ``(E) by advocating for individual and community 
                health, including dental, oral, mental, and 
                environmental health, or nutrition needs; and
                    ``(F) by providing referral and followup services.
            ``(2) Community setting.--The term `community setting' 
        means a home or a community organization located in the 
        neighborhood in which a participant resides.
            ``(3) Eligible entity.--The term `eligible entity' means--
                    ``(A) a unit of State, territorial, local, or 
                tribal government (including a federally recognized 
                tribe or Alaska native villages); or
                    ``(B) a community-based organization.
            ``(4) Medically underserved community.--The term `medically 
        underserved community' means a community--
                    ``(A) that has a substantial number of individuals 
                who are members of a medically underserved population, 
                as defined by section 330(b)(3); and
                    ``(B) a significant portion of which is a health 
                professional shortage area as designated under section 
                332.
            ``(5) Support.--The term `support' means the provision of 
        training, supervision, and materials needed to effectively 
        deliver the services described in subsection (b), reimbursement 
        for services, and other benefits.
            ``(6) Target population.--The term `target population' 
        means women of reproductive age, regardless of their current 
        childbearing status and children under 21 years of age.
    ``(k) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $15,000,000 for each of fiscal 
years 2008, 2009, 2010, 2011, and 2012.''.

SEC. 507. EXCEPTION FOR CITIZENS OF FREELY ASSOCIATED STATES.

    (a) In General.--Section 402(a)(2) of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612(a)(2)) 
is amended by adding at the end the following:
                    ``(M) Exception for citizens of freely associated 
                states.--With respect to eligibility for benefits for 
                the specified Federal programs described in paragraph 
                (3), paragraph (1) shall not apply to any individual 
                who lawfully resides in the United States (including 
                territories and possessions of the United States) in 
                accordance with--
                            ``(i) section 141 of the Compact of Free 
                        Association between the Government of the 
                        United States and the Government of the 
                        Federated States of Micronesia, approved by 
                        Congress in the Compact of Free Association 
                        Amendments Act of 2003;
                            ``(ii) section 141 of the Compact of Free 
                        Association between the Government of the 
                        United States and the Government of the 
                        Republic of the Marshall Islands, approved by 
                        Congress in the Compact of Free Association 
                        Amendments Act of 2003; or
                            ``(iii) section 141 of the Compact of Free 
                        Association between the Government of the 
                        United States and the Government of Palau, 
                        approved by Congress in Public Law 99-658 (100 
                        Stat. 3672).''.
    (b) Medicaid Exception.--Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1612(b)(2)) is amended by adding at the end the following:
                    ``(G) Medicaid exceptions for citizens of freely 
                associated states.--With respect to eligibility for 
                benefits for the programs defined in subparagraphs (A) 
                and (C) of paragraph (3) (relating to Medicaid), 
                paragraph (1) shall not apply to any individual who 
                lawfully resides in the United States (including 
                territories and possessions of the United States) in 
                accordance with a Compact of Free Association referred 
                to in subsection (a)(2)(M).''.
    (c) Qualified Alien.--Section 431(b) of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)) is 
amended--
            (1) in paragraph (6), by striking ``or'' at the end;
            (2) in paragraph (7), by striking the period at the end and 
        inserting ``; or''; and
            (3) by adding at the end the following:
            ``(8) an individual who lawfully resides in the United 
        States (including territories and possessions of the United 
        States) in accordance with a Compact of Free Association 
        referred to in section 402(a)(2)(M).''.
    (d) Financial Treatment Under Medicaid.--Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended--
            (1) in subsection (f), by striking ``subsection (g)'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following new subsection:
    ``(h) The limitations of subsections (f) and (g) shall not apply 
with respect to medical assistance provided to an individual described 
in section 431(b)(8) of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996.''.
    (e) Increased FMAP.--The third sentence of section 1905(b) of the 
Social Security Act (42 U.S.C. 1396d(b)) is amended by inserting before 
the period at the end the following: ``and for services furnished to 
individuals described in section 431(b)(8) of the Personal 
Responsibility and Work Opportunity Reconciliation Act of 1996''.

SEC. 508. MEDICARE GRADUATE MEDICAL EDUCATION.

    (a) Clarification of Congressional Intent Regarding the Counting of 
Residents in a Nonhospital Setting.--
            (1) D-GME.--Section 1886(h)(4)(E) of the Social Security 
        Act (42 U.S.C. 1395ww(h)(4)(E)) is amended by adding at the end 
        the following new sentences: ``For purposes of the preceding 
        sentence, the term `all, or substantially all, of the costs for 
        the training program' means the stipends and benefits provided 
        to the resident and other amounts, if any, as determined by the 
        hospital and the entity operating the nonhospital setting. The 
        hospital is not required to pay the entity any amounts other 
        than those determined by the hospital and the entity in order 
        for the hospital to be considered to have incurred all, or 
        substantially all, of the costs for the training program in 
        that setting.''.
            (2) IME.--Section 1886(d)(5)(B)(iv) of the Social Security 
        Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amended by adding at the 
        end the following new sentences: ``For purposes of the 
        preceding sentence, the term `all, or substantially all, of the 
        costs for the training program' means the stipends and benefits 
        provided to the resident and other amounts, if any, as 
        determined by the hospital and the entity operating the 
        nonhospital setting. The hospital is not required to pay the 
        entity any amounts other than those determined by the hospital 
        and the entity in order for the hospital to be considered to 
        have incurred all, or substantially all, of the costs for the 
        training program in that setting.''.
            (3) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2008.
    (b) Clarification of Eligibility of a Nonrural Hospital That Has a 
Training Program With an Integrated Rural Track.--
            (1) In general.--Section 1886(h)(4)(H) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(4)(H)) is amended--
                    (A) in clause (iv), by inserting ``(as defined in 
                clause (v))'' after ``an integrated rural track''; and
                    (B) by adding at the end the following new clause:
                            ``(v) Definition of accredited training 
                        program with an integrated rural track.--For 
                        purposes of clause (iv), the term `accredited 
                        training program with an integrated rural 
                        track' means an accredited medical residency 
                        training program located in an urban area which 
                        offers a curriculum for all residents in the 
                        program that includes the following 
                        characteristics:
                                    ``(I) A minimum of 3 block months 
                                of rural rotations. During such 3 block 
                                months, the resident is in a rural area 
                                for 4 weeks or a month.
                                    ``(II) A stated mission for 
                                training rural physicians.
                                    ``(III) A minimum of 3 months of 
                                obstetrical training, or an equivalent 
                                longitudinal experience.
                                    ``(IV) A minimum of 4 months of 
                                pediatric training that includes 
                                neonatal, ambulatory, inpatient, and 
                                emergency experiences through 
                                rotations, or an equivalent 
                                longitudinal experience.
                                    ``(V) A minimum of 2 months of 
                                emergency medicine rotations, or an 
                                equivalent longitudinal experience.''.
            (2) Effective date.--The amendments made by this subsection 
        apply with respect to--
                    (A) payments to hospitals under section 1886(h) of 
                the Social Security Act (42 U.S.C. 1395ww(h)) for cost 
                reporting periods beginning on or after January 1, 
                2008; and
                    (B) payments to hospitals under section 
                1886(d)(5)(B)(v) of such Act (42 U.S.C. 
                1395ww(d)(5)(B)(v)) for discharges occurring on or 
                after January 1, 2008.

