[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3090 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3090

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2009

Mrs. Christensen (for herself, Mr. Davis of Illinois, Ms. Bordallo, Ms. 
  Roybal-Allard, Mr. Clyburn, Mr. Rangel, Ms. Lee of California, Mr. 
 Honda, Mr. Cummings, Ms. Jackson-Lee of Texas, Ms. Clarke, Mr. Watt, 
 Mr. Clay, Mr. Thompson of Mississippi, Mr. Meek of Florida, Ms. Eddie 
    Bernice Johnson of Texas, Mr. Al Green of Texas, Mr. Johnson of 
Georgia, Mr. Cleaver, Mr. Ellison, Ms. Watson, Mr. Jackson of Illinois, 
    Mr. Carson of Indiana, Mr. Towns, Ms. Fudge, Ms. Kilpatrick of 
   Michigan, Ms. Richardson, Ms. Baldwin, Mr. Fattah, Mr. Bishop of 
 Georgia, Mr. Scott of Georgia, Mr. Payne, Mr. Meeks of New York, Mr. 
Grijalva, Mr. Scott of Virginia, Mr. Davis of Alabama, Mr. Grayson, Ms. 
   Edwards of Maryland, Ms. Moore of Wisconsin, Ms. Corrine Brown of 
  Florida, Ms. Waters, Ms. Hirono, Ms. DeGette, Mr. Faleomavaega, Ms. 
Matsui, Mr. Lewis of Georgia, Mr. Gonzalez, Mr. Sablan, Mr. Pierluisi, 
    Mr. Reyes, Mr. Ortiz, Ms. Velazquez, Mr. Lujan, Mr. Hastings of 
  Florida, and Mr. Cuellar) 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, the Judiciary, 
Natural Resources, Armed Services, Veterans' Affairs, and Agriculture, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To improve the health of minority individuals, 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 2009''.

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. Federal reimbursement for culturally and linguistically 
                            appropriate services under the Medicare, 
                            Medicaid and the State Children's Health 
                            Insurance Program.
Sec. 103. Increasing understanding of and improving health literacy.
Sec. 104. Assurances for receiving Federal funds.
Sec. 105. Report on Federal efforts to provide culturally and 
                            linguistically appropriate health care 
                            services.
Sec. 106. English for speakers of other languages.
Sec. 107. Definition.
Sec. 108. Treatment of the Medicare part B program under title VI of 
                            the Civil Rights Act of 1964.
Sec. 109. Implementation.
                  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. Hispanic-Serving Health Professions Schools.
Sec. 205. Health professions student loan fund; authorizations of 
                            appropriations regarding students from 
                            disadvantaged backgrounds.
Sec. 206. National Health Service Corps; recruitment and fellowships 
                            for individuals from disadvantaged 
                            backgrounds.
Sec. 207. Loan repayment program of Centers for Disease Control and 
                            Prevention.
Sec. 208. Cooperative agreements for online degree programs at schools 
                            of public health and schools of allied 
                            health.
Sec. 209. Mid-care health professions scholarship program.
Sec. 210. National report on the preparedness of health professionals 
                            to care for diverse populations.
Sec. 211. Scholarship and fellowship programs.
Sec. 212. Advisory Committee on Health Professions Training for 
                            Diversity.
Sec. 213. McNair Postbaccalaureate Achievement Program.
                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.
Sec. 312. Survey questions on sexual orientation and gender identity.
Sec. 313. Disaggregation of comparative effectiveness research data.
                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. Prohibition on discrimination in Federal assisted health care 
                            services and research programs on the basis 
                            of sex, race, color, national origin, 
                            sexual orientation, gender identity, or 
                            disability status.
Sec. 403. Accountability within the Department of Health and Human 
                            Services.
Sec. 404. Office of Minority Health.
Sec. 405. Establishment of the Indian Health Service as an agency of 
                            the Public Health Service.
Sec. 406. Establishment of individual offices of minority health within 
                            agencies of the Public Health Service.
Sec. 407. Office of Minority Health at the Centers for Medicare & 
                            Medicaid Services.
Sec. 408. Office of Minority Affairs at the Food and Drug 
                            Administration.
Sec. 409. Safety and effectiveness of drugs with respect to racial and 
                            ethnic background.
Sec. 410. United States Commission on Civil Rights.
Sec. 411. Sense of Congress concerning full funding of activities to 
                            eliminate racial and ethnic health 
                            disparities.
Sec. 412. Guidelines for disease screening for minority patients.
Sec. 413. National Institute for Minority Health and Health 
                            Disparities.
Sec. 414. IOM report on LGBT health disparities.
              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

                  Subtitle A--Health Empowerment Zones

Sec. 501. Short title.
Sec. 502. Findings.
Sec. 503. Designation of health empowerment zones.
Sec. 504. Assistance to those seeking designation.
Sec. 505. Benefits of designation.
Sec. 506. Definition.
Sec. 507. Authorization of appropriations.
         Subtitle B--Other Improvements of Health Care Services

                         Chapter 1--In General

Sec. 511. Amendment to the Public Health Service Act.
Sec. 512. Medicaid payment for certain aliens.
Sec. 513. Medicaid payment parity for the territories.
Sec. 514. Extension of Medicare secondary payer.
Sec. 515. Border health grants.
Sec. 516. Cancer prevention and treatment demonstration for ethnic and 
                            racial minorities.
Sec. 517. Grants to promote positive health behaviors in women and 
                            children.
Sec. 518. Exception for citizens of freely associated States.
Sec. 519. Medicare graduate medical education.
Sec. 520. HIV/AIDS reduction in racial and ethnic minority communities.
Sec. 521. Grants for racial and ethnic approaches to community health.
Sec. 522. Critical access hospital improvements.
Sec. 523. Coverage of marriage and family therapist services and mental 
                            health counselor services under part B of 
                            the Medicare program.
Sec. 524. Establishment of rural community hospital (RCH) program.
Sec. 525. Medicare remote monitoring pilot projects.
Sec. 526. Rural health quality advisory commission and demonstration 
                            projects.
Sec. 527. Rural health care services.
Sec. 528. Community health center collaborative access expansion.
Sec. 529. Facilitating the provision of telehealth services across 
                            State lines.
Sec. 530. Removing barriers to health care and nutrition assistance 
                            health coverage for children, pregnant 
                            women, and lawfully residing individuals.
Sec. 531. Removing Medicare barrier to health care.
               Chapter 2--Lung Cancer Mortality Reduction

Sec. 541. Short title.
Sec. 542. Findings.
Sec. 543. Sense of Congress concerning investment in lung cancer 
                            research.
Sec. 544. Lung Cancer Mortality Reduction Program.
Sec. 545. Department of defense and the department of veterans affairs.
Sec. 546. Lung cancer advisory board.
Sec. 547. Authorization of appropriations.
  TITLE VI--ELIMINATING DISPARITIES IN DIABETES PREVENTION ACCESS AND 
                                CARE ACT

               Subtitle A--NATIONAL INSTITUTES OF HEALTH

Sec. 611. Research, treatment, and education.
         Subtitle B--CENTERS FOR DISEASE CONTROL AND PREVENTION

Sec. 621. Research, education, and other activities.
        Subtitle C--HEALTH RESOURCES AND SERVICES ADMINISTRATION

Sec. 631. Research, education, and other activities.
                    Subtitle D--ADDITIONAL PROGRAMS

Sec. 641. Research, education, and other activities.

     TITLE I--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE

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

    (a) Findings.--Congress finds the following:
            (1) Effective communication is essential to meaningful 
        access to quality physical and mental health care.
            (2) Research establishes that the lack of language services 
        creates barriers to and diminishes the quality of health care 
        and health status for limited English proficient individuals.
            (3) The number of limited English speaking residents in the 
        United States who speak English less than very well and, 
        therefore, cannot effectively communicate with health and 
        social service providers continues to increase significantly.
            (4) The responsibility to fund language services in the 
        provision of health care and health care-related services to 
        limited English proficient individuals is a societal one that 
        cannot fairly be visited solely upon the health care, public 
        health or social services community.
            (5) Linguistic diversity in the health care and health 
        care-related services workforce is important for providing all 
        patients the environment most conducive to positive health 
        outcomes.
            (6) All members of the health care and health care-related 
        services community should continue to educate their staff and 
        constituents about limited English proficient issues and help 
        them identify resources to improve access to quality care for 
        limited English proficient individuals.
            (7) Access to English as a Second Language instruction is 
        an important mechanism for ensuring effective communication and 
        eliminating the language barriers that impede access to health 
        care.
            (8) Competent languages services in health care settings 
        should be available as a matter of course.
    (b) Amendment.--The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following:

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

``SEC. 3100. DEFINITIONS.

    ``In this title:
            ``(1) Bilingual.--The term `bilingual' with respect to an 
        individual means a person who has sufficient degree of 
        proficiency in two languages.
            ``(2) Competent interpreter services.--The term `competent 
        interpreter services' means a trans-language rendition of a 
        spoken message in which the interpreter comprehends the source 
        language and can speak comprehensively in the target language 
        to convey the meaning intended in the source language. The 
        interpreter knows health and health-related terminology and 
        provides accurate interpretations by choosing equivalent 
        expressions that convey the best matching and meaning to the 
        source language and captures, to the greatest possible extent, 
        all nuances intended in the source message.
            ``(3) Competent translation services.--The term `competent 
        translation services' means a trans-language rendition of a 
        written document in which the translator comprehends the source 
        language and can write comprehensively in the target language 
        to convey the meaning intended in the source language. The 
        translator knows health and health-related terminology and 
        provides accurate translations by choosing equivalent 
        expressions that convey the best matching and meaning to the 
        source language and captures, to the greatest possible extent, 
        all nuances intended in the source document.
            ``(4) Effective communication.--The term `effective 
        communication' means an exchange of information between the 
        provider of health care or health care-related services and the 
        limited English proficient recipient of such services that 
        enables limited English proficient individuals to access, 
        understand, and benefit from health care or health care-related 
        services.
            ``(5) Grievance resolution process.--The term `grievance 
        resolution process' means all aspects of dispute resolution 
        including filing complaints, grievance and appeal procedures 
        and court action.
            ``(6) Health care group.--The term `health care group' 
        means a group of physicians organized, at least in part, for 
        the purposes of providing physicians' services under the 
        Medicaid, SCHIP, or Medicare programs and may include a 
        hospital and any other individual or entity furnishing services 
        covered under the Medicaid, SCHIP or Medicare programs that is 
        affiliated with the health care group.
            ``(7) Health care services.--The term `health care 
        services' means services that address physical as well as 
        mental health conditions in all care settings.
            ``(8) Health care-related services.--The term `health care-
        related services' means human or social services programs or 
        activities that provide access, referrals or links to health 
        care.
            ``(9) 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.
            ``(10) Integrated health care delivery system.--The term 
        `integrated health care delivery system' means a system 
        comprised of more than one type of health care provider for the 
        purposes of providing a. The providers may include hospitals, 
        clinics, home health agencies, ambulatory surgery centers, 
        skilled nursing facilities, rehabilitation facilities and 
        clinics, and employed, independent or contracted physicians.
            ``(11) Interpreting/interpretation.--The terms 
        `interpreting' and `interpretation' mean the transmission of a 
        spoken message from one language into another, faithfully, 
        accurately, and objectively.
            ``(12) Language access.--The term `language access' means 
        the provision of language services to an LEP individual 
        designed to enhance that individual's access to, understanding 
        of or benefit from health care or health care-related services.
            ``(13) Language services.--The term `language services' 
        means provision of healthcare services directly in a non-
        English language, interpretation, translation and non-English 
        signage.
            ``(14) LEP.--The term `LEP' means limited English 
        proficient.
            ``(15) LEP related data collection activities.--The term 
        `LEP related data collection activities' includes identifying, 
        collecting, storing, tracking, and analyzing primary language 
        data, and information on the methods used to meet the language 
        access needs of limited English proficient individuals.
            ``(16) Medicare, medicaid, and schip.--The terms 
        `Medicare', `Medicaid', and `SCHIP' means the respective 
        programs under titles XVIII, XIX, and XXI of the Social 
        Security Act.
            ``(17) 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.
            ``(18) Minority group.--The term `minority group' has the 
        meaning given the term `racial and ethnic minority group'.
            ``(19) 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.
            ``(20) On-site interpreting/interpretation.--The term `on-
        site interpreting/interpretation' means a method of 
        interpreting/interpretation for which the interpreter is in the 
        physical presence of the provider of health care or health 
        care-related services and the limited English proficient 
        recipient of such services.
            ``(21) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(22) Sight translation.--The term `sight translation' 
        means the transmission of a written message in one language 
        into a spoken message in another language.
            ``(23) State.--The term `State' means each of the several 
        states, the District of Columbia, the Commonwealth of Puerto 
        Rico, the Indian tribes, the U.S. Virgin Islands, Guam, 
        American Samoa, and the Commonwealth of the Northern Mariana 
        Islands.
            ``(24) Telephonic interpretation.--The term `telephonic 
        interpretation' (also known as over the phone interpretation or 
        OPI) means a method of interpreting/interpretation for which 
        the interpreter is not in the physical presence of the provider 
        of health care or related services and the limited English 
        proficient recipient of such services but is connected via 
        telephone.
            ``(25) Translation.--The term `translation' means the 
        transmission of a written message in one language into a 
        written message in another language.
            ``(26) Video interpretation.--The term `video 
        interpretation' means a method of interpreting/interpretation 
        for which the interpreter is not in the physical presence of 
        the provider of health care or related services and the limited 
        English proficient recipient of such services but is connected 
        via a video hook-up that includes both audio and video 
        transmission.
            ``(27) Vital document.--The term `vital document' includes 
        but is not limited to applications for government programs that 
        provide health care services; medical or financial consent 
        forms; financial assistance documents, letters containing 
        important information regarding patient instructions (e.g., 
        prescriptions, referrals to other providers, discharge plans) 
        and participation in a program (such as a Medicaid managed care 
        program); notices pertaining to the reduction, denial or 
        termination of services or benefits; notices of the right to 
        appeal such actions; and notices advising limited English 
        proficient individuals of the availability of free language 
        services, and other outreach materials.

``SEC. 3101. 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 Federal agency performance regarding 
        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. Each Federal agency must ensure that 
        such plan is fully implemented not later than one year after 
        the date of enactment of this Act.
            ``(2) Plan requirement.--Each plan under paragraph (1) 
        shall include--
                    ``(A) the steps the agency will take to ensure that 
                limited English proficient individuals have access to 
                the agency's federally conducted health care and health 
                care-related programs and activities;
                    ``(B) the policies and procedures for identifying, 
                assessing, and meeting the language needs of its 
                limited English proficient beneficiaries served by 
                federally conducted programs and activities;
                    ``(C) the steps the agency will take for its 
                federally conducted programs and activities to provide 
                a range of language assistance options, notice to 
                limited English proficient individuals of the right to 
                competent language services, periodic training of 
                staff, monitoring and quality assessment of the 
                language services and, in appropriate circumstances, 
                the translation of written materials;
                    ``(D) the steps the agency will take to ensure that 
                applications, forms, and other relevant documents for 
                its federally conducted programs and activities are 
                competently translated into the primary language of a 
                limited English proficient client where such materials 
                are needed to improve access to federally conducted and 
                federally assisted programs and activities for such a 
                limited English proficient individual; and
                    ``(E) the resources the agency will provide to 
                assist recipients of Federal funds to improve access to 
                health care or health care related programs and 
                activities for limited English proficient individuals.
        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. 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 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 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 and 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 
        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;
                    ``(B) particular needs of the limited English 
                proficient individuals served by the agency's 
                recipients of Federal financial assistance; and
                    ``(C) burdens of compliance with the agency 
                guidance and this section for the agency and its 
                recipients.

``SEC. 3102. 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. 3103. ROBERT T. MATSUI CENTER FOR CULTURAL AND LINGUISTIC 
              COMPETENCE IN HEALTH CARE.

