I 111th CONGRESS 1st Session H. R. 3090 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. Velázquez, Mr. Luján, 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.

1.

Short title

This Act may be cited as the Health Equity and Accountability Act of 2009.

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.

.

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:

1899.

Medicare support for language services

(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 part C. (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: (hhh)

Language services; interpreter services; interpreter; translation; LEP

(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.

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.

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.

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.

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.

107.

Definition

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

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.

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.