SEC. 509. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MINORITY COMMUNITIES.

    (a) Expanded Funding.--The Secretary, in collaboration with the 
Director of the Office of Minority Health, the Director of the Centers 
for Disease Control and Prevention, the Administrator of the Health 
Resources and Services Administration, and the Administrator of the 
Substance Abuse and Mental Health Services Administration, shall 
provide funds and carry out activities to expand the Minority HIV/AIDS 
Initiative.
    (b) Use of Funds.--The additional funds made available under this 
section may be used, through the Minority AIDS Initiative, to support 
the following activities:
            (1) Providing technical assistance and infrastructure 
        support to reduce HIV/AIDS in minority populations.
            (2) Increasing minority populations' access to HIV/AIDS 
        prevention and care services.
            (3) Building strong community programs and partnerships to 
        address HIV prevention and the health care needs of specific 
        racial and ethnic minority populations.
    (c) Priority Interventions.--Within the racial and ethnic minority 
populations referred to in subsection (b), priority in conducting 
intervention services shall be given to--
            (1) women;
            (2) youth;
            (3) men who engage in homosexual activity;
            (4) persons who engage in intravenous drug abuse;
            (5) homeless individuals; and
            (6) individuals incarcerated or in the penal system.
    (d) Authorization of Appropriations.--For carrying out this 
section, there are authorized to be appropriated $610,000,0000 for 
fiscal year 2008 and such sums as may be necessary for each of fiscal 
years 2009 through 2012.

SEC. 510. GRANTS FOR RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH.

    (a) Purpose.--It is the purpose of this section to provide for the 
awarding of grants to assist communities in mobilizing and organizing 
resources in support of effective and sustainable programs that will 
reduce or eliminate disparities in health and health care experienced 
by racial and ethnic minority individuals.
    (b) Authority.--The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, in consultation with the 
Office of Minority Health, shall award grants to eligible entities to 
assist in designing, implementing, and evaluating culturally and 
linguistically appropriate, evidence-based, and community-driven 
sustainable strategies to eliminate racial and ethnic health and health 
care disparities.
    (c) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            (1) represent a coalition--
                    (A) whose principal purpose is to develop and 
                implement interventions to reduce or eliminate a health 
                or health care disparity in a targeted racial or ethnic 
                minority group in the community served by the 
                coalition; and
                    (B) that includes--
                            (i) at least 3 members selected from 
                        among--
                                    (I) public health departments;
                                    (II) community-based organizations;
                                    (III) university and research 
                                organizations;
                                    (IV) Indian tribes, tribal 
                                organizations, urban Indian 
                                organizations, national or regional 
                                Indian organizations, or the Indian 
                                Health Service;
                                    (V) organizations serving Native 
                                Hawaiians;
                                    (VI) organizations serving Pacific 
                                Islanders; and
                                    (VII) interested public or private 
                                health care providers or organizations 
                                as deemed appropriate by the Secretary; 
                                and
                            (ii) at least 1 member from a community-
                        based organization that represents the targeted 
                        racial or ethnic minority group; and
            (2) submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require, which shall include--
                    (A) a description of the targeted racial or ethnic 
                populations in the community to be served under the 
                grant;
                    (B) a description of at least 1 health disparity 
                that exists in the racial or ethnic targeted 
                populations, including infant mortality, breast and 
                cervical cancer screening and management, 
                cardiovascular disease, diabetes, child and adult 
                immunization levels, HIV/AIDS, hepatitis B, 
                tuberculosis, or asthma, or other health priority areas 
                as designated by the Secretary; and
                    (C) a demonstration of a proven record of 
                accomplishment of the coalition members in serving and 
                working with the targeted community.
    (d) Sustainability.--The Secretary shall give priority to an 
eligible entity under this section if the entity agrees that, with 
respect to the costs to be incurred by the entity in carrying out the 
activities for which the grant was awarded, the entity (and each of the 
participating partners in the coalition represented by the entity) will 
maintain its expenditures of non-Federal funds for such activities at a 
level that is not less than the level of such expenditures during the 
fiscal year immediately preceding the first fiscal year for which the 
grant is awarded.
    (e) Nonduplication.--Funds provided through this grant program 
should supplement, not supplant, existing Federal funding, and the 
funds should not be used to duplicate the activities of the other 
health disparity grant programs in this Act.
    (f) Technical Assistance.--The Secretary may, either directly or by 
grant or contract, provide any entity that receives a grant under this 
section with technical and other non-financial assistance necessary to 
meet the requirements of this section.
    (g) Dissemination.--The Secretary shall encourage and enable 
grantees to share best practices, evaluation results, and reports using 
the Internet, conferences, and other pertinent information regarding 
the projects funded by this section, including the outreach efforts of 
the Office of Minority Health and the Centers for Disease Control and 
Prevention. Such information shall be publicly available, and posted on 
the Internet website of relevant Government agencies.
    (h) Administrative Burdens.--The Secretary shall make every effort 
to minimize duplicative or unnecessary administrative burdens on 
grantees.

SEC. 511. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.