    ``(a) Establishment.--The Secretary, acting through the Director of 
the Agency for Healthcare Research and Quality, 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) Interpretation services.--The Center shall provide 
        resources via the Internet to identify and link health care 
        providers to competent interpreter and translation services.
            ``(2) Translation of written material.--
                    ``(A) The Center shall provide, directly or through 
                contract, vital documents from competent translation 
                services for providers of health care and health care-
                related services at no cost to such providers. 
                Materials may be submitted for translation into non-
                English languages. Translation services shall be 
                provided in a timely and reasonable manner and in 
                accordance with the guidelines and standards set forth 
                in subsection (c) when such standards become available. 
                The quality of such translation services shall be 
                monitored and reported publicly.
                    ``(B) For each form developed or revised by the 
                Secretary that will be used by LEP individuals in 
                health care or health care-related settings, the Center 
                shall translate the form, at a minimum, into the top 15 
                non-English languages in the United States according to 
                the most recent data from the American Community Survey 
                or its replacement. The translation must be completed 
                within 45 days of the Secretary receiving final 
                approval of the form from the Office of Management and 
                Budget.
            ``(3) Toll-free customer service telephone number.--The 
        Center shall provide, through a toll-free number, a customer 
        service line for LEP individuals--
                    ``(A) to obtain information about federally 
                conducted or funded health programs, including 
                Medicare, Medicaid, and SCHIP;
                    ``(B) to obtain assistance with applying for or 
                accessing these programs and understanding Federal 
                notices written in English; and
                    ``(C) to learn how to access language services.
            ``(4) Health information clearinghouse.--
                    ``(A) In general.--The Center shall develop and 
                maintain an information clearinghouse to facilitate the 
                provision of language services by providers of health 
                care and health care-related services to reduce medical 
                errors, improve medical outcomes, reduce health care 
                costs caused by miscommunication with individuals with 
                limited English proficiency, and reduce or eliminate 
                the duplication of effort to translate materials. The 
                clearinghouse shall make such information available on 
                the Internet and in print. Such information shall 
                include the information described in the succeeding 
                provisions of this paragraph.
                    ``(B) Document templates.--The Center shall collect 
                and evaluate for accuracy, develop, and make available 
                templates for standard documents that are necessary for 
                patients and consumers to access and make educated 
                decisions about their health care, including the 
                following:
                            ``(i) Administrative and legal documents, 
                        including--
                                    ``(I) intake forms;
                                    ``(II) Medicare, Medicaid, and 
                                SCHIP forms, including eligibility 
                                information;
                                    ``(III) forms informing patient of 
                                HIPAA compliance and consent; and
                                    ``(IV) documents concerning 
                                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) Public health, patient education, 
                        and outreach materials, such as immunization 
                        notices, health warnings, or screening notices.
                            ``(iv) Additional health or health care-
                        related materials as determined appropriate by 
                        the Director of the Center.
                    ``(C) Structure of forms.--The operating the 
                clearinghouse, the Center shall--
                            ``(i) ensure that the documents posted in 
                        English and non-English languages are 
                        culturally appropriate;
                            ``(ii) allow public review of the documents 
                        before dissemination in order to ensure that 
                        the documents are understandable and culturally 
                        appropriate for the target populations;
                            ``(iii) allow health care providers to 
                        customize the documents for their use;
                            ``(iv) facilitate access to these 
                        documents;
                            ``(v) provide technical assistance with 
                        respect to the access and use of such 
                        information; and
                            ``(vi) carry out any other activities the 
                        Secretary determines to be useful to fulfill 
                        the purposes of the clearinghouse.
                    ``(D) Language assistance programs.--The Center 
                shall provide for the collection and dissemination of 
                information on current examples of language assistance 
                programs and strategies to improve language services 
                for LEP individuals, including case studies using de-
                identified patient information, program summaries, and 
                program evaluations.
                    ``(E) Cultural and linguistic competence 
                materials.--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-related services at no cost. Such information 
                shall include--
                            ``(i) tenets of culturally and 
                        linguistically competent care;
                            ``(ii) cultural and linguistic competence 
                        self-assessment tools;
                            ``(iii) cultural and linguistic competence 
                        training tools;
                            ``(iv) strategic plans to increase cultural 
                        and linguistic competence in different types of 
                        providers of health care and health care-
                        related services, including regional 
                        collaborations among health care organizations; 
                        and
                            ``(v) cultural and linguistic competence 
                        information for educators, practitioners, and 
                        researchers.
                    ``(F) Information about progress.--The Center shall 
                regularly collect and make publicly available 
                information about the progress of entities receiving 
                grants under section 3104 regarding successful 
                innovations in implementing the obligations under this 
                subsection and provide public notice in the entities' 
                communities about the availability of this information;
    ``(b) Director.--The Center shall be headed by a Director who shall 
be appointed by, and who shall report to, the Director of the Agency 
for Healthcare Research and Quality.
    ``(c) Interpretation and Translation Guidelines and Standards.--The 
Center shall convene a working group to develop and adopt 
interpretation and translation quality guidelines and standards for use 
by the Center. The guidelines and standards must be sufficient to 
ensure that LEP individuals have the equal opportunity to benefit from 
health care services to the same extent as non-LEP individuals. The 
guidelines and standards shall address the training, assessment and 
certification of individuals to provide competent interpreter and 
translator services to work in health care and health care-related 
settings and of bilingual staff who provide services directly in non-
English languages. The working group may develop different guidelines 
and standards for bilingual staff, interpreters, and translators.
    ``(d) Membership.--
            ``(1) Qualifications.--The Working Group shall consist of 
        14 members as follows:
                    ``(A) Four members from organizations that advocate 
                on behalf of LEP individuals.
                    ``(B) One member who represents a professional 
                interpreter association (that is not the National 
                Council on Interpreting in Health Care) or translator 
                association.
                    ``(C) One member from a non-profit community based 
                organization that provides language services.
                    ``(D) Three members recommended by the National 
                Council on Interpreting in Health Care, including one 
                who individual who is a professional interpreter.
                    ``(E) Four members who are health care providers or 
                represent health care provider associations, including 
                one individual who represents a health care practice of 
                fewer than 5 clinicians.
                    ``(F) One member who works in or has extensive 
                knowledge of issues related to health care risk 
                management.
            ``(2) Geographic representation.--The membership of the 
        Working Group shall reflect a broad geographic representation 
        including both urban and rural representatives, including 
        representatives of the United States territories.
            ``(3) Prohibited appointments.--Members of the Working 
        Group shall not include Members of Congress or other elected 
        Federal, State, or local government officials.
            ``(4) Vacancies.--Any vacancies in the Working Group shall 
        not affect the power and duties of the Working Group but shall 
        be filled in the same manner as the original appointment.
            ``(5) Subcommittees.--The Working Group may establish 
        subcommittees if doing so increases the efficiency of the 
        Working Group in completing its tasks, including subcommittees 
        to develop different guidelines and standards for interpreters, 
        translators, and bilingual staff.
            ``(6) Advisory panel to the working group.--The Working 
        Group shall consult with the Advisory Panel in the development 
        of the guidelines and standards. The Advisory Panel shall 
        include--
                    ``(A) representatives from the American Translators 
                Association, Association of Language Companies, the 
                National Center for State Courts, and States which have 
                developed interpreter standards such as California, 
                Massachusetts and Oregon who have experience in the 
                development or implementation of their organizations' 
                interpreter and translator certification programs;
                    ``(B) Federal agencies including the Office for 
                Civil Rights, the Office of Minority Health, and the 
                Centers for Medicare & Medicaid Services and the 
                National Center on Minority Health and Health 
                Disparities; and
                    ``(C) other individuals or entities determined 
                appropriate by the Secretary who have specific 
                expertise that will be useful to the Working Group.
            ``(7) Publication.--
                    ``(A) Draft standards.--Not later than 18 months 
                after the date of enactment of this title, the Working 
                Group shall--
                            ``(i) prepare and make available to the 
                        public through the Internet, the Federal 
                        Register, and other appropriate public 
                        channels, a proposed set of interpretation and 
                        translation guidelines and standards for 
                        training, assessment, and certification; and
                            ``(ii) accept public comment on such 
                        guidelines and standards for a period of not 
                        less than 90 days.
                    ``(B) Final standards.--Not later than 120 days 
                after the expiration of the public comment period 
                described in subparagraph (A), the Director of the 
                Agency for Healthcare Research and Quality shall 
                publish, after consultation with and the approval of 
                the Working Group, final guidelines and standards in 
                the Federal Register and on the Internet.
                    ``(C) Testing development.--Not later than 120 days 
                after the publication of the final recommendations 
                described in subparagraph (B), the Director of the 
                Agency for Healthcare Research and Quality shall, if 
                deemed necessary by the Working Group, enter into a 
                contract with an entity experienced in the development 
                of designing certification tests in language related 
                fields to develop such tests as may be necessary to 
                implement the guidelines and standards.
                    ``(D) Pilot project.--
                            ``(i) Not later than 120 days after 
                        completion of the test development described in 
                        subparagraph (C) or after publication of the 
                        final guidelines and standards, whichever is 
                        later, the Secretary shall design, fund, and 
                        implement a pilot project in up to 50 
                        geographically and demographically diverse 
                        sites, two of which must be in the U.S. 
                        territory, to test and evaluate implementation 
                        of the recommendations.
                            ``(ii) The Secretary shall consult with the 
                        Working Group and the Advisory Panel in 
                        development of the pilot project and report 
                        progress to the Working Group on an ongoing 
                        basis.
                            ``(iii) The pilot project shall include 
                        interpreters and translators working with 
                        various provider types, including small group 
                        practices, hospitals, and community health 
                        clinics, and shall include broad geographic 
                        representation including both urban and rural 
                        representatives.
                            ``(iv) The pilot project shall operate for 
                        not less than two nor more than four years, as 
                        determined by the Secretary.
                            ``(v) If the Working Group determines that 
                        any revisions to guidelines and standards are 
                        necessary as a result of the pilot project, it 
                        shall revise such guidelines and standards and 
                        the Director of the Agency for Healthcare 
                        Research and Quality shall publish the 
                        revisions in the Federal Register for notice 
                        and comment. Not later than 120 days after the 
                        expiration of the public comment period on such 
                        revisions, the Director of the Agency for 
                        Healthcare Research and Quality shall publish, 
                        after consultation with and the approval of the 
                        Working Group, final revisions to the 
                        guidelines and standards in the Federal 
                        Register and on the Internet.
            ``(8) Administration.--
                    ``(A) Chairperson.--Not later than 15 days after 
                the date on which all members of the Working Group have 
                been appointed under subsection (d), the Working Group 
                shall designate its chairperson.
                    ``(B) Compensation.--While serving on the business 
                of the Working Group (including travel time), a member 
                of the Working Group or the Advisory Panel shall be 
                entitled to compensation at the per diem equivalent of 
                the rate provided for level IV of the Executive 
                Schedule under section 5315 of title 5, United States 
                Code, and while so serving away from home and the 
                member's regular place of business, a member may be 
                allowed travel expenses, as authorized by the 
                chairperson of the Working Group. For purposes of pay 
                and employment benefits, rights, and privileges, all 
                personnel of the Working Group shall be treated as if 
                they were employees of the House of Representatives.
                    ``(C) Information from federal agencies.--The 
                Working Group may secure directly from any Federal 
                department or agency such information as the Working 
                Group considers necessary to carry out this section. 
                Upon request of the Working Group, the head of such 
                department or agency shall furnish such information. 
                Any information that contains individually identifiable 
                information received by the Working Group shall not be 
                disseminated or disclosed outside of the Working Group 
                and shall not be used except by the Working Group.
                    ``(D) Detail.--Not more than 10 Federal Government 
                employees employed by the Department of Health and 
                Human Services may be detailed to staff the Working 
                Group under this section without further reimbursement. 
                Any detail of an employee shall be without interruption 
                or loss of civil service status or privilege.
                    ``(E) Temporary and intermittent services.--The 
                Working Group may procure temporary and intermittent 
                services under section 3109(b) of title 5, United 
                States Code, at rates for individuals which do not 
                exceed the daily equivalent of the annual rate of basic 
                pay prescribed for level V of the Executive Schedule 
                under section 5316 of such title.
                    ``(F) Authorization of appropriations.--There are 
                authorized to be appropriated to carry out this section 
                such sums as may be necessary for the activities of the 
                Working Group and Advisory Panel for each of fiscal 
                years 2010 through 2014, and for the funding of the 
                pilot project.
            ``(9) Deemed status.--
                    ``(A) Certification by private organization.--If a 
                private accreditation organization establishes 
                training, assessment, or certification standards for 
                interpreters or translators in health care which the 
                Secretary determines are at least equivalent to the 
                training, assessment, or certification standards 
                promulgated by the Secretary as described in subsection 
                (c), the Secretary shall find that all organizations or 
                individuals accredited by such organization comply also 
                with the standard described in subsection (c) if--
                            ``(i) such organization or individual 
                        authorizes the organization to release to the 
                        Secretary upon the Secretary's request (or such 
                        State agency as the Secretary may designate) a 
                        copy of the most current accreditation survey 
                        of such organization or individual made by the 
                        organization, together with any other 
                        information directly related to the survey as 
                        the Secretary may require (including corrective 
                        action plans); and
                            ``(ii) such organization releases such a 
                        copy and any such information to the Secretary.
                    ``(B) Certification by a state or locality.--If a 
                State or locality has or establishes training, 
                assessment, or certification standards for interpreters 
                or translators in health care which the Secretary 
                determines are at least equivalent to the training, 
                assessment, or certification standards promulgated by 
                the Secretary as described in subsection (c), the 
                Secretary shall find that all organizations or 
                individuals accredited by such State or locality comply 
                also with the standard described in subsection (c) if--
                            ``(i) such organization or individual 
                        authorizes the State or locality to release to 
                        the Secretary upon his request (or such State 
                        agency as the Secretary may designate) a copy 
                        of the most current accreditation survey of 
                        such organization or individual made by such 
                        State or locality, together with any other 
                        information directly related to the survey as 
                        the Secretary may require (including corrective 
                        action plans); and
                            ``(ii) such State or locality releases such 
                        a copy and any such information to the 
                        Secretary.
                    ``(C) Timely action on application.--The Secretary 
                shall determine, within 210 days after the date the 
                Secretary receives an application by a private 
                accrediting organization, State, or locality whether 
                the process of the private accrediting organization, 
                State, or locality meets the requirements with respect 
                to training, assessment, or certification standards for 
                interpreters or translators with respect to which 
                standards the application is made. The Secretary may 
                not deny an application on the basis that it seeks to 
                meet the requirements with respect to only one, or more 
                than one, training, assessment, or certification 
                standards for interpreters or translators.
                    ``(D) Disclosure of accreditation survey.--The 
                Secretary may not disclose any accreditation survey 
                made and released to him by the National Council on 
                Interpreting in Health Care or any State or locality of 
                an accredited organization or individual, except that 
                the Secretary may disclose such a survey and 
                information related to such a survey to the extent such 
                survey and information relate to an enforcement action 
                taken by the Secretary.
                    ``(E) Deficiencies.--If the Secretary finds that an 
                accredited organization or individual has significant 
                deficiencies (as defined in regulations pertaining to 
                the training, assessment, or certification standards), 
                the organization or individual shall, after the date of 
                notice of such finding to the organization and for such 
                period as may be prescribed in regulations, be deemed 
                not to meet the conditions or requirements the 
                organization or individual has been treated as meeting 
                pursuant to subparagraph (A).
    ``(e) Availability of Language Access.--The Director shall 
collaborate with the Administrator of the Office of Minority Health, 
the Administrator of the Centers for Medicare & Medicaid Services, and 
the Administrator of the Health Resources and Services Administration 
to notify health care providers and health care organizations about the 
availability of language access services by the Center.
    ``(f) Education.--The Secretary, directly or through contract, 
shall undertake a national education campaign to inform providers, LEP 
individuals, and health professional and graduate schools about--
            ``(1) Federal and State laws and guidelines governing 
        access to language services;
            ``(2) the value of using trained interpreters and the risks 
        associated with using family members, friends, minors, and 
        untrained bilingual staff;
            ``(3) funding sources for developing and implementing 
        language services; and
            ``(4) promising practices to effectively provide language 
        services.
    ``(g) Authorization of Appropriations.--In addition to the amounts 
authorized under subsection (e)(8)(F), there are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2014.

``SEC. 3104. INNOVATIONS IN CULTURAL AND LINGUISTIC COMPETENCE GRANTS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Agency for Healthcare Research and Quality, shall award grants to 
eligible entities to enable such entities to design, implement, and 
evaluate innovative, cost-effective programs to improve language access 
in health care for individuals with limited English proficiency. The 
Director of the Agency for Healthcare Research and Quality shall 
coordinate with, and ensure the participation of, other agencies 
including but not limited to the Health Resources and Services 
Administration, the Center on Minority Health and Health Disparities at 
the National Institutes of Health, and the Office of Minority Health, 
regarding the design and evaluation of the grants program.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be--
                    ``(A) a city, county, Indian tribe, State, 
                territory or subdivision thereof;
                    ``(B) an organization described in section 
                501(c)(3) of the Internal Revenue Code of 1986;
                    ``(C) a community health center or community 
                clinic;
                    ``(D) a solo or group physician practice;
                    ``(E) an integrated health care delivery system;
                    ``(F) public hospital;
                    ``(G) health care group, university, or college; or
                    ``(H) 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 
        competence interpretation services through on-site 
        interpretation, telephonic interpretation, or video 
        interpretation;
            ``(2) implement strategies to recruit, retain, and promote 
        individuals at all levels of the organization to maintain a 
        diverse staff and leadership that can promote and provide 
        language services to patient populations of the service area of 
        the organization;
            ``(3) develop and maintain a needs assessment that 
        identifies the current demographic, cultural, and 
        epidemiological profile of the community to accurately plan for 
        and implement language services needed in service area of the 
        organization;
            ``(4) develop a strategic plan to implement language 
        services;
            ``(5) develop participatory, collaborative partnerships 
        with communities encompassing the LEP patient populations being 
        served to gain input in designing and implementing language 
        services;
            ``(6) develop and implement grievance resolution processes 
        that are culturally and linguistically sensitive and capable of 
        identifying, preventing, and resolving complaints by LEP 
        individuals; or
            ``(7) develop short-term medical interpretation training 
        courses and incentives for bilingual health care staff who are 
        asked to interpret in the workplace;
            ``(8) develop formal training programs for individuals 
        interested in becoming dedicated health care interpreters and 
        culturally competent providers;
            ``(9) provide staff language training instruction, which 
        shall include information on the practical limitations of such 
        instruction for non-native speakers; and
            ``(10) develop other language assistance services as 
        determined appropriate by the Secretary; and
            ``(11) 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), and any applicable State 
        privacy laws, data on the individual patient or recipient's 
        race, ethnicity, and primary language are collected (and 
        periodically updated) in health records and integrated into the 
        organization's information management systems or any similar 
        system used to store and retrieve data;
    ``(d) Priority.--In awarding grants under this section, the 
Secretary shall give priority to entities that primarily engage in 
providing direct care and that have developed partnerships with 
community organizations or with agencies with experience language 
access.
    ``(e) Evaluation.--
            ``(1) An entity that receives a grant under this section 
        shall submit to the Secretary an evaluation that describes, in 
        the manner and to the extent required by the Secretary, the 
        activities carried out with funds received under the grant, and 
        how such activities improved access to health and health care-
        related 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 3103. The Director of the Agency for 
        Healthcare Research and Quality shall notify grantees of the 
        availability of technical assistance for the evaluation and 
        provide such assistance upon request.
            ``(2) The Director of the Agency for Healthcare Research 
        and Quality shall evaluate or arrange with other individuals or 
        organizations to evaluate projects funded under this section.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2010 through 2014.

``SEC. 3105. RESEARCH ON CULTURAL AND LANGUAGE COMPETENCE.

    ``(a) In General.--The Secretary, acting through the Director of 
the Agency for Healthcare Research and Quality, shall expand research 
concerning language access in the provision of health care.
    ``(b) Eligibility.--The Director of the Agency for Healthcare 
Research and Quality may conduct the research described in subsection 
(a) or enter into contracts with other individuals or organizations to 
do so.
    ``(c) Use of Funds.--Research under this section shall be designed 
to do one or more of the following:
            ``(1) To identify the barriers to mental and behavioral 
        services that are faced by LEP individuals.
            ``(2) To identify health care providers' and health 
        administrators' attitudes, knowledge, and awareness of the 
        barriers to quality health care services that are faced by LEP 
        individuals.
            ``(3) To identify optimal approaches for delivering 
        language access.
            ``(4) To identify best practices for data collection, 
        including--
                    ``(A) the collection by providers of health care 
                and health care-related services of data on the race, 
                ethnicity, and primary language of recipients of such 
                services, taking into account existing research 
                conducted by the Government or private sector;
                    ``(B) the development and implementation of data 
                collection and reporting systems; and
                    ``(C) effective privacy safeguards for collected 
                data.
            ``(5) To develop a minimum data collection set for primary 
        language.
            ``(6) To evaluate the most effective ways in which the 
        Department can create or coordinate, and then subsidize or 
        otherwise fund telephonic interpretation providers for health 
        care providers, taking into consideration, among other factors, 
        the flexibility necessary for such a system to accommodate 
        variations in--
                    ``(A) provider type;
                    ``(B) languages needed and their frequency of use;
                    ``(C) type of encounter;
                    ``(D) time of encounter, including regular business 
                hours and after hours; and
                    ``(E) location of encounter.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2014.''.