    (a) Clarification of Payment for Clinical Laboratory Tests 
Furnished by Critical Access Hospitals.--
            (1) In general.--Section 1834(g)(4) of the Social Security 
        Act (42 U.S.C. 1395m(g)(4)) is amended--
                    (A) in the heading, by striking ``no beneficiary 
                cost-sharing'' and inserting ``treatment of''; and
                    (B) by adding at the end the following new 
                sentence: ``For purposes of the preceding sentence and 
                section 1861(mm)(3), clinical diagnostic laboratory 
                services furnished by a critical access hospital shall 
                be treated as being furnished as part of outpatient 
                critical access services without regard to whether--
                    ``(A) the individual with respect to whom such 
                services are furnished is physically present in the 
                critical access hospital at the time the specimen is 
                collected;
                    ``(B) such individual is registered as an 
                outpatient on the records of, and receives such 
                services directly from, the critical access hospital; 
                or
                    ``(C) payment is (or, but for this subsection, 
                would be) available for such services under the fee 
                schedule established under section 1833(h).''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to cost reporting periods beginning on or after 
        October 1, 2008.
    (b) Elimination of Isolation Test for Cost-Based Ambulance 
Reimbursement.--
            (1) In general.--Section 1834(l)(8) of the Social Security 
        Act (42 U.S.C. 1395m(l)(8)) is amended--
                    (A) in subparagraph (B)--
                            (i) by striking ``owned and''; and
                            (ii) by inserting ``(including when such 
                        services are provided by the entity under an 
                        arrangement with the hospital)'' after 
                        ``hospital''; and
                    (B) by striking the comma at the end of 
                subparagraph (B) and all that follows and inserting a 
                period.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after January 1, 2008.
    (c) Provision of a More Flexible Alternative to the CAH Designation 
25 Inpatient Bed Limit Requirement.--
            (1) In general.--Section 1820(c)(2) of the Social Security 
        Act (42 U.S.C. 1395i-4(c)(2)) is amended--
                    (A) in subparagraph (B)(iii), by striking 
                ``provides not more than'' and inserting ``subject to 
                subparagraph (F), provides not more than''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(F) Alternative to 25 inpatient bed limit 
                requirement.--
                            ``(i) In general.--A State may elect to 
                        treat a facility, with respect to the 
                        designation of the facility for a cost 
                        reporting period, as satisfying the requirement 
                        of subparagraph (B)(iii) relating to a maximum 
                        number of acute care inpatient beds if the 
                        facility elects, in accordance with a method 
                        specified by the Secretary and before the 
                        beginning of the cost reporting period, to meet 
                        the requirement under clause (ii).
                            ``(ii) Alternate requirement.--The 
                        requirement under this clause, with respect to 
                        a facility and a cost reporting period, is that 
                        the total number of inpatient bed days 
                        described in subparagraph (B)(iii) during such 
                        period will not exceed 7,300. For purposes of 
                        this subparagraph, an individual who is an 
                        inpatient in a bed in the facility for a single 
                        day shall be counted as one inpatient bed day.
                            ``(iii) Withdrawal of election.--The option 
                        described in clause (i) shall not apply to a 
                        facility for a cost reporting period if the 
                        facility (for any two consecutive cost 
                        reporting periods during the previous 5 cost 
                        reporting periods) was treated under such 
                        option and had a total number of inpatient bed 
                        days for each of such two cost reporting 
                        periods that exceeded the number specified in 
                        such clause.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to cost reporting periods beginning on or after the 
        date of the enactment of this Act.

SEC. 512. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL 
              HEALTH COUNSELOR SERVICES UNDER PART B OF THE MEDICARE 
              PROGRAM.

    (a) Coverage of Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (Z), by striking ``and'' at the 
                end;
                    (B) in subparagraph (AA), by inserting ``and'' at 
                the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(BB) marriage and family therapist services (as defined 
        in subsection (ccc)(1)) and mental health counselor services 
        (as defined in subsection (ccc)(3));''.
            (2) Definitions.--Section 1861 of such Act (42 U.S.C. 
        1395x) is amended by adding at the end the following new 
        subsection:

     ``Marriage and Family Therapist Services; Marriage and Family 
  Therapist; Mental Health Counselor Services; Mental Health Counselor