SEC. 102. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID AND THE 
              STATE CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) Medicare.--Title XVIII of the Social Security Act is amended by 
adding at the end the following new section:

                ``medicare support for language services

    ``Sec. 1899. 
    ``(a) Ensuring Appropriate Payment for the Furnishing of 
Linguistically Appropriate Language Services to All Medicare 
Beneficiaries.--
    ``(b) Temporary Cost-based Payments for Language Services to 
Hospitals.--
            ``(1) In general.--Not later than 90 days after enactment 
        of this section, the Secretary shall initiate quarterly 
        payments to all hospitals that are certified as Medicare 
        providers (including short-term acute inpatient hospitals, 
        long-term care hospitals, inpatient rehabilitation facilities, 
        children's, cancer, psychiatric, and critical access hospitals) 
        to pay for the costs of providing language services to limited 
        English proficient Medicare beneficiaries. These payments shall 
        cover the provision of language services by hospitals in 
        inpatient and outpatient settings. These payments shall 
        continue until the Secretary develops and implements 
        reimbursement standards for language services pursuant to the 
        process set forth in subsection (b).
            ``(2) Determination of temporary payments.--Payments under 
        paragraph (1) shall be calculated based on the estimated 
        numbers of LEP Medicare beneficiaries in a hospital's service 
        area utilizing--
                    ``(A) data on the numbers of LEP individuals 
                (defined for purposes of this paragraph as individuals 
                who speak English less than `very well') from the most 
                recently available data from the Bureau of the Census; 
                or
                    ``(B) the hospital's own data if--
                            ``(i) the hospital routinely collects data 
                        on patients' primary language or need for an 
                        interpreter in both in- and out-patient 
                        settings;
                            ``(ii) the data collection system used by 
                        the hospital is, as determined by the 
                        Secretary, likely to yield accurate data 
                        regarding the number of LEP individuals served 
                        by the hospital, and,
                            ``(iii) the hospital's data documents 
                        greater numbers of LEP individuals than does 
                        the data described in clause (i).
                    ``(C) Distribution of funds.--On a quarterly basis, 
                the Secretary shall pay amounts directly to eligible 
                hospitals to pay for the costs of providing language 
                services to LEP Medicare beneficiaries.
                    ``(D) Methodologies.--In establishing a methodology 
                for temporary payments, the Secretary may establish one 
                or more payment methodologies for inpatient and 
                outpatient settings.
            ``(3) Reporting requirements.--Hospitals receiving payment 
        under paragraph (1) shall provide the Secretary with two 
        reports on--
                    ``(A) the number of Medicare beneficiaries to whom 
                language services are provided;
                    ``(B) the languages of those Medicare 
                beneficiaries;
                    ``(C) the types of language services provided (such 
                as provision of services directly in non-English 
                language by a health care provider or use of an 
                interpreter);
                    ``(D) type of interpretation (such as in-person, 
                telephonic, or video interpretation);
                    ``(E) the methods of providing language services 
                (staff, contract with external independent contractors, 
                or agencies);
                    ``(F) the length of time for each interpretation 
                encounter; and
                    ``(G) the costs of providing language services 
                (whether actual or estimated, as determined by the 
                Secretary).
            ``(4) No cost-sharing.--There shall be no cost-sharing for 
        language services provided as temporary payments to hospitals.
            ``(5) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out this subsection such sums as 
        may be necessary for each of fiscal years 2010 through 2014.
    ``(c) Development of Payment Amounts for Language Services.--
            ``(1) In general.--Not later than 6 months after enactment 
        of this section, the Secretary shall convene a Working Group to 
        advise the Secretary on the development of payment amounts that 
        are based on hospital-reported costs for language services 
        provided to LEP Medicare beneficiaries. Reimbursement shall 
        apply to all Medicare-covered services furnished by certified 
        providers to eligible beneficiaries, whether covered under 
        parts A and B or under the Medicare Advantage program under 
        partC.
            ``(2) Variations.--The Secretary, in consultation with the 
        Working Group, may establish variations within the 
        reimbursement system based upon available delivery methods and 
        costs for providing language services including such factors 
        as--
                    ``(A) the type of language services provided (such 
                as provision of services directly in a non-English 
                language by a health care provider or use of an 
                interpreter);
                    ``(B) type of interpretation services provided 
                (such as in-person, telephonic, or video 
                interpretation);
                    ``(C) the methods and costs of providing language 
                services (including the costs of providing language 
                services with internal staff or through contract with 
                external independent contractors or agencies);
                    ``(D) providing services for languages not 
                frequently encountered in the United States; and
                    ``(E) providing services in rural areas.
            ``(3) No cost-sharing.--There shall be no cost-sharing for 
        language services provided as payments to hospitals under this 
        subsection.
            ``(4) Limitations.--
                    ``(A) In general.--Reimbursement shall only be 
                provided to hospitals under this subsection that report 
                their costs of providing language services, including 
                information on the factors described in paragraph (1) 
                that are utilized in establishing the reimbursement 
                rates and any other information specified by the 
                Secretary.
                    ``(B) Use of interpreter or translation services.--
                            ``(i) In general.--Reimbursement shall be 
                        provided under this subsection only to 
                        hospitals that utilize interpreter or 
                        translation services.
                            ``(ii) Interpreter services defined.--In 
                        this paragraph the term `interpreter services' 
                        means services designed to provide a competent 
                        trans-language rendition of a spoken message in 
                        which an interpreter comprehends the source 
                        language and can speak comprehensively in the 
                        target language to convey the meaning intended 
                        in the source language. Such interpreter shall 
                        know health and health-related terminology and 
                        provide accurate interpretations by choosing 
                        equivalent expressions that convey the best 
                        matching and meaning to the source language and 
                        captures, to the greatest possible extent, all 
                        nuances intended in the source message.
                            ``(iii) Interpreter defined.--In this 
                        paragraph, the he term `interpreter' means an 
                        individual who transmits a spoken message from 
                        one language into another, faithfully, 
                        accurately, and objectively. Such term includes 
                        an individual who provide in-person, 
                        telephonic, and video interpretation and also 
                        includes an individual who is employed or 
                        contracted by those who provide benefits under 
                        section 1832.
                            ``(iv) Translation.--In this paragraph, the 
                        term `translation' means the competent 
                        transmission of a written message in one 
                        language into a written message in another 
                        language.
                            ``(v) Exemptions.--The requirements of 
                        clauses (i) and (ii) shall not apply--
                                    ``(I) when a individual (who has 
                                been informed in the individual's 
                                primary language of the availability of 
                                free interpreter and translation 
                                services) requests the use of family, 
                                friends or other persons untrained in 
                                interpretation or translation; and
                                    ``(II) when a medical emergency 
                                exists and the delay directly 
                                associated with obtaining a competent 
                                interpreter or translation services 
                                would jeopardize the health of the 
                                individual.
                        Nothing in this clause shall exempt emergency 
                        rooms or similar entities that regularly 
                        provide health care services in medical 
                        emergencies from having in place systems to 
                        provide competent interpreter and translation 
                        services without undue delay.
            ``(5) Working group.--The Secretary shall establish a 
        Working Group (in this subsection referred to as the `Working 
        Group') to develop the payment amounts under this paragraph. 
        Such Working Group include representatives from the American 
        Hospital Association, National Association of Public Hospitals 
        and Health Systems, Association of Language Companies, the 
        National Council of Interpreting in Health Care, organizations 
        that advocate on behalf of limited English proficient 
        individuals, and other individuals or entities determined 
        appropriate by the Secretary, including those who have specific 
        expertise in either developing cost-based reimbursement or 
        provision of language services, that will be useful.
            ``(6) Publication.--
                    ``(A) Proposed reimbursement standards.--Not later 
                than 18 months after the date of enactment of this 
                section, the Secretary shall, contingent upon 
                consultation with and approval of the Working Group--
                            ``(i) prepare and make available to the 
                        public through the Internet, the Federal 
                        Register, and other appropriate public 
                        channels, proposed payment amounts under this 
                        subsection based on hospital-reported costs; 
                        and
                            ``(ii) accept public comment on such 
                        reimbursement standards for a period of not 
                        less than 90 days.
                    ``(B) Final reimbursement standards.--
                            ``(i) In general.--Not later than 120 days 
                        after the expiration of the public comment 
                        period described in subparagraph (A), the 
                        Secretary shall publish, after consultation 
                        with and the approval of the Working Group, 
                        final reimbursement standards in the Federal 
                        Register and on the Internet. The final 
                        reimbursement standards shall go into effect 
                        within six months of the date of such 
                        publication.
                            ``(ii) Training.--Between such publication 
                        and effective dates, the Secretary shall 
                        provide training and technical assistance to 
                        hospitals on the final reimbursement standards. 
                        As necessary, the Secretary shall continue to 
                        provide training and technical assistance after 
                        the reimbursement standards becomes effective.
                            ``(iii) Phase-out.--When the final 
                        reimbursement standards go into effect, the 
                        temporary adjustments described in subsection 
                        (a) shall be phased out over a one-year period 
                        as hospitals implement the new reimbursement 
                        rates. Final reimbursement rates shall not be 
                        constrained at the level of total temporary 
                        adjustments. Reimbursement shall be set at the 
                        level of the costs of language services at 
                        eligible hospitals.
    ``(d) Other Medicare Payment Systems.--
            ``(1) Payment systems.--
                    ``(A) In general.--Not later than two years after 
                enactment of this Act, and using the guidelines 
                described in subsection (b), the Secretary shall make 
                recommendations to include payments or adjustments for 
                language services provided to limited English 
                proficient Medicare beneficiaries for all of the 
                remaining payment systems under this title, except the 
                physician fee schedule under such 1848, including 
                psychiatric hospitals, skilled nursing facilities, home 
                health agencies, rehabilitation facilities, and long-
                term care hospitals, as well as the TEFRA per discharge 
                limit for children's and cancer hospitals excluded from 
                the inpatient hospital prospective payment system under 
                section 1886(d), the ambulance fee schedule, and 
                payments to critical access hospitals. Program costs 
                for language services in critical access hospitals 
                shall be considered allowable costs under this title 
                and shall be calculated in the same manner as other 
                Medicare costs on the cost report. These costs should 
                be incorporated into interim payments.
                    ``(B) Implementation.--The Secretary shall 
                implement these payments within three years.
                    ``(C) No cost-sharing.--There shall be no cost-
                sharing for such language services.
            ``(2) Medicare reimbursement for language services provided 
        in support of physician office services.--
                    ``(A) Study.--The Medicare Payment Advisory 
                Commission shall conduct a study that examines ways 
                that Medicare can pay for language services (including 
                foreign language and sign language) provided in support 
                of physician office services and other services paid 
                for through the physician fee schedule under section 
                1848. The report on such study shall include the 
                following:
                            ``(i) Recommendations and effective methods 
                        for adopting a payment methodology for on-site 
                        interpreters, pursuant to which such 
                        interpreters and agencies could directly bill 
                        Medicare for language services provided in 
                        support of benefits paid for under section 1832 
                        for a limited English proficient Medicare 
                        patient. For purposes of this subparagraph, the 
                        term `on-site interpreters' include 
                        interpreters who work as independent 
                        contractors, for agencies that provide on-site 
                        interpretation, and who are employed by those 
                        who provide benefits provided under section 
                        1832.
                            ``(ii) Recommendations and effective 
                        methods for Medicare contracting directly with 
                        agencies that provide off-site interpretation, 
                        including telephonic and video interpretation, 
                        pursuant to which such contractors could 
                        directly bill Medicare for the services 
                        provided in support of benefits provided under 
                        section 1832 for a limited English proficient 
                        Medicare patient.
                            ``(iii) Recommendations for modifying the 
                        existing Medicare resource-based relative value 
                        scale (RBRVS) by adding new procedure codes in 
                        the Health Care Common Procedure Coding System.
                    ``(B) Report.--Not later than 1 year after the date 
                of the enactment of this section, the Commission shall 
                submit to Congress and the Centers for Medicare & 
                Medicaid Services a report on the study conducted under 
                subparagraph (A), together with recommendations 
                regarding the appropriateness of directly reimbursing 
                interpreters versus physicians for language services 
                provided in support of benefits provided under section 
                1832.
                    ``(C) Implementation.--
                            ``(i) In general.--Not later than 1 year 
                        after the submission of the report designated 
                        in subparagraph (B), the Secretary shall 
                        publish, after consultation with and the 
                        approval of the Medicare Payment Advisory 
                        Commission, final reimbursement standards for 
                        language services provided in support of 
                        benefits provided under section 1832. These 
                        standards shall be published in the Federal 
                        Register and on the Internet and shall go into 
                        effect within six months of the date of such 
                        publication. The final standards must ensure 
                        that--
                                    ``(I) for the first three years of 
                                implementation, the payments for 
                                language services do not diminish other 
                                fees provided in support of benefits 
                                provided under section 1832; and
                                    ``(II) enrollees do not have to pay 
                                any co-pays or cost-sharing for 
                                language services provided in support 
                                of benefits provided under section 
                                1832.
                            ``(ii) Training.--Between such date of 
                        publication and the effective date, the 
                        Secretary shall provide training and technical 
                        assistance to providers covered by the 
                        physician fee schedule under section 1848 on 
                        the final reimbursement standards. As 
                        necessary, the Secretary shall continue to 
                        provide training and technical assistance after 
                        the reimbursement standards becomes 
                        effective.''.
    (b) Conforming Amendments.--
            (1) Technical amendments.--
                    (A) Section 1861 of the Social Security Act (42 
                U.S.C. 1395x) is amended by adding at the end the 
                following new subsection:

 ``Language Services; Interpreter Services; Interpreter; Translation; 
                                  LEP

    ``(hhh)(1) The term `language services' means the provision of 
healthcare services to limited English proficient enrollees directly in 
a non-English language, or through the provision of interpreter 
services, translation and non-English signage.
    ``(2) For the purposes of this subsection, the term `interpreter 
services' means services designed to provide a competent trans-language 
rendition of a spoken message in which an interpreter comprehends the 
source language and can speak comprehensively in the target language to 
convey the meaning intended in the source language and interpreter 
knows health and health-related terminology and provides accurate 
interpretations by choosing equivalent expressions that convey the best 
matching and meaning to the source language and captures, to the 
greatest possible extent, all nuances intended in the source message.
    ``(3) The term `interpreter' means an individual who transmits a 
spoken message from one language into another, faithfully, accurately, 
and objectively. Such term includes individuals who provide in-person, 
telephonic, and video interpretation and such term `interpreter' 
individuals who are employed or contracted by those who provide 
benefits provided under section 1832.
    ``(4) The term `translation' means the competent transmission of a 
written message in one language into a written message in another 
language.
    ``(5) The terms `limited English proficient' and `LEP', with 
respect to an individual, means an individual who speaks a primary 
language other than English.''.
                    (B) Subsection (aa)(1)(B) of such section is 
                amended by inserting ``, language services as defined 
                in subsection (hhh),'' after ``clinical social worker 
                (as defined in subsection (hh)(1)),''.
                    (C) Section 1833(a) of the Social Security Act (42 
                U.S.C. 1395l) is amended--
                            (i) by redesignating paragraph (9) as 
                        paragraph (10); and
                            (ii) by inserting after paragraph (8) the 
                        following new paragraph:
            ``(9) in the case of language services described in section 
        1861(hhh), 100 percent of the reasonable charges for such 
        services.''.
                    (D) Section 1832(a)(2) of such Act (42 U.S.C. 
                1395k(a)(2)) is amended--
                            (i) by striking ``and'' at the end of 
                        subparagraph (I);
                            (ii) by striking the period at the end of 
                        subparagraph (K) and inserting ``and''; and
                            (iii) by adding at the end of subparagraph 
                        (K) the following:
                    ``(L) language services (as defined in section 
                1861(hhh) furnished by a interpreter or translator, 
                whether contracted or employed by the entity providing 
                benefits under this section.''
                    (E) Waiver of budget neutrality.--For the first 3 
                years after the effective date of this section, the 
                budget neutrality provision of section 
                1848(c)(2)(B)(ii) of the Social Security Act (42 U.S.C. 
                1395w-4(c)(2)(B)(ii)) shall not apply to language 
                services.
                    (F) Effective date.--These amendments made by this 
                subsection are effective upon publication of the final 
                reimbursement standards described in section 1899(b) of 
                the Social Security Act, as added by subsection (a).
            (2) Medicare part c and part d.--The Secretary of Health 
        and Human Services shall ensure Medicare Advantage plans 
        participating in Medicare part C and prescription drug plans 
        participating in Medicare part D effectively provide language 
        services to their enrollees. The Secretary shall require annual 
        reporting for such plans that includes information on internal 
        policies and procedures related to cultural appropriateness in 
        each of the following contexts:
                    (A) Collection of data regarding the enrollee 
                population.
                    (B) Education of plan staff and contractors who 
                have routine contact with enrollees regarding the 
                diverse needs of the enrollee population.
                    (C) Recruitment and retention efforts that 
                encourage workforce diversity.
                    (D) Evaluation of the health plan's language 
                services programs and services with respect to the 
                plan's enrollee population, using processes such as an 
                analysis of complaints and satisfaction survey results.
                    (E) Methods by which the plan provides information 
                regarding the ethnic diversity of the plan's enrollee 
                population.
                    (F) The periodic provision of educational 
                information to plan enrollee on the plan's language 
                services and programs. Plans may use existing means of 
                communications.
    (c) Improving Language Services in Medicaid and SCHIP.--
            (1) Section 1903(a)(2)(E) of the Social Security Act (42 
        U.S.C. 1396b(a)(2)(E)) is amended by--
                    (A) striking ``translation or interpretation 
                services'' and inserting ``language services''; and
                    (B) striking ``children of families'' and inserting 
                ``individuals''.
            (2) Section 1902(a)(10)(A) of the Social Security Act (42 
        U.S.C. 1396a(a)(10)(A)) is amended by striking ``and (21)'' and 
        inserting ``(21), and (28)''.
            (3) Section 1905(a) of the Social Security Act (42 U.S.C. 
        1396d(a)) is amended by--
                    (A) in paragraph (27), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (28) as paragraph 
                (29); and
                    (C) by inserting after paragraph (27) the following 
                new paragraph:
            ``(27) language services (including the provision of health 
        care services directly in a non-English language, 
        interpretation, translation, and non-English signage), provided 
        in a timely manner to limited English proficient individuals 
        who need language services in connection with administrative 
        and covered services; and''.
            (4) Section 1916(a)(2) of the Social Security Act (42 
        U.S.C. 1396o(2)) is amended by--
                    (A) by striking ``or'' at the end of subparagraph 
                (D);
                    (B) by striking ``and'' at the end of subparagraph 
                (E) and inserting ``or''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) language services described in section 
                1905(a)(27); and''.
            (5) Section 2103 of the Social Security Act (42 U.S.C. 
        1397cc) is amended--
                    (A) in subsection (a), in the matter before 
                paragraph (1), by striking ``(7)'' and inserting ``, 
                (7), and (9)''; and
                    (B) in subsection (c), by adding at the end the 
                following new paragraph:
            ``(9) Language services.--The child health assistance 
        provided to a targeted low-income child shall include coverage 
        of language services (including the provision of health care 
        services directly in a non-English language, interpretation, 
        translation and non-English signage) provided in a timely 
        manner to limited English proficient individuals who need them, 
        in connection with administrative and covered services.''; and
                    (C) in subsection (e)(2)--
                            (i) in the heading, by striking 
                        ``Preventive'' and inserting ``Certain''; and
                            (ii) by inserting ``or subsection (c)(9)'' 
                        after ``subsection (c)(1)(C)''.
            (6) Section 2110(a)(27) of the Social Security Act (42 
        U.S.C. 1397jj) is amended by striking ``translation'' and 
        inserting ``language services as described in section 
        2103(c)(7)''.
            (7) Pursuant to the reporting requirement described in 
        section 2107(b)(1) of the Social Security Act (42 U.S.C. 
        1397gg(b)(1)), the Secretary of Health and Human Services shall 
        ensure that States collect data on the--
                    (A) primary language of those assisted; and
                    (B) for individuals who are minors or 
                incapacitated, the primary language of the individual's 
                parent or guardian.
            (8) Section 2105(c)(2)(A) of the Social Security Act (42 
        U.S.C. 1397ee(c)) is amended by inserting before the period ``, 
        except that expenditures pursuant to section 2105(a)(1)(D)(iv) 
        shall not count towards this total''.
    (d) Funding Language Services Furnished by Providers of Health Care 
and Health Care-related Services That Serve High Rates of Uninsured LEP 
Individuals.--
            (1) Payment of costs.--
                    (A) In general.--Subject to subparagraph (B), the 
                Secretary of Health and Human Services shall make 
                payments (on a quarterly basis) directly to eligible 
                entities to support the provision of language services 
                to limited English proficient individuals in an amount 
                equal to an entity's eligible costs for such services 
                for the quarter.
                    (B) Limitation.--If the amount of funds 
                appropriated under subparagraph (C) to carry out this 
                subsection for a fiscal year is insufficient to ensure 
                that each eligible entity can receive full payment 
                under subparagraph (A), the Secretary shall reduce in a 
                pro rata manner the amount of such payment to each such 
                entity.
                    (C) Funding.--Out of any funds in the Treasury not 
                otherwise appropriated, there are appropriated to the 
                Secretary of Health and Human Services such sums as may 
                be necessary for each of fiscal years 2010 through 
                2014.
                    (D) Language services.--In this subsection, the 
                term ``language services'' has the meaning given such 
                term in section 3100 of the Public Health Service Act.
            (2) Eligible costs defined.--
                    (A) In general.--In this subsection, the term 
                ``eligible costs'' means, with respect to an eligible 
                entity that provides language services to LEP 
                individuals, the product of--
                            (i) the average per person cost of language 
                        services, determined according to the 
                        methodology devised under subparagraph (B), and
                            (ii) the number of limited English 
                        proficient individuals who are provided 
                        language services by the entity and for whom no 
                        reimbursement is available for such services 
                        under the amendments made by subsections (a), 
                        (b), or (c) or by private health insurance.
                    (B) Methodology.--The Secretary shall devise a 
                methodology to determine the average per person cost of 
                language services. In establishing a payment 
                methodology, the Secretary may establish different 
                methodologies for different types of eligible entities. 
                The Secretary shall not require eligible entities to 
                provide individual claims for language services for 
                each individual patient to be provided payment under 
                this subsection.
            (3) Eligible entity.--In order to receive grants under this 
        paragraph, an entity must--
                    (A) be--
                            (i) an individual provider;
                            (ii) a hospital with a low income 
                        utilization rate (as defined in section 
                        1923(b)(3) of the Social Security Act (42 
                        U.S.C. 1396r-4(b)(3))) of greater than 25 
                        percent; or
                            (iii) a federally qualified health center 
                        (as defined in section 1905(l)(2)(B) of the 
                        Social Security Act (42 U.S.C. 
                        1396d(l)(2)(B)));
                    (B) provide language services to at least 8 percent 
                of the entity's total number of patients; and
                    (C) prepare and submit an application to the 
                Secretary, at such time, in such manner, and 
                accompanied by such information as the Secretary may 
                require to ascertain the entities' eligibility for 
                funding under this subsection.
            (4) Relation to medicaid dsh.--Payments under this 
        subsection shall not offset or reduce payments under section 
        1923 of the Social Security Act, nor shall payments under such 
        section be considered when determining uncompensated costs 
        associated with the provision of language services.
            (5) Reporting requirements.--Entities receiving payment 
        under this subsection shall provide the Secretary with a 
        quarterly report on such payments. Such report shall contain 
        aggregate (and not individualized) data and shall otherwise be 
        in a form and manner determined by the Secretary. For purposes 
        of this subsection, the Secretary shall create a standard data 
        collection instrument that is consistent with any existing 
        reporting requirements by the Secretary or relevant accrediting 
        organizations regarding the number of individuals to whom 
        language access are provided.
            (6) Guidance.--
                    (A) Establishment.--Not later than 6 months after 
                the date of enactment of this Act, the Secretary of 
                Health and Human Services shall establish guidelines 
                concerning the implementation of this subsection.
                    (B) Report.--Not later than 2 years after the date 
                of enactment of this Act, and every 2 years thereafter, 
                the Secretary shall submit a report to Congress 
                concerning the implementation of such guidelines.
    (e) Effective Date.--The amendments made by this section take 
effect on October 1, 2009.