    ``(ccc)(1) The term `marriage and family therapist services' means 
services performed by a marriage and family therapist (as defined in 
paragraph (2)) for the diagnosis and treatment of mental illnesses, 
which the marriage and family therapist is legally authorized to 
perform under State law (or the State regulatory mechanism provided by 
State law) of the State in which such services are performed, as would 
otherwise be covered if furnished by a physician or as an incident to a 
physician's professional service, but only if no facility or other 
provider charges or is paid any amounts with respect to the furnishing 
of such services.
    ``(2) The term `marriage and family therapist' means an individual 
who--
            ``(A) possesses a master's or doctoral degree which 
        qualifies for licensure or certification as a marriage and 
        family therapist pursuant to State law;
            ``(B) after obtaining such degree has performed at least 2 
        years of clinical supervised experience in marriage and family 
        therapy; and
            ``(C) in the case of an individual performing services in a 
        State that provides for licensure or certification of marriage 
        and family therapists, is licensed or certified as a marriage 
        and family therapist in such State.
    ``(3) The term `mental health counselor services' means services 
performed by a mental health counselor (as defined in paragraph (4)) 
for the diagnosis and treatment of mental illnesses which the mental 
health counselor is legally authorized to perform under State law (or 
the State regulatory mechanism provided by the State law) of the State 
in which such services are performed, as would otherwise be covered if 
furnished by a physician or as incident to a physician's professional 
service, but only if no facility or other provider charges or is paid 
any amounts with respect to the furnishing of such services.
    ``(4) The term `mental health counselor' means an individual who--
            ``(A) possesses a master's or doctor's degree in mental 
        health counseling or a related field;
            ``(B) after obtaining such a degree has performed at least 
        2 years of supervised mental health counselor practice; and
            ``(C) in the case of an individual performing services in a 
        State that provides for licensure or certification of mental 
        health counselors or professional counselors, is licensed or 
        certified as a mental health counselor or professional 
        counselor in such State.''.
            (3) Provision for payment under part b.--Section 
        1832(a)(2)(B) of such Act (42 U.S.C. 1395k(a)(2)(B)) is amended 
        by adding at the end the following new clause:
                            ``(v) marriage and family therapist 
                        services and mental health counselor 
                        services;''.
            (4) Amount of payment.--Section 1833(a)(1) of such Act (42 
        U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and (V)'' and inserting ``(V)''; 
                and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (W) with respect to marriage and 
                family therapist services and mental health counselor 
                services under section 1861(s)(2)(BB), the amounts paid 
                shall be 80 percent of the lesser of the actual charge 
                for the services or 75 percent of the amount determined 
                for payment of a psychologist under subparagraph (L)''.
            (5) Exclusion of marriage and family therapist services and 
        mental health counselor services from skilled nursing facility 
        prospective payment system.--Section 1888(e)(2)(A)(ii) of such 
        Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 
        ``marriage and family therapist services (as defined in section 
        1861(ccc)(1)), mental health counselor services (as defined in 
        section 1861(ccc)(3)),'' after ``qualified psychologist 
        services,''.
            (6) Inclusion of marriage and family therapists and mental 
        health counselors as practitioners for assignment of claims.--
        Section 1842(b)(18)(C) of such Act (42 U.S.C. 1395u(b)(18)(C)) 
        is amended by adding at the end the following new clauses:
            ``(vii) A marriage and family therapist (as defined in 
        section 1861(ccc)(2)).
            ``(viii) A mental health counselor (as defined in section 
        1861(ccc)(4)).''.
    (b) Coverage of Certain Mental Health Services Provided in Certain 
Settings.--
            (1) Rural health clinics and federally qualified health 
        centers.--Section 1861(aa)(1)(B) of the Social Security Act (42 
        U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a 
        clinical social worker (as defined in subsection (hh)(1)),'' 
        and inserting ``, by a clinical social worker (as defined in 
        subsection (hh)(1)), by a marriage and family therapist (as 
        defined in subsection (ccc)(2)), or by a mental health 
        counselor (as defined in subsection (ccc)(4)),''.
            (2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of 
        such Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by 
        inserting ``or one marriage and family therapist (as defined in 
        subsection (ccc)(2))'' after ``social worker''.
    (c) Authorization of Marriage and Family Therapists To Develop 
Discharge Plans for Post-Hospital Services.--Section 1861(ee)(2)(G) of 
the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by 
inserting ``marriage and family therapist (as defined in subsection 
(ccc)(2)),'' after ``social worker,''.
    (d) Effective Date.--The amendments made by this section shall 
apply with respect to services furnished on or after January 1, 2008.

SEC. 513. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) PROGRAM.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x), as amended by section 512, is amended by adding at the end of 
the following new subsection:

     ``Rural Community Hospital; Rural Community Hospital Services

    ``(ddd)(1) The term `rural community hospital' means a hospital (as 
defined in subsection (e)) that--
            ``(A) is located in a rural area (as defined in section 
        1886(d)(2)(D)) or treated as being so located pursuant to 
        section 1886(d)(8)(E);
            ``(B) subject to paragraph (2), has less than 51 acute care 
        inpatient beds, as reported in its most recent cost report;
            ``(C) makes available 24-hour emergency care services;
            ``(D) subject to paragraph (3), has a provider agreement in 
        effect with the Secretary and is open to the public as of 
        January 1, 2008; and
            ``(E) applies to the Secretary for such designation.
    ``(2) For purposes of paragraph (1)(B), beds in a psychiatric or 
rehabilitation unit of the hospital which is a distinct part of the 
hospital shall not be counted.
    ``(3) Subparagraph (1)(D) shall not be construed to prohibit any of 
the following from qualifying as a rural community hospital:
            ``(A) A replacement facility (as defined by the Secretary 
        in regulations in effect on January 1, 2008) with the same 
        service area (as defined by the Secretary in regulations in 
        effect on such date).
            ``(B) A facility obtaining a new provider number pursuant 
        to a change of ownership.
            ``(C) A facility which has a binding written agreement with 
        an outside, unrelated party for the construction, 
        reconstruction, lease, rental, or financing of a building as of 
        January 1, 2008.
    ``(4) Nothing in this subsection shall be construed as prohibiting 
a critical access hospital from qualifying as a rural community 
hospital if the critical access hospital meets the conditions otherwise 
applicable to hospitals under subsection (e) and section 1866.
    ``(5) Nothing in this subsection shall be construed as prohibiting 
a rural community hospital participating in the demonstration program 
under Section 410A of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2313) from 
qualifying as a rural community hospital if the rural community 
hospital meets the conditions otherwise applicable to hospitals under 
subsection (e) and section 1866.''.
    (b) Payment.--
            (1) Inpatient hospital services.--Section 1814 of the 
        Social Security Act (42 U.S.C. 1395f) is amended by adding at 
        the end the following new subsection:

``Payment for Inpatient Services Furnished in Rural Community Hospitals

    ``(m) The amount of payment under this part for inpatient hospital 
services furnished in a rural community hospital, other than such 
services furnished in a psychiatric or rehabilitation unit of the 
hospital which is a distinct part, is, at the election of the hospital 
in the application referred to in section 1861(ddd)(1)(E)--
            ``(1) 101 percent of the reasonable costs of providing such 
        services, without regard to the amount of the customary or 
        other charge, or
            ``(2) the amount of payment provided for under the 
        prospective payment system for inpatient hospital services 
        under section 1886(d).''.
            (2) Outpatient services.--Section 1834 of such Act (42 
        U.S.C. 1395m) is amended by adding at the end the following new 
        subsection:
    ``(n) Payment for Outpatient Services Furnished in Rural Community 
Hospitals.--The amount of payment under this part for outpatient 
services furnished in a rural community hospital is, at the election of 
the hospital in the application referred to in section 
1861(ddd)(1)(E)--
            ``(1) 101 percent of the reasonable costs of providing such 
        services, without regard to the amount of the customary or 
        other charge and any limitation under section 1861(v)(1)(U), or
            ``(2) the amount of payment provided for under the 
        prospective payment system for covered OPD services under 
        section 1833(t).''.
            (3) Exemption from 30-percent reduction in reimbursement 
        for bad debt.--Section 1861(v)(1)(T) of such Act (42 U.S.C. 
        1395x(v)(1)(T)) is amended by inserting ``(other than for a 
        rural community hospital)'' after ``In determining such 
        reasonable costs for hospitals''.
    (c) Beneficiary Cost-Sharing for Outpatient Services.--Section 
1834(n) of such Act (as added by subsection (b)(2)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively;
            (2) by inserting ``(1)'' after ``(n)''; and
            (3) by adding at the end the following:
    ``(2) The amounts of beneficiary cost-sharing for outpatient 
services furnished in a rural community hospital under this part shall 
be as follows:
            ``(A) For items and services that would have been paid 
        under section 1833(t) if provided by a hospital, the amount of 
        cost-sharing determined under paragraph (8) of such section.
            ``(B) For items and services that would have been paid 
        under section 1833(h) if furnished by a provider or supplier, 
        no cost-sharing shall apply.
            ``(C) For all other items and services, the amount of cost-
        sharing that would apply to the item or service under the 
        methodology that would be used to determine payment for such 
        item or service if provided by a physician, provider, or 
        supplier, as the case may be.''.
    (d) Conforming Amendments.--
            (1) Part a payment.--Section 1814(b) of such Act (42 U.S.C. 
        1395f(b)) is amended in the matter preceding paragraph (1) by 
        inserting ``other than inpatient hospital services furnished by 
        a rural community hospital,'' after ``critical access hospital 
        services,''.
            (2) Part b payment.--Section 1833(a) of such Act (42 U.S.C. 
        1395l(a)) is amended--
                    (A) in paragraph (2), in the matter before 
                subparagraph (A), by striking ``and (I)'' and inserting 
                ``(I), and (K)'';
                    (B) by striking ``and'' at the end of paragraph 
                (8);
                    (C) by striking the period at the end of paragraph 
                (9) and inserting ``; and''; and
                    (D) by adding at the end the following:
            ``(10) in the case of outpatient services furnished by a 
        rural community hospital, the amounts described in section 
        1834(n).''.
            (3) Technical amendments.--
                    (A) Consultation with state agencies.--Section 1863 
                of such Act (42 U.S.C. 1395z) is amended by striking 
                ``and (dd)(2)'' and inserting ``(dd)(2), (mm)(1), and 
                (ddd)(1)''.
                    (B) Provider agreements.--Section 1866(a)(2)(A) of 
                such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
                inserting ``section 1834(n)(2),'' after ``section 
                1833(b),''.
    (e) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after October 1, 2007.

SEC. 514. MEDICARE REMOTE MONITORING PILOT PROJECTS.

    (a) Pilot Projects.--
            (1) In general.--Not later than 9 months after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services (in this section referred to as the ``Secretary'') 
        shall conduct pilot projects under title XVIII of the Social 
        Security Act for the purpose of providing incentives to home 
        health agencies to utilize home monitoring and communications 
        technologies that--
                    (A) enhance health outcomes for Medicare 
                beneficiaries; and
                    (B) reduce expenditures under such title.
            (2) Site requirements.--
                    (A) Urban and rural.--The Secretary shall conduct 
                the pilot projects under this section in both urban and 
                rural areas.
                    (B) Site in a small state.--The Secretary shall 
                conduct at least 3 of the pilot projects in a State 
                with a population of less than 1,000,000.
            (3) Definition of home health agency.--In this section, the 
        term ``home health agency'' has the meaning given that term in 
        section 1861(o) of the Social Security Act (42 U.S.C. 
        1395x(o)).
    (b) Medicare Beneficiaries Within the Scope of Projects.--The 
Secretary shall specify the criteria for identifying those Medicare 
beneficiaries who shall be considered within the scope of the pilot 
projects under this section for purposes of the application of 
subsection (c) and for the assessment of the effectiveness of the home 
health agency in achieving the objectives of this section. Such 
criteria may provide for the inclusion in the projects of Medicare 
beneficiaries who begin receiving home health services under title 
XVIII of the Social Security Act after the date of the implementation 
of the projects.
    (c) Incentives.--
            (1) Performance targets.--The Secretary shall establish for 
        each home health agency participating in a pilot project under 
        this section a performance target using one of the following 
        methodologies, as determined appropriate by the Secretary:
                    (A) Adjusted historical performance target.--The 
                Secretary shall establish for the agency--
                            (i) a base expenditure amount equal to the 
                        average total payments made to the agency under 
                        parts A and B of title XVIII of the Social 
                        Security Act for Medicare beneficiaries 
                        determined to be within the scope of the pilot 
                        project in a base period determined by the 
                        Secretary; and
                            (ii) an annual per capita expenditure 
                        target for such beneficiaries, reflecting the 
                        base expenditure amount adjusted for risk and 
                        adjusted growth rates.
                    (B) Comparative performance target.--The Secretary 
                shall establish for the agency a comparative 
                performance target equal to the average total payments 
                under such parts A and B during the pilot project for 
                comparable individuals in the same geographic area that 
                are not determined to be within the scope of the pilot 
                project.
            (2) Incentive.--Subject to paragraph (3), the Secretary 
        shall pay to each participating home care agency an incentive 
        payment for each year under the pilot project equal to a 
        portion of the Medicare savings realized for such year relative 
        to the performance target under paragraph (1).
            (3) Limitation on expenditures.--The Secretary shall limit 
        incentive payments under this section in order to ensure that 
        the aggregate expenditures under title XVIII of the Social 
        Security Act (including incentive payments under this 
        subsection) do not exceed the amount that the Secretary 
        estimates would have been expended if the pilot projects under 
        this section had not been implemented.
    (d) Waiver Authority.--The Secretary may waive such provisions of 
titles XI and XVIII of the Social Security Act as the Secretary 
determines to be appropriate for the conduct of the pilot projects 
under this section.
    (e) Report to Congress.--Not later than 5 years after the date that 
the first pilot project under this section is implemented, the 
Secretary shall submit to Congress a report on the pilot projects. Such 
report shall contain a detailed description of issues related to the 
expansion of the projects under subsection (f) and recommendations for 
such legislation and administrative actions as the Secretary considers 
appropriate.
    (f) Expansion.--If the Secretary determines that any of the pilot 
projects under this section enhance health outcomes for Medicare 
beneficiaries and reduce expenditures under title XVIII of the Social 
Security Act, the Secretary may initiate comparable projects in 
additional areas.
    (g) Incentive Payments Have No Effect on Other Medicare Payments to 
Agencies.--An incentive payment under this section--
            (1) shall be in addition to the payments that a home health 
        agency would otherwise receive under title XVIII of the Social 
        Security Act for the provision of home health services; and
            (2) shall have no effect on the amount of such payments.