SEC. 103. 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 
National Center on Minority Health and Health Disparities and 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 are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2014.

SEC. 104. ASSURANCES FOR RECEIVING FEDERAL FUNDS.

    (a) In General.--Entities that receive Federal funds under sections 
101 or 102 (including under the amendments made by such section), in 
order to ensure the right of LEP individuals to receive access to 
quality health care, shall--
            (1) ensure that appropriate clinical and support staff 
        receive ongoing education and training in linguistically 
        appropriate service delivery;
            (2) offer and provide appropriate language services at no 
        additional charge to each patient with limited English 
        proficiency at all points of contact, in a timely manner during 
        all hours of operation;
            (3) notify patients of their right to receive language 
        services in their primary language; and
            (4) utilize only competent interpreter or translation 
        services which--
                    (A) until adoption of the Interpreter and 
                Translator Guidelines and Standards described in 
                section 3103(c) of the Public Health Service Act, are 
                defined in section 3100 of the Public Health Service 
                Act; and
                    (B) after adoption of the Interpreter and 
                Translator Guidelines and Standards described in 
                section 3103(c) of the Public Health Service Act, meet 
                those guidelines and standards;
    (b) Exemptions.--The requirements of subsection (a)(4) shall not 
apply as follows:
            (1) When a patient (who has been informed in his or her 
        primary language of the availability of free interpreter and 
        translation services) requests the use of family, friends or 
        other persons untrained in interpretation or translation if the 
        following conditions are met:
                    (A) The interpreter requested by the patient is 
                over the age of 18.
                    (B) The recipient informs the patient that he or 
                she has the option of having the recipient provide an 
                interpreter for him/her without charge, or of using 
                his/her own interpreter.
                    (C) The recipient informs the patient that the 
                recipient may not require an LEP person to use a family 
                member or friend as an interpreter.
                    (D) The recipient evaluates whether the person the 
                patient wishes to use as an interpreter is competent. 
                If the recipient has reason to believe that the 
                interpreter is not competent, the recipient provides 
                its own interpreter to protect the recipient from 
                liability if the patient's interpreter is later found 
                not competent.
                    (E) If the recipient has reason to believe that 
                there is a conflict of interest between the interpreter 
                and patient, the recipient may not use the patient's 
                interpreter.
                    (F) The recipient has the patient sign a waiver, 
                witnessed by at least one individual not related to the 
                patient, that includes the information stated in 
                subparagraphs (A) through (E) and is translated into 
                the patient's language.
            (2) When a medical emergency exists and the delay directly 
        associated with obtaining competent interpreter or translation 
        services would jeopardize the health of the patient but only 
        until a competent interpreter or translation service is 
        available; however, nothing in this subsection shall exempt 
        emergency rooms or similar entities that regularly provide 
        health care services in medical emergencies from having in 
        place systems to provide competent interpreter and translation 
        services without undue delay.

SEC. 105. REPORT ON FEDERAL EFFORTS TO PROVIDE CULTURALLY AND 
              LINGUISTICALLY APPROPRIATE HEALTH CARE SERVICES.

    (a) Report.--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 with limited English proficiency 
have meaningful access to health care and health care-related services. 
Such report shall include--
            (1) a description and evaluation of the activities carried 
        out under this Act;
            (2) a description and analysis of best practices, model 
        programs, guidelines, and other effective strategies for 
        providing access to culturally and linguistically appropriate 
        health care services;
            (3) recommendations on the development and implementation 
        of policies and practices by providers of health care and 
        health care-related services for limited English proficient 
        individuals;
            (4) a description of the effect of providing language 
        services on quality of health care and access to care; and
            (5) a description of the costs associated with or savings 
        related to the provision of language services.
    (b) 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 2010 through 2014.

SEC. 106. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES.

    (a) Grants Authorized.--The Secretary of Education is authorized to 
provide grants to States for the provision of English as a second 
language (hereafter referred to as ``ESL'') instruction and shall 
determine, after consultation with appropriate stakeholders, the 
mechanism for administering and distributing such grants.
    (b) Application.--A State may apply for a grant under this section 
by submitting such information as the Secretary may require and in such 
form and manner as the Secretary may require.
    (c) Use of Grant.--As a condition of receiving a grant under this 
section, a State shall--
            (1) develop and implement a plan for assuring the 
        availability of ESL instruction that effectively integrates 
        information about the nature of the United States health care 
        system, how to access care, and any special language skills 
        that may be required for them to access and regularly negotiate 
        the system effectively;
            (2) develop a plan, including, where appropriate, public-
        private partnerships, for making ESL instruction progressively 
        available to all individuals seeking instruction; and
            (3) maintain current ESL instruction efforts by using the 
        additional funds to supplement rather than supplant any funds 
        expended for ESL instruction in the State as of January 1, 
        2006.
    (d) Additional Duties of the Secretary.--The Secretary of Education 
shall--
            (1) collect and publicize annual data on how much Federal, 
        State, and local governments spend on ESL instruction;
            (2) collect data from state and local governments to 
        identify the unmet needs of English language learners for 
        appropriate ESL instruction, including--
                    (A) the extent of waiting lists including how many 
                programs maintain waiting lists and, for programs that 
                do not have waiting lists, the reasons why not;
                    (B) the availability of programs to geographically 
                isolated communities;
                    (C) the impact of course enrollment policies, 
                including open enrollment, on the availability of ESL 
                instruction;
                    (D) the number individuals in the State and each 
                participating locality;
                    (E) the effectiveness of the instruction in meeting 
                the needs of individuals receiving instruction and 
                those needing instruction;
                    (F) as assessment of the need for programs that 
                integrate job training and ESL instruction, to assist 
                individuals to obtain better jobs; and
                    (G) the availability of ESL slots by State and 
                locality;
            (3) determine the cost and most appropriate methods of 
        making ESL instruction available to all English language 
        learners seeking instruction; and
            (4) within 1 year of the date of enactment of this Act, 
        issue a report to Congress that assesses the information 
        collected in subparagraphs (1), (2), and (3) and makes 
        recommendations on steps that should be taken to progressively 
        realize the goal of making ESL instruction available to all 
        English language learners seeking instruction.
    (e) Authorization of Appropriations.--There are authorized to be 
appropriated to the Secretary of Education for each of fiscal years 
2010 through 2013 $250,000,000 to carry out this section.

SEC. 107. DEFINITION.

    In this title, the definitions contained in section 3100 of the 
Public Health Service Act, as added by section 101, shall apply.

SEC. 108. TREATMENT OF THE MEDICARE PART B PROGRAM UNDER TITLE VI OF 
              THE CIVIL RIGHTS ACT OF 1964.

    A payment to a provider of services, physician, or other supplier 
under part B, C, ord D 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.

SEC. 109. IMPLEMENTATION.

    (a) General Provisions.--
            (1) A State shall not be immune under the Eleventh 
        Amendment of the Constitution of the United States from suit in 
        Federal court for failing to provide the language access funded 
        pursuant to this Act.
            (2) In a suit against a State for a violation of this Act, 
        remedies (including remedies at both at law and in equity) are 
        available for such a violation to the same extent as such 
        remedies are available for such a violation in the suit against 
        any public or private entity other than a State.
    (b) Rule of Construction.--Nothing in this Act shall be construed 
to limit otherwise existing obligations of recipients of Federal 
financial assistance under title VI of the Civil Rights Act of 1964 (42 
U.S.C. 2000(d) et seq.) or any other statute.

                  TITLE II--HEALTH WORKFORCE DIVERSITY

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

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

          ``Subtitle A--Diversifying the Healthcare Workplace

``SEC. 3111. REPORT ON WORKFORCE DIVERSITY.

    ``(a) In General.--Not later than July 1, 2010, and biannually 
thereafter, the Secretary, acting through the director of each entity 
within the Department of Health and Human Services, shall prepare and 
submit to the Committee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Commerce of the House of 
Representatives a report on health workforce diversity.
    ``(b) Requirement.--The report under subsection (a) shall contain 
the following information:
            ``(1) A description of any grant support that is provided 
        by each entity for workforce diversity initiatives with the 
        following information--
                    ``(A) the number of grants made;
                    ``(B) the purpose of the grants;
                    ``(C) the populations served through the grants;
                    ``(D) the organizations and institutions receiving 
                the grants; and
                    ``(E) the tracking efforts that were used to follow 
                the progress of participants.
            ``(2) A description of the entity's plan to achieve 
        workforce diversity goals that includes, to the extent relevant 
        to such entity--
                    ``(A) the number of underrepresented minority 
                health professionals that will be needed in various 
                disciplines over the next 10 years to achieve 
                population parity;
                    ``(B) the level of funding needed to fully expand 
                and adequately support health professions pipeline 
                programs;
                    ``(C) the impact such programs have had on the 
                admissions practices and policies of health professions 
                schools;
                    ``(D) the management strategy necessary to 
                effectively administer and institutionalize health 
                profession pipeline programs; and
                    ``(E) the impact that the Government Performance 
                and Results Act (GPRA) has had on evaluating the 
                performance of grantees and whether the GPRA is the 
                best assessment tool for programs under titles VII and 
                VIII.
            ``(3) A description of measurable objectives of each entity 
        relating to workforce diversity initiatives.
    ``(c) Public Availability.--The report under subsection (a) shall 
be made available for public review and comment.

``SEC. 3112. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions within the Health Resources and Services 
Administration, shall award a grant to an entity determined appropriate 
by the Secretary for the establishment of a national working group on 
workforce diversity.
    ``(b) Representation.--In establishing the national working group 
under subsection (a), the grantee shall ensure that the group has 
representation from the following entities:
            ``(1) The Health Resources and Services Administration.
            ``(2) The Department of Health and Human Services Data 
        Council.
            ``(3) The Office of Minority Health.
            ``(4) The Bureau of Labor Statistics of the Department of 
        Labor.
            ``(5) The Public Health Practice Program Office--Office of 
        Workforce Policy and Planning.
            ``(6) The National Center on Minority Health and Health 
        Disparities.
            ``(7) The Agency for Healthcare Research and Quality.
            ``(8) The Institute of Medicine Study Committee for the 
        2004 workforce diversity report.
            ``(9) The Indian Health Service.
            ``(10) Academic institutions.
            ``(11) Consumer organizations.
            ``(12) Health professional associations, including those 
        that represent underrepresented minority populations.
            ``(13) Researchers in the area of health workforce.
            ``(14) Health workforce accreditation entities.
            ``(15) Private foundations that have sponsored workforce 
        diversity initiatives.
            ``(16) Not less than 5 health professions students 
        representing various health profession fields and levels of 
        training.
    ``(c) Activities.--The working group established under subsection 
(a) shall convene at least twice each year to complete the following 
activities:
            ``(1) Review current public and private health workforce 
        diversity initiatives.
            ``(2) Identify successful health workforce diversity 
        programs and practices.
            ``(3) Examine challenges relating to the development and 
        implementation of health workforce diversity initiatives.
            ``(4) Draft a national strategic work plan for health 
        workforce diversity, including recommendations for public and 
        private sector initiatives.
            ``(5) Develop a framework and methods for the evaluation of 
        current and future health workforce diversity initiatives.
            ``(6) Develop recommended standards for workforce diversity 
        that could be applicable to all health professions programs and 
        programs funded under this Act.
            ``(7) Develop curriculum guidelines for diversity training.
            ``(8) Develop a strategy for the inclusion of community 
        members on admissions committees for health profession schools.
            ``(9) Other activities determined appropriate by the 
        Secretary.
    ``(d) Annual Report.--Not later than 1 year after the establishment 
of the working group under subsection (a), and annually thereafter, the 
working group shall prepare and make available to the general public 
for comment, an annual report on the activities of the working group. 
Such report shall include the recommendations of the working group for 
improving health workforce diversity.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3113. 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, 
the National Center on Minority Health and Health Disparities, shall 
establish a technical clearinghouse on health workforce diversity 
within the Office of Minority Health and coordinate current and future 
clearinghouses.
    ``(b) Information and Services.--The clearinghouse established 
under subsection (a) shall offer the following information and 
services:
            ``(1) Information on the importance of health workforce 
        diversity.
            ``(2) Statistical information relating to underrepresented 
        minority representation in health and allied health professions 
        and occupations.
            ``(3) Model health workforce diversity practices and 
        programs.
            ``(4) Admissions policies that promote health workforce 
        diversity and are in compliance with Federal and State laws.
            ``(5) Lists of scholarship, loan repayment, and loan 
        cancellation grants as well as fellowship information for 
        underserved populations for health professions schools.
            ``(6) Foundation and other large organizational initiatives 
        relating to health workforce diversity.
    ``(c) Consultation.--In carrying out this section, the Secretary 
shall consult with non-Federal entities which may include minority 
health professional associations to ensure the adequacy and accuracy of 
information.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3114. EVALUATION OF WORKFORCE DIVERSITY INITIATIVES.

    ``(a) In General.--The Secretary, acting through the Bureau of 
Health Professions within the Health Resources and Services 
Administration, shall award grants to eligible entities for the conduct 
of an evaluation of current health workforce diversity initiatives 
funded by the Department of Health and Human Services.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a city, county, Indian tribe, State, territory, 
        community-based nonprofit organization, health center, 
        university, college, or other entity determined appropriate by 
        the Secretary;
            ``(2) with respect to an entity that is not an academic 
        medical center, university, or private research institution, 
        carry out activities under the grant in partnership with an 
        academic medical center, university, or private research 
        institution; and
            ``(3) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts awarded under a grant under subsection 
(a) shall be used to support the following evaluation activities:
            ``(1) Determinations of measures of health workforce 
        diversity success.
            ``(2) The short- and long-term tracking of participants in 
        health workforce diversity pipeline programs funded by the 
        Department of Health and Human Services.
            ``(3) Assessments of partnerships formed through activities 
        to increase health workforce diversity.
            ``(4) Assessments of barriers to health workforce 
        diversity.
            ``(5) Assessments of policy changes at the Federal, State, 
        and local levels.
            ``(6) Assessments of coordination within and between 
        Federal agencies and other institutions.
            ``(7) Other activities determined appropriate by the 
        Secretary and the Working Group established under section 3112.
    ``(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 2010 through 2015.

``SEC. 3115. 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, primary language, 
gender, and sexual orientation 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 2010 through 2015.

``SEC. 3116. 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 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, loan repayment, and 
        loan cancellation programs;
            ``(3) post-baccalaureate programs;
            ``(4) academic enrichment programs, particularly targeting 
        those who would not be competitive for health professions 
        schools;
            ``(5) kindergarten through 12th grade and other health 
        pipeline programs;
            ``(6) mentoring programs;
            ``(7) internship or rotation programs involving hospitals, 
        health systems, health plans and other health entities;
            ``(8) community partnership development for purposes 
        relating to workforce diversity; or
            ``(9) leadership training.
    ``(d) Reports.--Not later than 1 year after receiving a grant under 
this section, and annually for the term of the grant, a grantee shall 
submit to the Secretary a report that summarizes and evaluates all 
activities conducted under the grant.
    ``(e) Definition.--In this section, the term `Asian American and 
Pacific Islander-serving institutions' means institutions--
            ``(1) that are eligible institutions under section 312(b) 
        of the Higher Education Act of 1965; and
            ``(2) that, at the time of their application, have an 
        enrollment of undergraduate students that is made up of at 
        least 10 percent Asian American and Pacific Islander students.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3117. 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.
    ``(e) Student Loan Cancellation.--The Secretary shall establish a 
student loan cancellation program to provide student loan cancellation 
assistance to researchers who focus on racial and ethnic disparities in 
health. Students participating in the program shall make a minimum 5-
year commitment to work at an accredited health profession school. The 
Secretary shall promulgate additional regulations to define the scope 
and procedures for the program under this subsection.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3118. CAREER SUPPORT FOR NON-RESEARCH HEALTH PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, the Administrator of 
the Substance Abuse and Mental Health Services Administration, the 
Administrator of the Health Resources and Services Administration, and 
the Administrator of the Centers for Medicare and Medicaid Services 
shall establish a program to award grants to eligible individuals for 
career support in non-research-related healthcare.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an individual shall--
            ``(1) be a student in a health professions school, a 
        graduate of such a school who is working in a health 
        profession, or a faculty member of such a school; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--An individual shall use amounts received under 
a grant under this section to--
            ``(1) support the individual's health activities or 
        projects that involve underserved communities, including racial 
        and ethnic minority communities;
            ``(2) support health-related career advancement activities; 
        and
            ``(3) to pay, or as reimbursement for payments of, student 
        loans for individuals who are health professionals and are 
        focused on health issues affecting underserved communities, 
        including racial and ethnic minority communities.
    ``(d) Definition.--In this section, the term `career in non-
research-related healthcare' means employment or intended employment in 
the field of public health, health policy, health management, health 
administration, medicine, nursing, pharmacy, allied health, community 
health, or other fields determined appropriate by the Secretary, other 
than in a position that involves research.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3119. RESEARCH ON THE EFFECT OF WORKFORCE DIVERSITY ON QUALITY.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Director of the Office 
of Minority Health and the Director of the National Center on Minority 
Health and Health Disparities, shall award grants to eligible entities 
to expand research on the link between health workforce diversity and 
quality healthcare.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a clinical, public health, or health services 
        research entity or other entity determined appropriate by the 
        Director; and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant awarded under 
subsection (a) shall be used to support research that investigates the 
effect of health workforce diversity on--
            ``(1) language access;
            ``(2) cultural competence;
            ``(3) patient satisfaction;
            ``(4) timeliness of care;
            ``(5) safety of care;
            ``(6) effectiveness of care;
            ``(7) efficiency of care;
            ``(8) patient outcomes;
            ``(9) community engagement;
            ``(10) resource allocation;
            ``(11) organizational structure;
            ``(12) other topics determined appropriate by the Director; 
        or
            ``(13) compliance of care.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give individualized consideration to all relevant 
aspects of the applicant's background. Consideration of prior research 
experience involving the health of underserved communities shall be 
such a factor.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3120. HEALTH DISPARITIES EDUCATION PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the National 
Center on Minority Health and Health Disparities and in collaboration 
with the Office of Minority Health, the Office for Civil Rights, the 
Centers for Disease Control and Prevention, the Centers for Medicare 
and Medicaid Services, the Health Resources and Services 
Administration, and other appropriate public and private entities, 
shall establish and coordinate a health and healthcare disparities 
education program to support, develop, and implement educational 
initiatives and outreach strategies that inform healthcare 
professionals and the public about the existence of and methods to 
reduce racial and ethnic disparities in health and healthcare.
    ``(b) Activities.--The Secretary, through the education program 
established under subsection (a) shall, through the use of public 
awareness and outreach campaigns targeting the general public and the 
medical community at large--
            ``(1) disseminate scientific evidence for the existence and 
        extent of racial and ethnic disparities in healthcare, 
        including disparities that are not otherwise attributable to 
        known factors such as access to care, patient preferences, or 
        appropriateness of intervention, as described in the 2002 
        Institute of Medicine Report, Unequal Treatment;
            ``(2) disseminate new research findings to healthcare 
        providers and patients to assist them in understanding, 
        reducing, and eliminating health and healthcare disparities;
            ``(3) disseminate information about the impact of 
        linguistic and cultural barriers on healthcare quality and the 
        obligation of health providers who receive Federal financial 
        assistance to ensure that people with limited English 
        proficiency have access to language access services;
            ``(4) disseminate information about the importance and 
        legality of racial, ethnic, and primary language data 
        collection, analysis, and reporting;
            ``(5) design and implement specific educational initiatives 
        to health care providers relating to health and health care 
        disparities; and
            ``(6) assess the impact of the programs established under 
        this section in raising awareness of health and healthcare 
        disparities and providing information on available resources.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3120A. CULTURAL COMPETENCE TRAINING FOR HEALTHCARE 
              PROFESSIONALS.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, the Director of 
the Office of Minority Health, and the Director of the National Center 
for Minority Health and Health Disparities, shall award grants to 
eligible entities to test, implement, and evaluate models of cultural 
competence training, including continuing education, for healthcare 
providers in coordination with the initiative under section 3120(a).
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) be an academic medical center, a health center or 
        clinic, a hospital, a health plan, a health system, or a health 
        care professional guild (including a mental health care 
        professional guild);
            ``(2) partner with a minority serving institution, minority 
        professional association, or community-based organization 
        representing minority populations, in addition to a research 
        institution to carry out activities under this grant; and
            ``(3) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.''.