SEC. 515. RURAL HEALTH QUALITY ADVISORY COMMISSION AND DEMONSTRATION 
              PROJECTS.

    (a) Rural Health Quality Advisory Commission.--
            (1) Establishment.--Not later than 6 months after the date 
        of the enactment of this section, the Secretary of Health and 
        Human Services (in this section referred to as the 
        ``Secretary'') shall establish a commission to be known as the 
        Rural Health Quality Advisory Commission (in this section 
        referred to as the ``Commission'').
            (2) Duties of commission.--
                    (A) National plan.--The Commission shall develop, 
                coordinate, and facilitate implementation of a national 
                plan for rural health quality improvement. The national 
                plan shall--
                            (i) identify objectives for rural health 
                        quality improvement;
                            (ii) identify strategies to eliminate known 
                        gaps in rural health system capacity and 
                        improve rural health quality; and
                            (iii) provide for Federal programs to 
                        identify opportunities for strengthening and 
                        aligning policies and programs to improve rural 
                        health quality.
                    (B) Demonstration projects.--The Commission shall 
                design demonstration projects to test alternative 
                models for rural health quality improvement, including 
                with respect to both personal and population health.
                    (C) Monitoring.--The Commission shall monitor 
                progress toward the objectives identified pursuant to 
                paragraph (1)(A).
            (3) Membership.--
                    (A) Number.--The Commission shall be composed of 11 
                members appointed by the Secretary.
                    (B) Selection.--The Secretary shall select the 
                members of the Commission from among individuals with 
                significant rural health care and health care quality 
                expertise, including expertise in clinical health care, 
                health care quality research, population or public 
                health, or purchaser organizations.
            (4) Contracting authority.--Subject to the availability of 
        funds, the Commission may enter into contracts and make other 
        arrangements, as may be necessary to carry out the duties 
        described in paragraph (2).
            (5) Staff.--Upon the request of the Commission, the 
        Secretary may detail, on a reimbursable basis, any of the 
        personnel of the Office of Rural Health Policy of the Health 
        Resources and Services Administration, the Agency for Health 
        Care Quality and Research, or the Centers for Medicare & 
        Medicaid Services to the Commission to assist in carrying out 
        this subsection.
            (6) Reports to congress.--Not later than 1 year after the 
        establishment of the Commission, and annually thereafter, the 
        Commission shall submit a report to the Congress on rural 
        health quality. Each such report shall include the following:
                    (A) An inventory of relevant programs and 
                recommendations for improved coordination and 
                integration of policy and programs.
                    (B) An assessment of achievement of the objectives 
                identified in the national plan developed under 
                paragraph (2) and recommendations for realizing such 
                objectives.
                    (C) Recommendations on Federal legislation, 
                regulations, or administrative policies to enhance 
                rural health quality and outcomes.
    (b) Rural Health Quality Demonstration Projects.--
            (1) In general.--Not later than 270 days after the date of 
        the enactment of this section, the Secretary, in consultation 
        with the Rural Health Quality Advisory Commission, the Office 
        of Rural Health Policy of the Health Resources and Services 
        Administration, the Agency for Healthcare Research and Quality, 
        and the Centers for Medicare & Medicaid Services, shall 
        make grants to eligible entities for 5 demonstration projects 
        to implement and evaluate methods for improving the quality of 
        health care in rural communities. Each such demonstration 
        project shall include--
                    (A) alternative community models that--
                            (i) will achieve greater integration of 
                        personal and population health services; and
                            (ii) address safety, effectiveness, 
                        patient- or community-centeredness, timeliness, 
                        efficiency, and equity (the six aims identified 
                        by the Institute of Medicine of the National 
                        Academies in its report entitled ``Crossing the 
                        Quality Chasm: A New Health System for the 21st 
                        Century'' released on March 1, 2001);
                    (B) innovative approaches to the financing and 
                delivery of health services to achieve rural health 
                quality goals; and
                    (C) development of quality improvement support 
                structures to assist rural health systems and 
                professionals (such as workforce support structures, 
                quality monitoring and reporting, clinical care 
                protocols, and information technology applications).
            (2) Eligible entities.--In this subsection, the term 
        ``eligible entity'' means a consortium that--
                    (A) shall include--
                            (i) at least one health care provider or 
                        health care delivery system located in a rural 
                        area; and
                            (ii) at least one organization representing 
                        multiple community stakeholders; and
                    (B) may include other partners such as rural 
                research centers.
            (3) Consultation.--In developing the program for awarding 
        grants under this subsection, the Secretary shall consult with 
        the Administrator of the Agency for Healthcare Research and 
        Quality, rural health care providers, rural health care 
        researchers, and private and non-profit groups (including 
        national associations) which are undertaking similar efforts.
            (4) Expedited waivers.--The Secretary shall expedite the 
        processing of any waiver that--
                    (A) is authorized under title XVIII or XIX of the 
                Social Security Act (42 U.S.C. 1395 et seq.); and
                    (B) is necessary to carry out a demonstration 
                project under this subsection.
            (5) Demonstration project sites.--The Secretary shall 
        ensure that the 5 demonstration projects funded under this 
        subsection are conducted at a variety of sites representing the 
        diversity of rural communities in the Nation.
            (6) Duration.--Each demonstration project under this 
        subsection shall be for a period of 4 years.
            (7) Independent evaluation.--The Secretary shall enter into 
        an arrangement with an entity that has experience working 
        directly with rural health systems for the conduct of an 
        independent evaluation of the program carried out under this 
        subsection.
            (8) Report.--Not later than one year after the conclusion 
        of all of the demonstration projects funded under this 
        subsection, the Secretary shall submit a report to the Congress 
        on the results of such projects. The report shall include--
                    (A) an evaluation of patient access to care, 
                patient outcomes, and an analysis of the cost 
                effectiveness of each such project; and
                    (B) recommendations on Federal legislation, 
                regulations, or administrative policies to enhance 
                rural health quality and outcomes.
    (c) Appropriation.--
            (1) In general.--Out of funds in the Treasury not otherwise 
        appropriated, there are appropriated to the Secretary to carry 
        out this section $30,000,000 for the period of fiscal years 
        2008 through 2012.
            (2) Availability.--
                    (A) In general.--Funds appropriated under paragraph 
                (1) shall remain available for expenditure through 
                fiscal year 2012.
                    (B) Report.--For purposes of carrying out 
                subsection (b)(8), funds appropriated under paragraph 
                (1) shall remain available for expenditure through 
                fiscal year 2013.
            (3) Reservation.--Of the amount appropriated under 
        paragraph (1), the Secretary shall reserve--
                    (A) $5,000,000 to carry out subsection (a); and
                    (B) $25,000,000 to carry out subsection (b), of 
                which--
                            (i) 2 percent shall be for the provision of 
                        technical assistance to grant recipients; and
                            (ii) 5 percent shall be for independent 
                        evaluation under subsection (b)(7).

SEC. 516. RURAL HEALTH CARE SERVICES.

    Section 330A of the Public Health Service Act (42 U.S.C. 254c) is 
amended to read as follows:

``SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK 
              DEVELOPMENT, DELTA RURAL DISPARITIES AND HEALTH SYSTEMS 
              DEVELOPMENT, AND SMALL RURAL HEALTH CARE PROVIDER QUALITY 
              IMPROVEMENT GRANT PROGRAMS.

    ``(a) Purpose.--The purpose of this section is to provide for 
grants--
            ``(1) under subsection (b), to promote rural health care 
        services outreach;
            ``(2) under subsection (c), to provide for the planning and 
        implementation of integrated health care networks in rural 
        areas;
            ``(3) under subsection (d), to assist rural communities in 
        the Delta Region to reduce health disparities and to promote 
        and enhance health system development; and
            ``(4) under subsection (e), to provide for the planning and 
        implementation of small rural health care provider quality 
        improvement activities.
    ``(b) Rural Health Care Services Outreach Grants.--
            ``(1) Grants.--The Director of the Office of Rural Health 
        Policy of the Health Resources and Services Administration may 
        award grants to eligible entities to promote rural health care 
        services outreach by expanding the delivery of health care 
        services to include new and enhanced services in rural areas. 
        The Director may award the grants for periods of not more than 
        3 years.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection for a project, an entity--
                    ``(A) shall be a rural public or rural nonprofit 
                private entity, a facility that qualifies as a rural 
                health clinic under title XVIII of the Social Security 
                Act, a public or nonprofit entity existing exclusively 
                to provide services to migrant and seasonal farm 
                workers in rural areas, or a tribal government whose 
                grant-funded activities will be conducted within 
                federally recognized tribal areas;
                    ``(B) shall represent a consortium composed of 
                members--
                            ``(i) that include 3 or more independently-
                        owned health care entities; and
                            ``(ii) that may be nonprofit or for-profit 
                        entities; and
                    ``(C) shall not previously have received a grant 
                under this subsection for the same or a similar 
                project, unless the entity is proposing to expand the 
                scope of the project or the area that will be served 
                through the project.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Director an application at such time, in such 
        manner, and containing such information as the Director may 
        require, including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) a description of the manner in which the 
                project funded under the grant will meet the health 
                care needs of rural populations in the local community 
                or region to be served;
                    ``(C) a plan for quantifying how health care needs 
                will be met through identification of the target 
                population and benchmarks of service delivery or health 
                status, such as--
                            ``(i) quantifiable measurements of health 
                        status improvement for projects focusing on 
                        health promotion; or
                            ``(ii) benchmarks of increased access to 
                        primary care, including tracking factors such 
                        as the number and type of primary care visits, 
                        identification of a medical home, or other 
                        general measures of such access;
                    ``(D) a description of how the local community or 
                region to be served will be involved in the development 
                and ongoing operations of the project;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated;
                    ``(G) the administrative capacity to submit annual 
                performance data electronically as specified by the 
                Director; and
                    ``(H) other such information as the Director 
                determines to be appropriate.
    ``(c) Rural Health Network Development Grants.--
            ``(1) Grants.--
                    ``(A) In general.--The Director may award rural 
                health network development grants to eligible entities 
                to promote, through planning and implementation, the 
                development of integrated health care networks that 
                have combined the functions of the entities 
                participating in the networks in order to--
                            ``(i) achieve efficiencies and economies of 
                        scale;
                            ``(ii) expand access to, coordinate, and 
                        improve the quality of the health care delivery 
                        system through development of organizational 
                        efficiencies;
                            ``(iii) implement health information 
                        technology to achieve efficiencies, reduce 
                        medical errors, and improve quality;
                            ``(iv) coordinate care and manage chronic 
                        illness; and
                            ``(v) strengthen the rural health care 
                        system as a whole in such a manner as to show a 
                        quantifiable return on investment to the 
                        participants in the network.
                    ``(B) Grant periods.--The Director may award such a 
                rural health network development grant--
                            ``(i) for a period of 3 years for 
                        implementation activities; or
                            ``(ii) for a period of 1 year for planning 
                        activities to assist in the initial development 
                        of an integrated health care network, if the 
                        proposed participants in the network do not 
                        have a history of collaborative efforts and a 
                        3-year grant would be inappropriate.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection, an entity--
                    ``(A) shall be a rural public or rural nonprofit 
                private entity, a facility that qualifies as a rural 
                health clinic under title XVIII of the Social Security 
                Act, a public or nonprofit entity existing exclusively 
                to provide services to migrant and seasonal farm 
                workers in rural areas, or a tribal government whose 
                grant-funded activities will be conducted within 
                federally recognized tribal areas;
                    ``(B) shall represent a network composed of 
                participants--
                            ``(i) that include 3 or more independently-
                        owned health care entities; and
                            ``(ii) that may be nonprofit or for-profit 
                        entities; and
                    ``(C) shall not previously have received a grant 
                under this subsection (other than a 1-year grant for 
                planning activities) for the same or a similar project.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity, in consultation with 
        the appropriate State office of rural health or another 
        appropriate State entity, shall prepare and submit to the 
        Director an application at such time, in such manner, and 
        containing such information as the Director may require, 
        including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of--
                            ``(i) the history of collaborative 
                        activities carried out by the participants in 
                        the network;
                            ``(ii) the degree to which the participants 
                        are ready to integrate their functions; and
                            ``(iii) how the local community or region 
                        to be served will benefit from and be involved 
                        in the activities carried out by the network;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services across the continuum of 
                care as a result of the integration activities carried 
                out by the network, including a description of--
                            ``(i) return on investment for the 
                        community and the network members; and
                            ``(ii) other quantifiable performance 
                        measures that show the benefit of the network 
                        activities;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated;
                    ``(G) the administrative capacity to submit annual 
                performance data electronically as specified by the 
                Director; and
                    ``(H) other such information as the Director 
                determines to be appropriate.
    ``(d) Delta Rural Disparities and Health Systems Development 
Grants.--
            ``(1) Grants.--The Director may award grants to eligible 
        entities to support reduction of health disparities, improve 
        access to health care, and enhance rural health system 
        development in the Delta Region.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        this subsection, an entity shall be a rural public or rural 
        nonprofit private entity, a facility that qualifies as a rural 
        health clinic under title XVIII of the Social Security Act, a 
        public or nonprofit entity existing exclusively to provide 
        services to migrant and seasonal farm workers in rural areas, 
        or a tribal government whose grant-funded activities will be 
        conducted within federally recognized tribal areas.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Director an application at such time, in such 
        manner, and containing such information as the Director may 
        require, including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of the manner in which the 
                project funded under the grant will meet the health 
                care needs of the Delta Region;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services as a result of the 
                activities carried out by the entity;
                    ``(E) a description of how health disparities will 
                be reduced or the health system will be improved;
                    ``(F) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(G) a description of how the project will be 
                evaluated including process and outcome measures 
                related to the quality of care provided or how the 
                health care system improves its performance;
                    ``(H) a description of how the grantee will develop 
                an advisory group made up of representatives of the 
                communities to be served to provide guidance to the 
                grantee to best meet community need; and
                    ``(I) other such information as the Director 
                determines to be appropriate.
    ``(e) Small Rural Health Care Provider Quality Improvement 
Grants.--
            ``(1) Grants.--The Director may award grants to provide for 
        the planning and implementation of small rural health care 
        provider quality improvement activities. The Director may award 
        the grants for periods of 1 to 3 years.
            ``(2) Eligibility.--To be eligible for a grant under this 
        subsection, an entity--
                    ``(A) shall be--
                            ``(i) a rural public or rural nonprofit 
                        private health care provider or provider of 
                        health care services, such as a rural health 
                        clinic; or
                            ``(ii) another rural provider or network of 
                        small rural providers identified by the 
                        Director as a key source of local care; and
                    ``(B) shall not previously have received a grant 
                under this subsection for the same or a similar 
                project.
            ``(3) Preference.--In awarding grants under this 
        subsection, the Director shall give preference to facilities 
        that qualify as rural health clinics under title XVIII of the 
        Social Security Act.
            ``(4) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Director an application at such time, in such 
        manner, and containing such information as the Director may 
        require, including--
                    ``(A) a description of the project that the 
                eligible entity will carry out using the funds provided 
                under the grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of the manner in which the 
                project funded under the grant will assure continuous 
                quality improvement in the provision of services by the 
                entity;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services as a result of the 
                activities carried out by the entity;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated including process and outcome measures 
                related to the quality of care provided; and
                    ``(G) other such information as the Director 
                determines to be appropriate.
    ``(f) General Requirements.--
            ``(1) Prohibited uses of funds.--An entity that receives a 
        grant under this section may not use funds provided through the 
        grant--
                    ``(A) to build or acquire real property; or
                    ``(B) for construction.
            ``(2) Coordination with other agencies.--The Director shall 
        coordinate activities carried out under grant programs 
        described in this section, to the extent practicable, with 
        Federal and State agencies and nonprofit organizations that are 
        operating similar grant programs, to maximize the effect of 
        public dollars in funding meritorious proposals.
    ``(g) Report.--Not later than September 30, 2010, the Secretary 
shall prepare and submit to the appropriate committees of Congress a 
report on the progress and accomplishments of the grant programs 
described in subsections (b), (c), (d), and (e).
    ``(h) Definitions.--In this section:
            ``(1) The term `Delta Region' has the meaning given to the 
        term `region' in section 382A of the Consolidated Farm and 
        Rural Development Act (7 U.S.C. 2009aa).
            ``(2) The term `Director' means the Director of the Office 
        of Rural Health Policy of the Health Resources and Services 
        Administration.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $40,000,000 for fiscal year 
2008, and such sums as may be necessary for each of fiscal years 2009 
through 2012.''.