SEC. 202. HEALTH CAREERS OPPORTUNITY PROGRAM.

    (a) Purpose.--It is the purpose of this section to diversify the 
healthcare workforce by increasing the number of individuals from 
disadvantaged backgrounds in the health and allied health professions 
by enhancing the academic skills of students from disadvantaged 
backgrounds and supporting them in successfully competing, entering, 
and graduating from health professions training programs.
    (b) Authorization of Appropriations.--Section 740(c) of the Public 
Health Service Act (42 U.S.C. 293d(c)) is amended by striking 
``$29,400,000'' and all that follows through ``2002'' and inserting 
``$50,000,000 for fiscal year 2010, and such sums as may be necessary 
for each of fiscal years 2011 through 2015''.

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

    (a) Purpose.--It is the purpose of this section to diversify the 
healthcare workforce by supporting programs of excellence in designated 
health professions schools that demonstrate a commitment to 
underrepresented minority populations with a focus on minority health 
issues, cultural and linguistic competence, and eliminating health 
disparities.
    (b) Authorization of Appropriation.--Section 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 2010, and such sums as 
        may be necessary for each of the fiscal years 2011 through 
        2015.''.

SEC. 204. HISPANIC-SERVING HEALTH PROFESSIONS SCHOOLS.

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

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

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration, shall award grants 
to Hispanic-serving health professions schools for the purpose of 
carrying out programs to recruit Hispanic individuals to enroll in and 
graduate from such schools, which may include providing scholarships 
and other financial assistance as appropriate.
    ``(b) Eligibility.--In subsection (a), the term `Hispanic-serving 
health professions school' means an entity that--
            ``(1) is a school or program under section 799B;
            ``(2) has an enrollment of full-time equivalent students 
        that is made up of at least 9 percent Hispanic students;
            ``(3) has been effective in carrying out programs to 
        recruit Hispanic individuals to enroll in and graduate from the 
        school;
            ``(4) has been effective in recruiting and retaining 
        Hispanic faculty members; and
            ``(5) has a significant number of graduates who are 
        providing health services to medically underserved populations 
        or to individuals in health professional shortage areas.''.

SEC. 205. HEALTH PROFESSIONS STUDENT LOAN FUND; AUTHORIZATIONS OF 
              APPROPRIATIONS REGARDING STUDENTS FROM DISADVANTAGED 
              BACKGROUNDS.

    Section 724(f)(1) of the Public Health Service Act (42 U.S.C. 
292t(f)(1)) is amended by striking ``$8,000,000'' and all that follows 
and inserting ``$35,000,000 for fiscal year 2010, and such sums as may 
be necessary for each of the fiscal years 2011 through 2015.''.

SEC. 206. NATIONAL HEALTH SERVICE CORPS; RECRUITMENT AND FELLOWSHIPS 
              FOR INDIVIDUALS FROM DISADVANTAGED BACKGROUNDS.

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

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

    Section 317F(c) of the Public Health Service Act (42 U.S.C. 247b-
7(c)) is amended--
            (1) by striking ``and'' after ``1994,''; and
            (2) by inserting before the period the following: 
        ``$750,000 for fiscal year 2010, and such sums as may be 
        necessary for each of the fiscal years 2011 through 2015.''.

SEC. 208. COOPERATIVE AGREEMENTS FOR ONLINE DEGREE PROGRAMS AT SCHOOLS 
              OF PUBLIC HEALTH AND SCHOOLS OF ALLIED HEALTH.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.), as amended by section 204, is further amended by adding at 
the end the following:

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

    ``(a) Cooperative Agreements.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, in 
consultation with the Director of the Centers for Disease Control and 
Prevention, the Director of the Agency for Healthcare Research and 
Quality, and the Director of the Office of Minority Health, shall award 
cooperative agreements to schools of public health and schools of 
allied health to design and implement online degree programs.
    ``(b) Priority.--In awarding cooperative agreements under this 
section, the Secretary shall give priority to any school of public 
health or school of allied health that has an established track record 
of serving medically underserved communities.
    ``(c) Requirements.--Awardees must design and implement an online 
degree program, that meet the following restrictions:
            ``(1) Enrollment of individuals who have obtained a 
        secondary school diploma or its recognized equivalent.
            ``(2) Maintaining a significant enrollment of 
        underrepresented minority or disadvantaged students.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.''.

SEC. 209. MID-CAREER HEALTH PROFESSIONS SCHOLARSHIP PROGRAM.

    Part B of title VII of the Public Health Service Act (as amended by 
section 208) is further amended by adding at the end the following:

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

    ``(a) In General.--The Secretary may make grants to eligible 
schools for awarding scholarships to eligible individuals to attend the 
school involved, for the purpose of enabling the individuals to make a 
career change from a non-health profession to a health profession.
    ``(b) Expenses.--Amounts awarded as a scholarship under this 
section--
            ``(1) subject to paragraph (2), may be expended only for 
        tuition expenses, other reasonable educational expenses, and 
        reasonable living expenses incurred in the attendance of the 
        school involved; and
            ``(2) may be expended for stipends to eligible individuals 
        for the enrolled period at eligible schools, except that such a 
        stipend may not be provided to an individual for more than 4 
        years, and such a stipend may not exceed $35,000 per year 
        (notwithstanding any other provision of law regarding the 
        amount of stipends).
    ``(c) Definitions.--In this section:
            ``(1) Eligible school.--The term `eligible school' means a 
        school of medicine, osteopathic medicine, dentistry, nursing 
        (as defined in section 801), pharmacy, podiatric medicine, 
        optometry, veterinary medicine, public health, chiropractic, or 
        allied health, a school offering a graduate program in mental 
        and behavioral health practice, or an entity providing programs 
        for the training of physician assistants and nurse midwives.
            ``(2) Eligible individual.--The term `eligible individual' 
        means an individual who has obtained a secondary school diploma 
        or its recognized equivalent.
    ``(d) Priority.--In providing scholarships to eligible individuals, 
eligible schools shall give to individuals from disadvantaged 
backgrounds.
    ``(e) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.''.

SEC. 210. NATIONAL REPORT ON THE PREPAREDNESS OF HEALTH PROFESSIONALS 
              TO CARE FOR DIVERSE POPULATIONS.

    The Secretary of Health and Human Services, in collaboration with 
the Bureau of Health Professions, the Office of Minority Health and the 
National Center on Minority Health and Health Disparities, shall 
prepare and disseminate a report that details and assesses the 
preparedness of health professionals to care for racially and 
ethnically diverse populations. Such information, which shall be 
collected by the Bureau of Health Professions, shall include--
            (1) with respect to health professions education, the 
        number and percentage of hours of classroom discussion relating 
        to minority health issues, including cultural competence;
            (2) a description of the coursework involved in such 
        education;
            (3) a description of the results of an evaluation of the 
        preparedness of students in such education;
            (4) a description of the types of exposure that students 
        have during their education to minority patient populations; 
        and
            (5) a description of model programs and practices.

SEC. 211. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.

    Subtitle A of title XXXI of the Public Health Service Act, as 
amended by section 201, is further amended by adding at the end the 
following:

``SEC. 3120B. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.

    ``(a) In General.--The Administrator of the Health Resources and 
Services Administration and Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the Office of 
Minority Health, shall award grants to eligible entities to increase 
awareness among post-primary and post-secondary students of career 
opportunities in the health professions.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a clinical, public health or health services 
        organization, community-based or non-profit entity, or other 
        entity determined appropriate by the Director of the Centers 
        for Disease Control and Prevention;
            ``(2) serve a health professional shortage area, as 
        determined by the Secretary;
            ``(3) work with students, including those from racial and 
        ethnic minority backgrounds, that have expressed an interest in 
        the health professions; and
            ``(4) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Grant awards under subsection (a) shall be 
used to support internships that will increase awareness among students 
of non-research based and career opportunities in the following health 
professions:
            ``(1) Medicine.
            ``(2) Nursing.
            ``(3) Public Health.
            ``(4) Pharmacy.
            ``(5) Health Administration and Management.
            ``(6) Health Policy.
            ``(7) Psychology.
            ``(8) Dentistry.
            ``(9) International Health.
            ``(10) Social Work.
            ``(11) Allied Health.
            ``(12) Psychiatry.
            ``(13) Hospice care.
            ``(14) Other professions deemed appropriate by the Director 
        of the Centers for Disease Control and Prevention.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Centers for Disease Control and Prevention shall give 
priority to those entities that--
            ``(1) serve a high proportion of individuals from 
        disadvantaged backgrounds;
            ``(2) have experience in health disparity elimination 
        programs;
            ``(3) facilitate the entry of disadvantaged individuals 
        into institutions of higher education; and
            ``(4) provide counseling or other services designed to 
        assist disadvantaged individuals in successfully completing 
        their education at the post-secondary level.
    ``(e) Stipends.--The Secretary may approve stipends under this 
section for individuals for any period of education in student-
enhancement programs (other than regular courses) at health professions 
schools, programs, or entities, except that such a stipend may not be 
provided to an individual for more than 6 months, and such a stipend 
may not exceed $20 per day (notwithstanding any other provision of law 
regarding the amount of stipends).
    ``(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 2010 through 2015.

``SEC. 3120C. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the Office of 
Minority Health, shall award scholarships to postsecondary students who 
seek a career in public health.
    ``(b) Eligibility.--To be eligible to receive a scholarship under 
subsection (a) an individual shall--
            ``(1) have experience in public health research or public 
        health practice, or other health professions as determined 
        appropriate by the Director of the Centers for Disease Control 
        and Prevention;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) have expressed an interest in public health;
            ``(4) demonstrate promise for becoming a leader in public 
        health;
            ``(5) secure admission to a 4-year institution of higher 
        education;
            ``(6) comply with subsection (f); and
            ``(7) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become public health professionals.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give priority to those students that--
            ``(1) are from disadvantaged backgrounds;
            ``(2) have secured admissions to a minority serving 
        institution; and
            ``(3) have identified a health professional as a mentor at 
        their school or institution and an academic advisor to assist 
        in the completion of their baccalaureate degree.
    ``(e) Scholarships.--The Secretary may approve payment of 
scholarships under this section for such individuals for any period of 
education in student undergraduate tenure, except that such a 
scholarship may not be provided to an individual for more than 4 years, 
and such scholarships may not exceed $10,000 per academic year 
(notwithstanding any other provision of law regarding the amount of 
scholarship).
    ``(f) 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 2010 through 2015.

``SEC. 3120D. PATSY MINK HEALTH AND GENDER RESEARCH FELLOWSHIP PROGRAM.

    ``(a) In General.--The Director of the Centers for Disease Control 
and Prevention, in collaboration with the Director of the Office of 
Minority Health, the Administrator of the Substance Abuse and Mental 
Health Services Administration, and the Director of the Indian Health 
Services, shall award research fellowships to post-baccalaureate 
students to conduct research that will examine gender and health 
disparities and to pursue a career in the health professions.
    ``(b) Eligibility.--To be eligible to receive a fellowship under 
subsection (a) an individual shall--
            ``(1) have experience in health research or public health 
        practice;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) have expressed an interest in the health professions;
            ``(4) demonstrate promise for becoming a leader in the 
        field of women's health;
            ``(5) secure admission to a health professions school or 
        graduate program with an emphasis in gender studies;
            ``(6) comply with subsection (f); and
            ``(7) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become researchers and advance the research base on the intersection 
between gender and health.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Centers for Disease Control and Prevention shall give 
priority to those applicants that--
            ``(1) are from disadvantaged backgrounds; and
            ``(2) have identified a mentor and academic advisor who 
        will assist in the completion of their graduate or professional 
        degree and have secured a research assistant position with a 
        researcher working in the area of gender and health.
    ``(e) Fellowships.--The Director of the Centers for Disease Control 
and Prevention may approve fellowships for individuals under this 
section for any period of education in the student's graduate or health 
profession tenure, except that such a fellowship may not be provided to 
an individual for more than 3 years, and such a fellowship may not 
exceed $18,000 per academic year (notwithstanding any other provision 
of law regarding the amount of fellowship).
    ``(f) 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 2010 through 2015.

``SEC. 3120E. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP 
              PROGRAM.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, in collaboration with the Director of the Office 
of Minority Health, shall award research fellowships to college 
students or recent graduates to advance their understanding of 
international health.
    ``(b) Eligibility.--To be eligible to receive a fellowship under 
subsection (a) an individual shall--
            ``(1) have educational experience in the field of 
        international health;
            ``(2) reside in a health professional shortage area as 
        determined by the Secretary;
            ``(3) demonstrate promise for becoming a leader in the 
        field of international health;
            ``(4) be a college senior or recent graduate of a four year 
        higher education institution;
            ``(5) comply with subsection (f); and
            ``(6) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under an award under 
subsection (a) shall be used to support opportunities for students to 
become health professionals and to advance their knowledge about 
international issues relating to healthcare access and quality.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director shall give priority to those applicants that--
            ``(1) are from a disadvantaged background; and
            ``(2) have identified a mentor at a health professions 
        school or institution, an academic advisor to assist in the 
        completion of their graduate or professional degree, and an 
        advisor from an international health Non-Governmental 
        Organization, Private Volunteer Organization, or other 
        international institution or program that focuses on increasing 
        healthcare access and quality for residents in developing 
        countries.
    ``(e) Fellowships.--The Secretary shall approve fellowships for 
college seniors or recent graduates, except that such a fellowship may 
not be provided to an individual for more than 6 months, may not be 
awarded to a graduate that has not been enrolled in school for more 
than 1 year, and may not exceed $4,000 per academic year 
(notwithstanding any other provision of law regarding the amount of 
fellowship).
    ``(f) 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 2010 through 2015.

``SEC. 3120F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR PROGRAM.

    ``(a) In General.--The Director of the Agency for Healthcare 
Research and Quality, the Director of the Centers for Medicaid and 
Medicare, and the Administrator for Health Resources and Services 
Administration, in collaboration with the Director of the Office of 
Minority Health, shall award grants to eligible entities to expose 
entering graduate students to the health professions.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) an entity shall--
            ``(1) be a clinical, public health or health services 
        organization, community-based or non-profit entity, or other 
        entity determined appropriate by the Director of the Agency for 
        Healthcare Research and Quality;
            ``(2) serve in a health professional shortage area as 
        determined by the Secretary;
            ``(3) work with students obtaining a degree in the health 
        professions; and
            ``(4) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require.
    ``(c) Use of Funds.--Amounts received under a grant awarded under 
subsection (a) shall be used to support opportunities that expose 
students to non-research based health professions, including--
            ``(1) public health policy;
            ``(2) healthcare and pharmaceutical policy;
            ``(3) healthcare administration and management;
            ``(4) health economics; and
            ``(5) other professions determined appropriate by the 
        Director of the Agency for Healthcare Research and Quality.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Agency for Healthcare Research and Quality shall give 
priority to those entities that--
            ``(1) have experience with health disparity elimination 
        programs;
            ``(2) facilitate training in the fields described in 
        subsection (c); and
            ``(3) provide counseling or other services designed to 
        assist such individuals in successfully completing their 
        education at the post-secondary level.
    ``(e) Stipends.--The Secretary may approve the payment of stipends 
for individuals under this section for any period of education in 
student-enhancement programs (other than regular courses) at health 
professions schools or entities, except that such a stipend may not be 
provided to an individual for more than 2 months, and such a stipend 
may not exceed $100 per day (notwithstanding any other provision of law 
regarding the amount of stipends).
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2010 through 2015.''.

SEC. 212. ADVISORY COMMITTEE ON HEALTH PROFESSIONS TRAINING FOR 
              DIVERSITY.

    (a) Establishment.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall establish an 
advisory committee to be known as the Advisory Committee on Health 
Professions Training for Diversity (in this section referred to as the 
``Advisory Committee'').
    (b) Composition.--
            (1) In general.--The Secretary shall determine the 
        appropriate number of individuals to serve on the Advisory 
        Committee. Such individuals shall not be officers or employees 
        of the Federal Government.
            (2) Appointment.--Not later than 60 days after the date of 
        enactment of this section, the Secretary shall appoint the 
        members of the Advisory Committee from among individuals who 
        are health professionals. In making such appointments, the 
        Secretary shall ensure a fair balance between the health 
        professions, that at least 75 percent of the members of the 
        Advisory Committee are health professionals, a broad geographic 
        representation of members and a balance between urban and rural 
        members. Members shall be appointed based on their competence, 
        interest, and knowledge of the mission of the profession 
        involved.
            (3) Minority representation.--In appointing the members of 
        the Advisory Committee under paragraph (2), the Secretary shall 
        ensure the adequate representation of women and minorities.
    (c) Terms.--
            (1) In general.--A member of the Advisory Committee shall 
        be appointed for a term of 3 years, except that of the members 
        first appointed--
                    (A) \1/3\ of such members shall serve for a term of 
                1 year;
                    (B) \1/3\ of such members shall serve for a term of 
                2 years; and
                    (C) \1/3\ of such members shall serve for a term of 
                3 years.
            (2) Vacancies.--
                    (A) In general.--A vacancy on the Advisory 
                Committee shall be filled in the manner in which the 
                original appointment was made and shall be subject to 
                any conditions which applied with respect to the 
                original appointment.
                    (B) Filling unexpired term.--An individual chosen 
                to fill a vacancy shall be appointed for the unexpired 
                term of the member replaced.
    (d) Duties.--
            (1) In general.--The Advisory Committee shall--
                    (A) provide advice and recommendations to the 
                Secretary concerning policy and program development and 
                other matters of significance concerning activities 
                under this part; and
                    (B) not later than 2 years after the date of 
                enactment of this section, and annually thereafter, 
                prepare and submit to the Secretary, and 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 describing the activities 
                of the Committee.
            (2) Consultation with students.--In carrying out duties 
        under paragraph (1), the Advisory Committee shall consult with 
        individuals who are attending health professions schools with 
        which this part is concerned.
    (e) Meetings and Documents.--
            (1) Meetings.--The Advisory Committee shall meet not less 
        than 2 times each year. Such meetings shall be held jointly 
        with other related entities established under this title where 
        appropriate.
            (2) Documents.--Not later than 14 days prior to the 
        convening of a meeting under paragraph (1), the Advisory 
        Committee shall prepare and make available an agenda of the 
        matters to be considered by the Advisory Committee at such 
        meeting. At any such meeting, the Advisory Committee shall 
        distribute materials with respect to the issues to be addressed 
        at the meeting. Not later than 30 days after the adjourning of 
        such a meeting, the Advisory Committee shall prepare and make 
        available a summary of the meeting and any actions taken by the 
        Committee based upon the meeting.
    (f) Compensation and Expenses.--
            (1) Compensation.--Each member of the Advisory Committee 
        shall be compensated at a rate equal to the daily equivalent of 
        the annual rate of basic pay prescribed for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, for each day (including travel time) during which such 
        member is engaged in the performance of the duties of the 
        Committee.
            (2) Expenses.--The members of the Advisory Committee shall 
        be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in the performance of services for the Committee.
    (g) FACA.--The Federal Advisory Committee Act shall apply to the 
Advisory Committee under this section only to the extent that the 
provisions of such Act do not conflict with the requirements of this 
section.

SEC. 213. MCNAIR POSTBACCALAUREATE ACHIEVEMENT PROGRAM.

    Section 402E of the Higher Education Act of 1965 (20 U.S.C. 1070a-
15) is amended by striking subsection (g) and inserting the following:
    ``(g) 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.
    ``(h) Funding.--From amounts appropriated pursuant to the authority 
of section 402A(g), 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 2010 
through 2016.''.

                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 XXXI 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. 3131. 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, 
                primary language, and sexual orientation 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 as well as 
                disparities along lines of sexual orientation 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, 
                primary language, gender, and sexual orientation 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, primary language, and sexual 
        orientation 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 are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3132. 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 2009 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 are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.''.

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 
        ``2014'';
            (2) in paragraph (2), in the first sentence, by striking 
        ``2003'' and inserting ``2014''; and
            (3) in paragraph (3), by striking ``2002'' and inserting 
        ``2014''.

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, 2010, 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 2010 through 2015.

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 are authorized to be appropriated $20,000,000 
        for fiscal year 2010, $30,000,000 for fiscal year 2011, and 
        such sums as may be necessary, but not to exceed $30,000,000 
        for each of fiscal years 2012 through 2014.
            ``(2) Availability.--Amounts appropriated under paragraph 
        (1) shall remain available through fiscal year 2013.
    ``(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.''.

SEC. 312. SURVEY QUESTIONS ON SEXUAL ORIENTATION AND GENDER IDENTITY.

    The Secretary of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
include in the National Health Interview Survey (or any successor 
survey) questions to identify the sexual orientation and gender 
identity of individuals participating in the survey.

SEC. 313. DISAGGREGATION OF COMPARATIVE EFFECTIVENESS RESEARCH DATA.

    The Secretary of Health and Human Services may not make available 
any Federal funds for comparative effectiveness health care research, 
unless the recipient of the funds agrees to ensure that the research 
data will be disaggregated by race, ethnicity, and gender to detect and 
measure differences among subpopulations.

                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, 2010, 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. PROHIBITION ON DISCRIMINATION IN FEDERAL ASSISTED HEALTH CARE 
              SERVICES AND RESEARCH PROGRAMS ON THE BASIS OF SEX, RACE, 
              COLOR, NATIONAL ORIGIN, SEXUAL ORIENTATION, GENDER 
              IDENTITY, OR DISABILITY STATUS.

    No person in the United States shall, on the basis of sex, race, 
color, national origin, sexual orientation, gender identity, or 
disability status, be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under any health care 
service or research program or activity receiving Federal financial 
assistance.

SEC. 403. ACCOUNTABILITY WITHIN THE DEPARTMENT OF HEALTH AND HUMAN 
              SERVICES.

    Title XXXI 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. 3141. 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 3142.
            ``(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, 2010, 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 2010 through 2015.

``SEC. 3142. 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. 404. 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 
        3103.
            ``(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 2010, and such sums as may be necessary for each of 
fiscal years 2011 through 2015.''.

SEC. 405. 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 XXXI 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. 406. 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.
                    ``(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. 407. 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 2010, and such sums may be necessary for each of fiscal 
years 2011 through 2016.

SEC. 408. 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. 911. 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 Institute 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 2010 through 2015.''.

SEC. 409. 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 505D the 
following:

``SEC. 505E. 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:
    ``(aa) 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 505E.''.
    (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 505E''.

SEC. 410. 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 2010, and such sums as may be necessary for 
each of the fiscal years 2011 through 2015.''.

SEC. 411. 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 2010 for the 
        National Institute 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 2010, 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 2010; and
            (4) stewardship and accountability should be provided to 
        Congress and the President for measurable and sustainable 
        progress toward health disparity elimination.

SEC. 412. 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, the National Center on Minority Health and 
        Health Disparities, 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 are authorized to be 
appropriated to carry out this section, sums as may be necessary for 
each of fiscal years 2010 through 2015.

SEC. 413. NATIONAL INSTITUTE FOR MINORITY HEALTH AND HEALTH 
              DISPARITIES.

    (a) Redesignation.--
            (1) In general.--Title IV of the Public Health Service Act 
        (42 U.S.C. 281 et seq.) is amended--
                    (A) in section 401(b)(24), by striking ``National 
                Center on Minority Health and Health Disparities'' and 
                inserting ``National Institute for Minority Health and 
                Health Disparities''; and
                    (B) in subpart 6 of part E--
                            (i) in the subpart heading, by striking 
                        ``Center'' and inserting ``Institute'';
                            (ii) in the headings of sections 485E and 
                        485H, by striking ``center'' and inserting 
                        ``institute''; and
                            (iii) by striking (other than in section 
                        485E(i)(1)) the term ``Center'' each place it 
                        appears and inserting ``Institute''.
            (2) References.--Any reference in any law, map, regulation, 
        document, paper, or other record of the United States to the 
        National Center on Minority Health and Health Disparities shall 
        be deemed to be a reference to the National Institute for 
        Minority Health and Health Disparities.
    (b) Duties; Authorities; Funding.--Section 485E of the Public 
Health Service Act (42 U.S.C. 287c-31) is amended--
            (1) by amending subsection (e) to read as follows:
    ``(e) Duties of the Director.--
            ``(1) Interagency coordination of minority health and 
        health disparity activities.--With respect to minority health 
        and health disparities, the Director of the Institute shall 
        plan, coordinate, and evaluate research and other activities 
        conducted or supported by the institutes and centers of the 
        National Institutes of Health. In carrying out the preceding 
        sentence, the Director of the Institute shall evaluate the 
        minority health and health disparity activities of each of such 
        institutes and centers and shall provide for the periodic 
        reevaluation of such activities. Such institutes and centers 
        shall be responsible for providing information to the 
        Institute, including data on clinical trials funded or 
        conducted by these institutes and centers.
            ``(2) Consultations.--The Director of the Institute shall 
        carry out this subpart (including developing and revising the 
        plan and budget required by subsection (f) in consultation with 
        the heads of the institutes and centers of the National 
        Institutes of Health, the advisory councils of such institutes 
        and centers, and the advisory council established pursuant to 
        subsection (j).
            ``(3) Coordination of activities.--The Director of the 
        Institute--
                    ``(A) shall act as the primary Federal official 
                with responsibility for coordinating all research and 
                activities conducted or supported by the National 
                Institutes of Health on minority or other health 
                disparities;
                    ``(B) shall represent the health disparities 
                research program of the National Institutes of Health, 
                including the minority health and other health 
                disparities research program, at all relevant executive 
                branch task forces, committees, and planning 
                activities; and
                    ``(C) shall maintain communications with all 
                relevant agencies of the Public Health Service, 
                including the Indian Health Service, and various other 
                departments and agencies of the Federal Government to 
                ensure the timely transmission of information 
                concerning advances in minority health disparities 
                research and other health disparities research among 
                these various agencies for dissemination to affected 
                communities and health care providers.'';
            (2) by amending subsection (f) to read as follows:
    ``(f) Strategic Plan.--
            ``(1) In general.--Subject to the provisions of this 
        section and other applicable law, the Director of the 
        Institute, in consultation with the Director of NIH, the 
        Directors of the other institutes and centers of the National 
        Institutes of Health, and the advisory council established 
        pursuant to subsection (j), shall--
                    ``(A) annually review and revise a strategic plan 
                (referred to in this section as `the plan') and budget 
                for the conduct and support of all minority health 
                disparity research and other health disparity research 
                activities of the institutes and centers of the 
                National Institutes of Health that include time-based 
                targeted objectives with measurable outcomes and assure 
                that the annual review and revision of the plan uses an 
                established trans-National Institutes of Health process 
                subject to timely review, approval, and dissemination;
                    ``(B) ensure that the plan and budget establish 
                priorities among the health disparities research 
                activities that such agencies are authorized to carry 
                out;
                    ``(C) ensure that the plan and budget establish 
                objectives regarding such activities, describe the 
                means for achieving the objectives, and designate the 
                date by which the objectives are expected to be 
                achieved;
                    ``(D) ensure that all amounts appropriated for such 
                activities are expended in accordance with the plan and 
                budget;
                    ``(E) annually submit to Congress a report on the 
                progress made with respect to the plan; and
                    ``(F) create and implement a plan for the systemic 
                review of research activities supported by the National 
                Institutes of Health that are within the mission of 
                both the Institute and other institutes and centers of 
                the National Institutes of Health, including by 
                establishing mechanisms for--
                            ``(i) tracking minority health and health 
                        disparity research conducted within the 
                        institutes and centers 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 
                        institutes and centers that are within the 
                        mission of the Institute;
                            ``(iii) providing the Institute with the 
                        written descriptions and scientific peer review 
                        results of such applications and proposals;
                            ``(iv) enabling the institutes and centers 
                        to consult with the Director of the Institute 
                        prior to final approval of such applications 
                        and proposals; and
                            ``(v) reporting to the Director of the 
                        Institute all such applications and proposals 
                        that are approved for funding by the institutes 
                        and centers.
            ``(2) Certain components of plan and budget.--With respect 
        to health disparities research activities of the agencies of 
        the National Institutes of Health, the Director of the 
        Institute shall ensure that the plan and budget under paragraph 
        (1) provide for--
                    ``(A) basic research and applied research, 
                including research and development with respect to 
                products;
                    ``(B) research that is conducted by the agencies;
                    ``(C) research that is supported by the agencies;
                    ``(D) proposals developed pursuant to solicitations 
                by the agencies and for proposals developed 
                independently of such solicitations; and
                    ``(E) behavioral research and social sciences 
                research, which may include cultural and linguistic 
                research in each of the agencies.
            ``(3) Minority health disparities research.--The plan and 
        budget under paragraph (1) shall include a separate statement 
        of the plan and budget for minority health disparities 
        research.'';
            (3) by amending subsection (h) to read as follows:
    ``(h) Research Endowments.--
            ``(1) In general.--The Director of the Institute shall 
        carry out a program to facilitate minority health and health 
        disparities research and other health disparities research by 
        providing research endowments at--
                    ``(A) centers of excellence under section 736; and
                    ``(B) centers of excellence under section 485F.
            ``(2) Eligibility.--The Director of the Institute shall 
        provide for a research endowment under paragraph (1) only if 
        the institution involved meets the following conditions:
                    ``(A) The institution does not have an endowment 
                that is worth in excess of an amount equal to 50 
                percent of the national average of endowment funds at 
                institutions that conduct similar biomedical research 
                or training of health professionals.
                    ``(B) The application of the institution under 
                paragraph (1) regarding a research endowment has been 
                recommended pursuant to technical and scientific peer 
                review and has been approved by the advisory council 
                established pursuant to subsection (j).
                    ``(C) The institution at any time was deemed to be 
                eligible to receive a grant under section 736 and at 
                any time received a research endowment under paragraph 
                (1).''; and
            (4) by adding at the end the following:
    ``(k) Funding.--
            ``(1) Full funding budget.--
                    ``(A) In general.--With respect to a fiscal year, 
                the Director of the Institute shall prepare and submit 
                directly to the President, for review and transmittal 
                to Congress, a budget estimate for carrying out the 
                plan for the fiscal year, after reasonable opportunity 
                for comment (but without change) by the Secretary, the 
                Director of the National Institutes of Health, the 
                directors of the other institutes and centers of the 
                National Institutes of Health, and the advisory council 
                established pursuant to subsection (j). The budget 
                estimate shall include an estimate of the number and 
                type of personnel needs for the Institute.
                    ``(B) Amounts necessary.--The budget estimate 
                submitted under subparagraph (A) shall estimate the 
                amounts necessary for the institutes and centers of the 
                National Institutes of Health to carry out all minority 
                health and health disparities activities determined by 
                the Director of the Institute to be appropriate, 
                without regard to the probability that such amounts 
                will be appropriated.
            ``(2) Alternate budgets.--
                    ``(A) In general.--With respect to a fiscal year, 
                the Director of the Institute shall prepare and submit 
                to the Secretary and the Director of the National 
                Institutes of Health the budget estimates described in 
                subparagraph (B) for carrying out the plan for the 
                fiscal year. The Secretary and such Director shall 
                consider each of such estimates in making 
                recommendations to the President regarding a budget for 
                the plan for such year.
                    ``(B) Description.--With respect to the fiscal year 
                involved, the budget estimates referred to in 
                subparagraph (A) for the plan are as follows:
                            ``(i) The budget estimate submitted under 
                        paragraph (1).
                            ``(ii) A budget estimate developed on the 
                        assumption that the amounts appropriated will 
                        be sufficient only for--
                                    ``(I) continuing the conduct by the 
                                institutes and centers of the National 
                                Institutes of Health of existing 
                                minority health and health disparity 
                                activities (if approved for 
                                continuation), and continuing the 
                                support of such activities by the 
                                institutes and centers in the case of 
                                projects or programs for which the 
                                institutes or centers have made a 
                                commitment of continued support; and
                                    ``(II) carrying out activities that 
                                are in addition to activities specified 
                                in subclause (I), only for which the 
                                Director determines there is the most 
                                substantial need.
                            ``(iii) Such other budget estimates as the 
                        Director of the Institute determines to be 
                        appropriate.''.

SEC. 414. IOM REPORT ON LGBT HEALTH DISPARITIES.

    The Secretary of Health and Human Services shall enter into an 
agreement with the Institute of Medicine to prepare and submit to the 
Congress a report on--
            (1) health and health care disparities experienced by the 
        lesbian, gay, bisexual, and transgender communities; and
            (2) the unique health and health care challenges 
        experienced by such communities.

              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 2010; and
            (2) such sums as may be necessary for fiscal years 2011 
        through 2014.

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

                  Subtitle A--Health Empowerment Zones

SEC. 501. SHORT TITLE.

    This subtitle may be cited as the ``Health Empowerment Zone Act of 
2009''.

SEC. 502. FINDINGS.

    The Congress finds the following:
            (1) Numerous studies and reports, including the National 
        Healthcare Disparities Report and Unequal Treatment, the 2002 
        Institute of Medicine Report, document the extensiveness to 
        which health disparities exist across the country.
            (2) These studies have found that, on average, racial and 
        ethnic minorities are disproportionately afflicted with chronic 
        and acute conditions--such as cancer, diabetes, and 
        hypertension--and suffer worse health outcomes, worse health 
        status, and higher mortality rates than their White 
        counterparts.
            (3) Several recent studies also show that health 
        disparities are a function of not only access to health care, 
        but also the social determinants of health--including the 
        environment, the physical structure of communities, nutrition 
        and food options, educational attainment, employment, race, 
        ethnicity, geography, and language preference--that directly 
        and indirectly affect the health, health care, and wellness of 
        individuals and communities.
            (4) Integrally involving and fully supporting the 
        communities most affected by health inequities in the 
        assessment, planning, launch, and evaluation of health 
        disparity elimination efforts is among the leading 
        recommendations made to adequately address and ultimately 
        reduce health disparities.
            (5) Recommendations also include supporting the efforts of 
        community stakeholders from a broad cross-section--including, 
        but not limited to local businesses, local departments of 
        commerce, education, labor, urban planning, and transportation, 
        and community-based and other nonprofit organizations--to find 
        areas of common ground around health disparity elimination and 
        collaborate to improve the overall health and wellness of a 
        community and its residents.

SEC. 503. DESIGNATION OF HEALTH EMPOWERMENT ZONES.

    (a) In General.--At the request of an eligible community 
partnership, the Secretary may designate an eligible area as a health 
empowerment zone.
    (b) Eligibility Criteria.--
            (1) Eligible community partnership.--A community 
        partnership is eligible to submit a request under this section 
        if the partnership--
                    (A) demonstrates widespread public support from key 
                individuals and entities in the eligible area, 
                including State and local governments, nonprofit 
                organizations, and community and industry leaders, for 
                designation of the eligible area as a health 
                empowerment zone; and
                    (B) includes representatives of--
                            (i) a broad cross section of stakeholders 
                        and residents from communities in the eligible 
                        area experiencing disproportionate disparities 
                        in health status and health care; and
                            (ii) organizations, facilities, and 
                        institutions that have a history of working 
                        within and serving such communities.
            (2) Eligible area.--An area is eligible to be designated as 
        a health empowerment zone under this section if one or more 
        communities in the area experience disproportionate disparities 
        in health status and health care. In determining whether a 
        community experiences such disparities, the Secretary shall 
        consider the data collected by the Department of Health and 
        Human Services focusing on the following areas:
                    (A) Access to high-quality health services.
                    (B) Arthritis, osteoporosis, and chronic back 
                conditions.
                    (C) Cancer.
                    (D) Chronic kidney disease.
                    (E) Diabetes.
                    (F) Injury and violence prevention.
                    (G) Maternal, infant, and child health.
                    (H) Medical product safety.
                    (I) Mental health and mental disorders.
                    (J) Nutrition and overweight.
                    (K) Disability and secondary conditions.
                    (L) Educational and community-based health 
                programs.
                    (M) Environmental health.
                    (N) Family planning.
                    (O) Food safety.
                    (P) Health communication.
                    (Q) Health disease and stroke.
                    (R) HIV/AIDS.
                    (S) Immunization and infectious diseases.
                    (T) Occupational safety and health.
                    (U) Oral health.
                    (V) Physical activity and fitness.
                    (W) Public health infrastructure.
                    (X) Respiratory diseases.
                    (Y) Sexually transmitted diseases.
                    (Z) Substance abuse.
                    (AA) Tobacco use.
                    (BB) Vision and hearing.
    (c) Procedure.--
            (1) Request.--A request under subsection (a) shall--
                    (A) describe the bounds of the area to be 
                designated as a health empowerment zone and the process 
                used to select those bounds;
                    (B) demonstrate that the partnership submitting the 
                request is an eligible community partnership described 
                in subsection (b)(1);
                    (C) demonstrate that the area is an eligible area 
                described in subsection (b)(2);
                    (D) include a comprehensive assessment of 
                disparities in health status and health care experience 
                by one or more communities in the area;
                    (E) set forth--
                            (i) a vision and a set of values for the 
                        area; and
                            (ii) a comprehensive and holistic set of 
                        goals to be achieved in the area through 
                        designation as a health empowerment zone; and
                    (F) include a strategic plan for achieving the 
                goals described in subparagraph (E)(ii).
            (2) Approval.--Not later than 60 days after the receipt of 
        a request for designation of an area as a health empowerment 
        zone under this section, the Secretary shall approve or 
        disapprove the request.
    (d) Minimum Number.--The Secretary--
            (1) shall designate not more than 110 health empowerment 
        zones under this section; and
            (2) shall designate at least one health empowerment zone in 
        each of the several States, the District of Columbia, and each 
        territory or possession of the United States.

SEC. 504. ASSISTANCE TO THOSE SEEKING DESIGNATION.

    At the request of any organization or entity seeking to submit a 
request under section 503(a), the Secretary shall provide technical 
assistance, and may award a grant, to assist such organization or 
entity--
            (1) to form an eligible community partnership described in 
        section 503(b)(1);
            (2) to complete a health assessment, including an 
        assessment of health disparities under section 503(c)(1)(D); or
            (3) to prepare and submit a request, including a strategic 
        plan, in accordance with section 503.

SEC. 505. BENEFITS OF DESIGNATION.