SEC. 517. COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.

    Section 330 of the Public Health Service Act (42 U.S.C. 254b) is 
amended by adding at the end the following:
    ``(s) Miscellaneous Provisions.--
            ``(1) Rule of construction with respect to rural health 
        clinics.--
                    ``(A) In general.--Nothing in this section shall be 
                construed to prevent a community health center from 
                contracting with a federally certified rural health 
                clinic (as defined by section 1861(aa)(2) of the Social 
                Security Act) for the delivery of primary health care 
                services that are available at the rural health clinic 
                to individuals who would otherwise be eligible for free 
                or reduced cost care if that individual were able to 
                obtain that care at the community health center. Such 
                services may be limited in scope to those primary 
                health care services available in that rural health 
                clinic.
                    ``(B) Assurances.--In order for a rural health 
                clinic to receive funds under this section through a 
                contract with a community health center under paragraph 
                (1), such rural health clinic shall establish policies 
                to ensure--
                            ``(i) nondiscrimination based upon the 
                        ability of a patient to pay; and
                            ``(ii) the establishment of a sliding fee 
                        scale for low-income patients.''.

SEC. 518. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS 
              STATE LINES.

    (a) In General.--For purposes of expediting the provision of 
telehealth services, for which payment is made under the Medicare 
program, across State lines, the Secretary of Health and Human Services 
shall, in consultation with representatives of States, physicians, 
health care practitioners, and patient advocates, encourage and 
facilitate the adoption of provisions allowing for multistate 
practitioner practice across State lines.
    (b) Definitions.--In subsection (a):
            (1) Telehealth service.--The term ``telehealth service'' 
        has the meaning given that term in subparagraph (F) of section 
        1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
            (2) Physician, practitioner.--The terms ``physician'' and 
        ``practitioner'' have the meaning given those terms in 
        subparagraphs (D) and (E), respectively, of such section.
            (3) Medicare program.--The term ``Medicare program'' means 
        the program of health insurance administered by the Secretary 
        of Health and Human Services under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
                                 <all>