    (a) Priority.--In awarding any competitive grant, a Federal 
official shall give priority to any applicant that--
            (1) meets the eligibility criteria for the grant;
            (2) proposes to use the grant for activities in a health 
        empowerment zone; and
            (3) demonstrates that such activities will directly and 
        significantly further the goals of the strategic plan approved 
        for such zone under section 503.
    (b) Grants for Initial Implementation of Strategic Plan.--
            (1) In general.--Upon designating an eligible area as a 
        health empowerment zone at the request of an eligible community 
        partnership, the Secretary shall, subject to the availability 
        of appropriations, make a grant to the community partnership 
        for implementation of the strategic plan for such zone.
            (2) Grant period.--A grant under paragraph (1) for a health 
        empowerment zone shall be for a period of 2 years and may be 
        renewed, except that the total period of grants under paragraph 
        (1) for such zone may not exceed 10 years.
            (3) Limitation.--In awarding grants under this subsection, 
        the Secretary shall not give less priority to an applicant or 
        reduce the amount of a grant because the Secretary rendered 
        technical assistance or made a grant to the same applicant 
        under section 504.
            (4) Reporting.--The Secretary shall require each recipient 
        of a grant under this subsection to report to the Secretary not 
        less than every 6 months on the progress in implementing the 
        strategic plan for the health empowerment zone.

SEC. 506. DEFINITION.

    In this subtitle, the term ``Secretary'' means the Secretary of 
Health and Human Services, acting through the Administrator of the 
Health Resources and Services Administration and the Director of the 
Office of Minority Health, and in cooperation with the Director of the 
Office of Community Services and the Director of the National Institute 
for Minority Health and Health Disparities.

SEC. 507. AUTHORIZATION OF APPROPRIATIONS.

    To carry out this subtitle, there is authorized to be appropriated 
$100,000,000 for fiscal year 2010.

         Subtitle B--Other Improvements of Health Care Services

                         CHAPTER 1--IN GENERAL

SEC. 511. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title XXXI 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. 3151. 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 are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3152. 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 3151(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 are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of fiscal years 2010 through 2015.

``SEC. 3153. 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);
            ``(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 are authorized to be 
appropriated such sums as necessary to carry out this section.''.

SEC. 512. MEDICAID PAYMENT FOR CERTAIN ALIENS.

    (a) Medicaid.--Section 1903(v) of the Social Security Act (42 
U.S.C. 1396b(v)) is amended by striking paragraph (4) and inserting the 
following:
    ``(4)(A) Notwithstanding sections 401(a), 402(b), 403, and 421 of 
Public Law 104-193, payment shall be made under this section for care 
and services that are furnished to individuals, if they who otherwise 
meet the eligibility requirements for medical assistance under the 
State plan approved under this title (other than the requirement of the 
receipt of aid or assistance under title IV, supplemental security 
income benefits under title XVI, or a State supplementary payment), and 
are--
            ``(i) lawfully present in the United States;
            ``(ii) children under age 21, including optional targeted 
        low-income children described in section 1905(u)(2)(B); or
            ``(iii) pregnant women during pregnancy (and during the 60-
        day period beginning on the last day of the pregnancy).
    ``(B) No debt shall accrue under an affidavit of support against 
any sponsor of such individual on the basis of provision of medical 
assistance and the cost of such assistance shall not be considered as 
an unreimbursed cost.''.
    (b) SCHIP.--Section 2107(e)(1) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)) is amended by striking subparagraph (H) and 
inserting the following:
                    ``(H) Paragraph (4) of section 1903(v) (relating to 
                individuals who, but for sections 401(a), 403, and 421 
                of Public Law 104-193 would be eligible for medical 
                assistance under title XXI).''.
    (c) Conforming Amendment.--Section 1137(f) of such Act (42 U.S.C. 
1320b-7(f)) is amended by inserting ``and for medical assistance 
provided to children and pregnant women'' before the period at the end.

SEC. 513. MEDICAID PAYMENT PARITY FOR THE TERRITORIES.

    (a) Elimination of Funding Limitations for Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands, and American Samoa.--
            (1) In general.--Section 1108 of the Social Security Act 
        (42 U.S.C. 1308) is amended--
                    (A) in subsection (f), in the matter before 
                paragraph (1), by striking ``subsection (g)'' and 
                inserting ``subsections (g) and (h)'';
                    (B) in subsection (g)(2), in the matter before 
                subparagraph (A), by inserting ``and subsection (h)'' 
                after ``paragraph (3)''; and
                    (C) by adding at the end the following new 
                subsection:
    ``(h) Sunset of Funding Limitations for Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands, and American Samoa.--
Subsections (f) and (g) shall not apply to Puerto Rico, the Virgin 
Islands, Guam, the Northern Mariana Islands, and American Samoa for any 
fiscal year after fiscal year 2009.''.
            (2) Conforming amendment.--Section 1903(u) of such Act (42 
        U.S.C. 1396c(u)) is amended by striking paragraph (4).
            (3) Effective date.--The amendments made by this subsection 
        shall apply beginning with fiscal year 2010.
    (b) Parity in FMAP.--
            (1) In general.--Section 1905(b)(2) of such Act (42 U.S.C. 
        1396d(b)(2)) is amended by inserting after ``50 per centum'' 
        the following: ``(except that, beginning with fiscal year 2012, 
        the Federal medical assistance percentage for Puerto Rico, the 
        Virgin Islands, Guam, the Northern Mariana Islands, and 
        American Samoa shall be the Federal medical assistance 
        percentage determined by the Secretary in consultation (for the 
        Virgin Islands, Guam, the Northern Mariana Islands, and 
        American Samoa) with the Secretary of the Interior)''.
            (2) 2-fiscal-year transition.--Notwithstanding any other 
        provision of law, during fiscal years 2010 and 2011, the 
        Federal medical assistance percentage established under section 
        1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) for 
        Puerto Rico, the Virgin Islands, Guam, the Northern Mariana 
        Islands, and American Samoa shall be the highest such Federal 
        medical assistance percentage applicable to any of the 50 
        States or the District of Columbia for the fiscal year 
        involved, taking into account the application of subsections 
        (a) and (b)(1) of 5001 of division B of the American Recovery 
        and Reinvestment Act of 2009 (Public Law 111-5) to such States 
        and District for calendar quarters during such fiscal years for 
        which such subsections apply respectively.
            (3) Per capita income data.--
                    (A) Report to congress.--Not later than October 1, 
                2010, the Secretary of Health and Human Services shall 
                submit to Congress a report that describes the per 
                capita income data used to promulgate the Federal 
                medical assistance percentage in the territories and 
                how such data differ from the per capita income data 
                used to promulgate Federal medical assistance 
                percentages for the 50 States and the District of 
                Columbia. The report should include recommendations on 
                how the Federal medical assistance percentages can be 
                calculated for the territories to ensure parity with 
                the 50 States and the District of Columbia.
                    (B) Application.--Section 1101(a)(8)(B) of the 
                Social Security Act (42 U.S.C. 1308(a)(8)(B)) is 
                amended--
                            (i) by striking ``(other than Puerto Rico, 
                        the Virgin Islands, and Guam)'' and inserting 
                        ``(including Puerto Rico, the Virgin Islands, 
                        Guam, the Northern Mariana Islands, and 
                        American Samoa)''; and
                            (ii) by inserting ``(or, if such 
                        satisfactory data are not available in the case 
                        of the Virgin Islands, Guam, the Northern 
                        Mariana Islands, or American Samoa, 
                        satisfactory data available from the Department 
                        of the Interior for the same period, or if such 
                        satisfactory data are not available in the case 
                        of Puerto Rico, satisfactory data available 
                        from the government of the Commonwealth of 
                        Puerto Rico for the same period)'' after 
                        ``Department of Commerce''.
            (4) Relation to american recovery and reinvestment act of 
        2009.--For any period and territory in which the provisions of 
        this subsection apply to a territory, the provisions of section 
        5001(b)(2) of division B of the American Recovery and 
        Reinvestment Act of 2009 (Public Law 111-5) shall not apply 
        (except as otherwise specifically provided in paragraph (2)).

SEC. 514. EXTENSION OF MEDICARE SECONDARY PAYER.

    (a) In General.--Section 1862(b)(1)(C) of the Social Security Act 
(42 U.S.C. 1395y(b)(1)(C)) is amended--
            (1) in the last sentence, by inserting ``, and before 
        January 1, 2010'' after ``prior to such date)''; and
            (2) by adding at the end the following new sentence: 
        ``Effective for items and services furnished on or after 
        January 1, 2010 (with respect to periods beginning on or after 
        the date that is 42 months prior to such date), clauses (i) and 
        (ii) shall be applied by substituting `42-month' for `12-month' 
        each place it appears in the first sentence.''.
    (b) Effective Date.--The amendments made by this subsection shall 
take effect on the date of enactment of this Act. For purposes of 
determining an individual's status under section 1862(b)(1)(C) of the 
Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by paragraph 
(1), an individual who is within the coordinating period as of the date 
of enactment of this Act shall have that period extended to the full 42 
months described in the last sentence of such section, as added by the 
amendment made by paragraph (1)(B).

SEC. 515. 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 are authorized to be 
appropriated to carry out this section, $200,000,000 for fiscal year 
2010, and such sums as may be necessary for each succeeding fiscal 
year.

SEC. 516. 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. 517. 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--
            (1) by redesignating the second and third sections 399R 
        (added by Public Laws 110-373 and 110-374) as sections 399S and 
        399T, respectively; and
            (2) by adding at the end the following:

``SEC. 399U. 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 2010, 2011, 2012, 2013, and 2014.''.

SEC. 518. 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:
                    ``(N) 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)(N).''.
    (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)(N).''.
    (d) 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. 519. 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, 2010.
    (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 (vi))'' after ``an integrated rural track''; and
                    (B) by adding at the end the following new clause:
                            ``(vi) 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, 
                2010; 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, 2010.

SEC. 520. 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 2010 and such sums as may be necessary for each of fiscal 
years 2011 through 2014.

SEC. 521. GRANTS FOR RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH.

    (a) Purpose.--It is the purpose of this section to provide for the 
awarding of grants to assist communities in mobilizing and organizing 
resources in support of effective and sustainable programs that will 
reduce or eliminate disparities in health and healthcare experienced by 
racial and ethnic minority individuals.
    (b) Authority To Award Grants.--The Secretary, acting through the 
Centers for Disease Control and Prevention, shall award grants to 
eligible entities to assist in designing, implementing, and evaluating 
culturally and linguistically appropriate, science-based and community-
driven sustainable strategies to eliminate racial and ethnic health and 
healthcare disparities.
    (c) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            (1) represent a coalition--
                    (A) whose principal purpose is to develop and 
                implement interventions to reduce or eliminate a health 
                or healthcare disparity in a targeted racial or ethnic 
                minority group in the community served by the 
                coalition; and
                    (B) that includes--
                            (i) members selected from among--
                                    (I) public health departments;
                                    (II) community-based organizations;
                                    (III) university and research 
                                organizations;
                                    (IV) American Indian tribal 
                                organizations, national American Indian 
                                organizations, Indian Health Service, 
                                or organizations serving Alaska 
                                Natives; and
                                    (V) interested public or private 
                                healthcare 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 health issues such as infant 
                mortality, breast and cervical cancer screening and 
                management, cardiovascular disease, diabetes, child and 
                adult immunization levels, or other health priority 
                area(s) 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 nonfinancial 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 with 
communities not affiliated with grantees 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 Health Disparity Elimination and the Centers for 
Disease Control and Prevention.
    (h) Administrative Burdens.--The Secretary shall make every effort 
to minimize duplicative or unnecessary administrative burdens on 
grantees.
    (i) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out the Public 
Health Service Act.

SEC. 522. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.

    (a) 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, 2010.
    (b) 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. 523. 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 (DD), by striking ``and'' at 
                the end;
                    (B) in subparagraph (EE), by inserting ``and'' at 
                the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(FF) marriage and family therapist services (as defined 
        in subsection (ccc)(1)) and mental health counselor services 
        (as defined in subsection (hhh)(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

    ``(hhh)(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 (W)'' and inserting ``(W)''; 
                and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (X) with respect to marriage and 
                family therapist services and mental health counselor 
                services under section 1861(s)(2)(FF), 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(hhh)(1)), mental health counselor services (as defined in 
        section 1861(hhh)(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(hhh)(2)).
            ``(viii) A mental health counselor (as defined in section 
        1861(hhh)(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 (hhh)(2)), or by a mental health 
        counselor (as defined in subsection (hhh)(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 (hhh)(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 
(hhh)(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, 2010.

SEC. 524. 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 523, is amended by adding at the end of 
the following new subsection:

     ``Rural Community Hospital; Rural Community Hospital Services

    ``(iii)(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, 2010; 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, 2010) 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, 2010.
    ``(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(iii)(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(iii)(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 
                (iii)(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, 2009.

SEC. 525. 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. 526. 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 
        2010 through 2014.
            (2) Availability.--
                    (A) In general.--Funds appropriated under paragraph 
                (1) shall remain available for expenditure through 
                fiscal year 2014.
                    (B) Report.--For purposes of carrying out 
                subsection (b)(8), funds appropriated under paragraph 
                (1) shall remain available for expenditure through 
                fiscal year 2015.
            (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. 527. 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, 2012, 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 
2010, and such sums as may be necessary for each of fiscal years 2011 
through 2014.''.

SEC. 528. 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. 529. 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.).

SEC. 530. REMOVING BARRIERS TO HEALTH CARE AND NUTRITION ASSISTANCE 
              HEALTH COVERAGE FOR CHILDREN, PREGNANT WOMEN, AND 
              LAWFULLY RESIDING INDIVIDUALS.

    (a) Medicaid.--Section 1903(v) of the Social Security Act (42 
U.S.C. 1396b(v)) is amended by striking paragraph (4) and inserting the 
following new paragraph:
    ``(4)(A) Notwithstanding sections 401(a), 402(b), 403, and 421 of 
the Personal Responsibility and Work Opportunity Reconciliation Act of 
1996, payment shall be made under this section for care and services 
that are furnished to individuals, including those described in 
paragraph (1), if they otherwise meet the eligibility requirements for 
medical assistance under the State plan approved under this title 
(other than the requirement of the receipt of aid or assistance under 
title IV, supplemental security income benefits under title XVI, or a 
State supplementary payment), and are--
            ``(i) lawfully present in the United States;
            ``(ii) children under age 21, including optional targeted 
        low-income children described in section 1905(u)(2)(B); or
            ``(iii) pregnant women during pregnancy (and during the 60-
        day period beginning on the last day of the pregnancy).
    ``(B) No debt shall accrue under an affidavit of support against 
any sponsor of such an alien on the basis of provision of assistance to 
such category and the cost of such assistance shall not be considered 
as an unreimbursed cost.''.
    (b) SCHIP.--Section 2107(e)(1) of the Social Security Act (42 
U.S.C. 1397gg(e)(1)) is amended by striking subparagraph (H) and 
inserting the following new subparagraph:
                    ``(H) Paragraph (4) of section 1903(v) (relating to 
                individuals who, but for sections 401(a), 403, and 421 
                of the Personal Responsibility and Work Opportunity 
                Reconciliation Act of 1996, would be eligible for 
                medical assistance under title XXI).''.
    (c) Nutrition Assistance.--
            (1) Supplemental nutrition assistance.--Notwithstanding 
        sections 401(a), 402(a), and 403(a) of the Personal 
        Responsibility and Work Opportunity Reconciliation Act of 1996 
        (8 U.S.C. 1611(a); 1612(a), 1613(a)) and section 6(f) of the 
        Food and Nutrition Act of 2008 (7 U.S.C 2015(f)), persons who 
        are lawfully present in the United States shall be not be 
        ineligible for benefits under the supplemental nutrition 
        assistance program on the basis of their immigration status or 
        date of entry into the United States.
            (2) Eligibility for families with children.--Section of the 
        421(d)(3) of the Personal Responsibility and Work Opportunity 
        Reconciliation Act of 1996 (8 U.S.C. 1631(d)(3)) is amended by 
        striking ``to the extent that a qualified alien is eligible 
        under section 402(a)(2)(J)'' and inserting, ``to the extent 
        that a child is a member of a household under the supplemental 
        nutrition assistance program''.
            (3) Ensuring proper screening.--Section 11(e)(2)(B) of the 
        Food and Nutrition Act of 2008 (7 U.S.C. 2020(e)(2)(B)) is 
        amended--
                    (A) by redesignating clauses (vi) and (viii) as 
                clauses (vii) and (viii); and
                    (B) by inserting after clause (v) the following:
                            ``(vi) shall provide a method for 
                        implementing section 421 of the Personal 
                        Responsibility and Work Opportunity 
                        Reconciliation Act of 1996 (8 U.S.C. 1631) that 
                        does not require any unnecessary information 
                        from persons who may be exempt from that 
                        provision;''.

SEC. 531. REMOVING MEDICARE BARRIER TO HEALTH CARE.

    Section 1818(a)(3) of the Social Security Act (42 U.S.C. 1395i-
2(a)(3)) is amended by amending clause (B) to read as follows: ``(B) an 
individual who is lawfully present in the United States''.

               CHAPTER 2--LUNG CANCER MORTALITY REDUCTION

SEC. 541. SHORT TITLE.

    This chapter may be cited as the ``Lung Cancer Mortality Reduction 
Act of 2009''.

SEC. 542. FINDINGS.

    Congress makes the following findings:
            (1) Lung cancer is the leading cause of cancer death for 
        both men and women, accounting for 28 percent of all cancer 
        deaths.
            (2) Lung cancer kills more people annually than breast 
        cancer, prostate cancer, colon cancer, liver cancer, melanoma, 
        and kidney cancer combined.
            (3) Since the National Cancer Act of 1971 (Public Law 92-
        218; 85 Stat. 778), coordinated and comprehensive research has 
        raised the 5-year survival rates for breast cancer to 88 
        percent, for prostate cancer to 99 percent, and for colon 
        cancer to 64 percent.
            (4) However, the 5-year survival rate for lung cancer is 
        still only 15 percent and a similar coordinated and 
        comprehensive research effort is required to achieve increases 
        in lung cancer survivability rates.
            (5) Sixty percent of lung cancer cases are now diagnosed as 
        nonsmokers or former smokers.
            (6) Two-thirds of nonsmokers diagnosed with lung cancer are 
        women.
            (7) Certain minority populations, such as African-American 
        males, have disproportionately high rates of lung cancer 
        incidence and mortality, notwithstanding their similar smoking 
        rate.
            (8) Members of the baby boomer generation are entering 
        their sixties, the most common age at which people develop lung 
        cancer.
            (9) Tobacco addiction and exposure to other lung cancer 
        carcinogens such as Agent Orange and other herbicides and 
        battlefield emissions are serious problems among military 
        personnel and war veterans.
            (10) Significant and rapid improvements in lung cancer 
        mortality can be expected through greater use and access to 
        lung cancer screening tests for at-risk individuals.
            (11) Additional strategies are necessary to further enhance 
        the existing tests and therapies available to diagnose and 
        treat lung cancer in the future.
            (12) The August 2001 Report of the Lung Cancer Progress 
        Review Group of the National Cancer Institute stated that 
        funding for lung cancer research was ``far below the levels 
        characterized for other common malignancies and far out of 
        proportion to its massive health impact''.
            (13) The Report of the Lung Cancer Progress Review Group 
        identified as its ``highest priority'' the creation of 
        integrated, multidisciplinary, multi-institutional research 
        consortia organized around the problem of lung cancer rather 
        than around specific research disciplines.
            (14) The United States must enhance its response to the 
        issues raised in the Report of the Lung Cancer Progress Review 
        Group, and this can be accomplished through the establishment 
        of a coordinated effort designed to reduce the lung cancer 
        mortality rate by 50 percent by 2015 and targeted funding to 
        support this coordinated effort.

SEC. 543. SENSE OF CONGRESS CONCERNING INVESTMENT IN LUNG CANCER 
              RESEARCH.

    It is the sense of the Congress that--
            (1) lung cancer mortality reduction should be made a 
        national public health priority; and
            (2) a comprehensive mortality reduction program coordinated 
        by the Secretary of Health and Human Services is justified and 
        necessary to adequately address and reduce lung cancer 
        mortality.

SEC. 544. LUNG CANCER MORTALITY REDUCTION PROGRAM.

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

``SEC. 417G. LUNG CANCER MORTALITY REDUCTION PROGRAM.

    ``(a) In General.--Not later than 6 months after the date of the 
enactment of this section, the Secretary, in consultation with the 
Secretary of Defense, the Secretary of Veterans Affairs, the Director 
of the National Institutes of Health, the Director of the Centers for 
Disease Control and Prevention, the Commissioner of Food and Drugs, the 
Administrator of the Centers for Medicare & Medicaid Services, the 
Director of the National Center on Minority Health and Health 
Disparities, and other members of the Lung Cancer Advisory Board 
established under section 546 of the Lung Cancer Mortality Reduction 
Act of 2009, shall implement a comprehensive program, to be known as 
the Lung Cancer Mortality Reduction Program, to achieve a reduction of 
at least 25 percent in the mortality rate of lung cancer by 2015.
    ``(b) Requirements.--The Program shall include at least the 
following:
            ``(1) With respect to the National Institutes of Health--
                    ``(A) a strategic review and prioritization by the 
                National Cancer Institute of research grants to achieve 
                the goal of the Lung Cancer Mortality Reduction Program 
                in reducing lung cancer mortality;
                    ``(B) the provision of funds to enable the Airway 
                Biology and Disease Branch of the National Heart, Lung, 
                and Blood Institute to expand its research programs to 
                include predispositions to lung cancer, the 
                interrelationship between lung cancer and other 
                pulmonary and cardiac disease, and the diagnosis and 
                treatment of these interrelationships;
                    ``(C) the provision of funds to enable the National 
                Institute of Biomedical Imaging and Bioengineering to 
                expedite the development of computer assisted 
                diagnostic, surgical, treatment, and drug testing 
                innovations to reduce lung cancer mortality, such as 
                through expansion of the Institute's Quantum Grant 
                Program and Image-Guided Interventions programs; and
                    ``(D) the provision of funds to enable the National 
                Institute of Environmental Health Sciences to implement 
                research programs relative to the lung cancer 
                incidence.
            ``(2) With respect to the Food and Drug Administration--
                    ``(A) activities under section 529 of the Federal 
                Food, Drug, and Cosmetic Act; and
                    ``(B) activities under section 561 of the Federal 
                Food, Drug, and Cosmetic Act to expand access to 
                investigational drugs and devices for the diagnosis, 
                monitoring, or treatment of lung cancer.
            ``(3) With respect to the Centers for Disease Control and 
        Prevention, the establishment of an early disease research and 
        management program under section 1511.
            ``(4) With respect to the Agency for Healthcare Research 
        and Quality, the conduct of a biannual review of lung cancer 
        screening, diagnostic, and treatment protocols, and the 
        issuance of updated guidelines.
            ``(5) The cooperation and coordination of all minority and 
        health disparity programs within the Department of Health and 
        Human Services to ensure that all aspects of the Lung Cancer 
        Mortality Reduction Program under this section adequately 
        address the burden of lung cancer on minority and rural 
        populations.
            ``(6) The cooperation and coordination of all tobacco 
        control and cessation programs within agencies of the 
        Department of Health and Human Services to achieve the goals of 
        the Lung Cancer Mortality Reduction Program under this section 
        with particular emphasis on the coordination of drug and other 
        cessation treatments with early detection protocols.''.
    (b) Federal Food, Drug, and Cosmetic Act.--Subchapter B of chapter 
V of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 
seq.) is amended by adding at the end the following:

                    ``drugs relating to lung cancer

    ``Sec. 529.  (a) In General.--The provisions of this subchapter 
shall apply to a drug described in subsection (b) to the same extent 
and in the same manner as such provisions apply to a drug for a rare 
disease or condition.
    ``(b) Qualified Drugs.--A drug described in this subsection is--
            ``(1) a chemoprevention drug for precancerous conditions of 
        the lung;
            ``(2) a drug for a targeted therapeutic treatments, 
        including any vaccine for, lung cancer; and
            ``(3) a drug to curtail or prevent nicotine addiction.
    ``(c) Board.--The Board established under section 546 of the Lung 
Cancer Mortality Reduction Act of 2009 shall monitor the program 
implemented under this section.''.
    (c) Access to Unapproved Therapies.--Section 561(e) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is amended by 
inserting before the period the following: ``and shall include 
expanding access to drugs under section 529, with substantial 
consideration being given to whether the totality of information 
available to the Secretary regarding the safety and effectiveness of an 
investigational drug, as compared to the risk of morbidity and death 
from the disease, indicates that a patient may obtain more benefit than 
risk if treated with the drug''.
    (d) CDC.--Title XV of the Public Health Service Act (42 U.S.C. 300k 
et seq.) is amended by adding at the end the following:

``SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT PROGRAM.

    ``The Secretary shall establish and implement an early disease 
research and management program targeted at the high incidence and 
mortality rates of lung cancer among minority and low-income 
populations.''.

SEC. 545. DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS.

    The Secretary of Defense and the Secretary of Veterans Affairs 
shall coordinate with the Secretary of Health and Human Services--
            (1) in the development of the Lung Cancer Mortality 
        Reduction Program under section 417G;
            (2) in the implementation within the Department of Defense 
        and the Department of Veterans Affairs of an early detection 
        and disease management research program for military personnel 
        and veterans whose smoking history and exposure to carcinogens 
        during active duty service has increased their risk for lung 
        cancer; and
            (3) in the implementation of coordinated care programs for 
        military personnel and veterans diagnosed with lung cancer.

SEC. 546. LUNG CANCER ADVISORY BOARD.

    (a) In General.--The Secretary of Health and Human Services shall 
convene a Lung Cancer Advisory Board (referred to in this section as 
the ``Board'')--
            (1) to monitor the programs established under this chapter 
        (and the amendments made by this chapter); and
            (2) to provide annual reports to the Congress concerning 
        benchmarks, expenditures, lung cancer statistics, and the 
        public health impact of such programs.
    (b) Composition.--The Board shall be composed of--
            (1) the Secretary of Health and Human Services;
            (2) the Secretary of Defense;
            (3) the Secretary of Veterans Affairs; and
            (4) two representatives each from the fields of clinical 
        medicine focused on lung cancer, lung cancer research, imaging, 
        drug development, and lung cancer advocacy, to be appointed by 
        the Secretary of Health and Human Services.

SEC. 547. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--To carry out this chapter (and the amendments made 
by this chapter), there are authorized to be appropriated such sums as 
may be necessary for each of fiscal years 2010 through 2014.
    (b) Lung Cancer Mortality Reduction Program.--Of the amounts 
authorized to be appropriated by subsection (a), there are authorized 
to be appropriated--
            (1) $25,000,000 for fiscal year 2010, and such sums as may 
        be necessary for each of fiscal years 2011 through 2014, for 
        the activities described in section 417G(b)(1)(B) of the Public 
        Health Service Act, as added by section 544(a);
            (2) $25,000,000 for fiscal year 2010, and such sums as may 
        be necessary for each of fiscal years 2011 through 2014, for 
        the activities described in section 417G(b)(1)(C) of such Act;
            (3) $10,000,000 for fiscal year 2010, and such sums as may 
        be necessary for each of fiscal years 2011 through 2014, for 
        the activities described in section 417G(b)(1)(D) of such Act; 
        and
            (4) $15,000,000 for fiscal year 2010, and such sums as may 
        be necessary for each of fiscal years 2011 through 2014, for 
        the activities described in section 417G(b)(3) of such Act.

  TITLE VI--ELIMINATING DISPARITIES IN DIABETES PREVENTION ACCESS AND 
                                CARE ACT

               Subtitle A--NATIONAL INSTITUTES OF HEALTH

SEC. 611. RESEARCH, TREATMENT, AND EDUCATION.

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

``SEC. 434B. DIABETES IN MINORITY POPULATIONS.

    ``(a) In General.--The Director of the National Institutes of 
Health shall expand, intensify, and support ongoing research and other 
activities with respect to pre-diabetes and diabetes, particularly type 
2, in minority populations, including research to identify clinical, 
socioeconomic, geographical, cultural, and organizational factors that 
contribute to type 2 diabetes in such populations.
    ``(b) Certain Activities.--Activities under subsection (a) 
regarding type 2 diabetes in minority populations shall include the 
following:
            ``(1) Continue research on behavior and obesity, including 
        research through the obesity research center that is sponsored 
        by the National Institutes of Health.
            ``(2) Research on environmental factors that may contribute 
        to the increase in type 2 diabetes.
            ``(3) Support for new methods to identify environmental 
        triggers and genetic interactions that lead to the development 
        of type 2 diabetes in minority newborns. Such research should 
        follow the newborns through puberty, an increasingly high-risk 
        period for developing type 2 diabetes.
            ``(4) Research to identify genes that predispose 
        individuals to the onset of developing type 1 and type 2 
        diabetes and to the development of complications.
            ``(5) Research to prevent complications in individuals who 
        have already developed diabetes, such as research that attempts 
        to identify the genes that predispose individuals with diabetes 
        to the development of complications.
            ``(6) Research methods and alternative therapies to control 
        blood glucose.
            ``(7) Support of ongoing research efforts examining the 
        level of glycemia at which adverse outcomes develop during 
        pregnancy and to address the many clinical issues associated 
        with minority mothers and fetuses during diabetic and 
        gestational diabetic pregnancies.
    ``(c) Education.--The Director of the National Institutes of Health 
shall--
            ``(1) through the National Center on Minority Health and 
        Health Disparities and the National Diabetes Education 
        Program--
                    ``(A) make grants to programs funded under section 
                485F (relating to centers of excellence) for the 
                purpose of establishing a mentoring program for health 
                care professionals to be more involved in weight 
                counseling, obesity research, and nutrition; and
                    ``(B) provide for the participation of minority 
                health professionals in diabetes-focused research 
                programs; and
            ``(2) make grants for programs to establish a pipeline from 
        high school to professional school that will increase minority 
        representation in diabetes-focused health fields by expanding 
        Minority Access to Research Careers (MARC) program internships 
        and mentoring opportunities for recruitment.
    ``(d) Definition.--For purposes of this section, the term `minority 
population' means a racial and ethnic minority group, as defined in 
section 1707.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
are necessary for fiscal year 2010 and each subsequent fiscal year.''.
    (b) Diabetes Mellitus Interagency Coordinating Committee.--Section 
429 of the Public Health Service Act (42 U.S.C. 285c-3) is amended by 
adding at the end the following new subsection:
    ``(c)(1) In each annual report prepared by the Diabetes Mellitus 
Interagency Coordinating Committee, the Committee shall include an 
assessment of the Federal activities and programs related to diabetes 
in minority populations. Such assessment shall--
                    ``(A) compile the current activities of all current 
                Federal health programs to allow for the assessment of 
                their adequacy as a systemic method of addressing the 
                impact of diabetes mellitus on minority populations;
                    ``(B) develop strategic planning activities to 
                develop an effective and comprehensive Federal plan to 
                address diabetes mellitus within minority populations 
                which will involve all appropriate Federal health 
                programs and shall--
                            ``(i) include steps to address issues 
                        including type 1 and type 2 diabetes in 
                        children and the disproportionate impact of 
                        diabetes mellitus on minority populations; and
                            ``(ii) remain consistent with the programs 
                        and activities identified in section 399O, as 
                        well as remaining consistent with the intent of 
                        the Eliminating Disparities in Diabetes 
                        Prevention Access and Care Act of 2009; and
                    ``(C) assess the implementation of such a plan 
                throughout Federal health programs.
            ``(2) For the purposes of this subsection, the term 
        `minority population' means a racial and ethnic minority group, 
        as defined in section 1707.
            ``(3) For the purpose of carrying out this subsection, 
        there are authorized to be appropriated such sums as are 
        necessary for fiscal year 2010 and each subsequent fiscal 
        year.''.

         Subtitle B--CENTERS FOR DISEASE CONTROL AND PREVENTION

SEC. 621. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.

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

``SEC. 317U. DIABETES IN MINORITY POPULATIONS.

    ``(a) Research and Other Activities.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall conduct and support research and other activities with 
        respect to diabetes in minority populations.
            ``(2) Certain activities.--Activities under paragraph (1) 
        regarding diabetes in minority populations shall include the 
        following:
                    ``(A) Expanding the National Diabetes Laboratory 
                capacity for translational research and the 
                identification of genetic and immunological risk 
                factors associated with diabetes.
                    ``(B) Enhancing the National Health and Nutrition 
                Examination Survey to include risk factors for type 2 
                diabetes and pre-diabetes with emphasis on eating and 
                dietary habits, and focus, including cultural and 
                socioeconomic factors, on Hispanic-American, African-
                American, American Indian and Alaskan Native, and 
                Asian-American, Native Hawaiian and other Pacific 
                Islander communities.
                    ``(C) Further enhancing the National Health and 
                Nutrition Examination Survey by over-sampling Asian-
                American, Native Hawaiian, and Other Pacific Islanders 
                in appropriate geographic areas to better determine the 
                prevalence of diabetes in such populations as well as 
                to improve the data collection of diabetes penetration 
                disaggregated into major ethnic groups within such 
                populations.
                    ``(D) Within the Division of Diabetes Translation, 
                providing for prevention research to better understand 
                how to influence health care systems changes to improve 
                quality of care being delivered to such populations, 
                and within the Division of Diabetes Translation, 
                carrying out model demonstration projects to design, 
                implement, and evaluate effective diabetes prevention 
                and control intervention for such populations.
                    ``(E) Through the Division of Diabetes Translation, 
                carrying out culturally appropriate community-based 
                interventions designed to address issues and problems 
                experienced by such populations.
                    ``(F) Conducting applied research within the 
                Division of Diabetes Translation to reduce health 
                disparities within such populations with diabetes.
                    ``(G) Conducting applied research on primary 
                prevention within the Division of Diabetes Translation 
                to specifically focus on such populations with pre-
                diabetes.
    ``(b) Education.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall direct the Division of Diabetes Translation to conduct 
        and support programs to educate the public on the causes and 
        effects of diabetes in minority populations.
            ``(2) Certain activities.--Programs under paragraph (1) 
        regarding education on diabetes in minority populations shall 
        include carrying out public awareness campaigns directed toward 
        such populations to aggressively emphasize the importance and 
        impact of physical activity and diet in regard to diabetes and 
        diabetes-related complications through the National Diabetes 
        Education Program.
    ``(c) Diabetes; Health Promotion, Prevention Activities, and 
Access.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, 
        shall carry out culturally appropriate diabetes health 
        promotion and prevention programs for minority populations.
            ``(2) Certain activities.--Activities regarding culturally 
        appropriate diabetes health promotion and prevention programs 
        for minority populations shall include the following:
                    ``(A) Expanding the Diabetes Prevention and Control 
                Program (currently existing in all the States and 
                territories) and providing funds for education and 
                community outreach on diabetes.
                    ``(B) Providing funds for an expansion of the 
                Diabetes Prevention Program Initiative that focuses on 
                physical inactivity and diet and its relation to type 2 
                diabetes within such populations.
                    ``(C) Providing funds to strengthen existing 
                surveillance systems to improve the quality, accuracy, 
                and timeliness of morbidity and mortality diabetes data 
                for such populations.
    ``(d) Definition.--For purposes of this section, the term `minority 
population' means a racial and ethnic minority group, as defined in 
section 1707.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
are necessary for fiscal year 2010 and each subsequent fiscal year.''.

        Subtitle C--HEALTH RESOURCES AND SERVICES ADMINISTRATION

SEC. 631. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.

    Part P of title III of the Public Health Service Act, as amended, 
is amended by adding at the end the following new section:

``SEC. 399V. PROGRAMS TO EDUCATE HEALTH PROVIDERS ON THE CAUSES AND 
              EFFECTS OF DIABETES IN MINORITY POPULATIONS.

    ``(a) In General.--The Secretary, acting through the Director of 
the Health Resources and Services Administration, shall conduct and 
support programs described in subsection (b) to educate health 
professionals on the causes and effects of diabetes in minority 
populations.
    ``(b) Programs.--Programs described in this subsection, with 
respect to education on diabetes in minority populations, shall include 
the following:
            ``(1) Making grants for diabetes-focused education classes 
        or training programs on cultural sensitivity and patient care 
        within such populations for health care providers.
            ``(2) Providing funds to community health centers for 
        programs that provide diabetes services and screenings.
            ``(3) Providing additional funds for the Health Careers 
        Opportunity Program, Centers for Excellence, and the Minority 
        Faculty Fellowship Program to partner with the Office of 
        Minority Health under section 1707 and the National Institutes 
        of Health to strengthen programs for career opportunities 
        within minority populations focused on diabetes treatment and 
        care.
            ``(4) Developing a diabetes focus within, and providing 
        additional funds for, the National Health Service Corps 
        Scholarship program to place individuals in areas that are 
        disproportionately affected by diabetes and to provide health 
        care services to such areas.
            ``(5) Establishing a diabetes ambassador program for 
        recruitment efforts to increase the number of underrepresented 
        minorities currently serving in student, faculty, or 
        administrative positions in institutions of higher learning, 
        hospitals, and community health centers.
            ``(6) Establishing a loan repayment program that focuses on 
        diabetes care and prevention in minority populations.''.

                    Subtitle D--ADDITIONAL PROGRAMS

SEC. 641. RESEARCH, EDUCATION, AND OTHER ACTIVITIES.

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

``SEC. 399W. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING 
              DIABETES IN MINORITY POPULATIONS.

    ``(a) Research and Other Activities.--
            ``(1) In general.--In addition to activities under sections 
        317U and 434B, the Secretary shall conduct and support research 
        and other activities with respect to diabetes within minority 
        populations.
            ``(2) Certain activities.--Activities under paragraph (1) 
        regarding diabetes in minority populations shall include the 
        following:
                    ``(A) Through the National Center on Minority 
                Health and Health Disparities, the Office of Minority 
                Health under section 1707, the Health Resources and 
                Services Administration, the Centers for Disease 
                Control and Prevention, and the Indian Health Service, 
                establishing partnerships within minority populations 
                to conduct studies on cultural, familial, and social 
                factors that may influence health promotion, diabetes 
                management, and prevention.
                    ``(B) Through the Indian Health Service, in 
                collaboration with other appropriate Federal agencies, 
                coordinating the collection of data on ethnic and 
                culturally appropriate diabetes treatment, care, 
                prevention, and services by health care professionals 
                to the American Indian population.
            ``(3) Programs relating to clinical research.--
                    ``(A) Education regarding clinical trials.--The 
                Secretary shall carry out education and awareness 
                programs designed to increase participation of minority 
                populations in clinical trials.
                    ``(B) Minority researchers.--The Secretary shall 
                carry out mentorship programs for minority researchers 
                who are conducting or intend to conduct research on 
                diabetes in minority populations.
                    ``(C) Supplementing clinical research regarding 
                children.--The Secretary shall make grants to 
                supplement clinical research programs to assist such 
                programs in obtaining the services of health 
                professionals and other resources to provide 
                specialized care for children with type 1 and type 2 
                diabetes.
            ``(4) Additional programs.--Activities under paragraph (1) 
        regarding education on diabetes in minority populations shall 
        include providing funds for new and existing diabetes-focused 
        education grants and programs for present and future students 
        and clinicians in the medical field from minority populations, 
        including for the following:
                    ``(A) For Federal and State loan repayment programs 
                for health profession students within communities of 
                color.
                    ``(B) For the Office of Minority Health under 
                section 1707 for training health profession students to 
                focus on diabetes within such populations.
                    ``(C) For State and local entities to establish 
                diabetes awareness week or day every month in schools, 
                nursing homes, and colleges through partnerships with 
                the Office of Minority Health under section 1707 and 
                the Health Resources and Services Administration.
    ``(b) Definition.--For purposes of this section, the term `minority 
population' means a racial and ethnic minority group as defined in 
section 1707.
    ``(c) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
are necessary for fiscal year 2010 and each subsequent fiscal year.''.
                                 <all>