[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2841 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2841

     To provide for a study by the Institute of Medicine on health 
 disparities, to direct the Secretary of Health and Human Services to 
   develop guidelines on reducing health disparities, and for other 
                               purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

           September 17 (legislative day, September 16), 2014

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

_______________________________________________________________________

                                 A BILL


 
     To provide for a study by the Institute of Medicine on health 
 disparities, to direct the Secretary of Health and Human Services to 
   develop guidelines on reducing health disparities, 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 ``Reducing Disparities Using Care 
Models and Education Act of 2014''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) The infant death rate among African-Americans is more 
        than double that of Whites.
            (2) The death rate for all cancers is 30 percent higher for 
        African-Americans than for Whites; for prostate cancer, it is 
        more than double that for Whites.
            (3) Black women have a higher death rate from breast cancer 
        despite having a mammography screening rate that is nearly the 
        same as the rate for White women.
            (4) Diabetes incidence is highest among Native Americans, 
        at 15.9 percent, followed by 13.2 percent for African-
        Americans, 12.8 percent for Hispanics, 9.0 percent for Asians, 
        and 7.6 percent for Whites.
            (5) New cases of hepatitis and tuberculosis are higher in 
        Asians and Pacific Islanders living in the United States than 
        in Whites.
            (6) Individuals in same-sex couples were more likely than 
        individuals in different-sex couples to report a delay in 
        getting necessary prescriptions.
            (7) Infants born to Black women are 1.5 to 3 times more 
        likely to die than those born to women of other races or 
        ethnicities, and American Indian and Alaska Native infants die 
        from sudden infant death syndrome (SIDS) at nearly 2.5 times 
        the rate of White infants.
            (8) Low-income children have higher rates of mortality 
        (even with the same condition), have higher rates of 
        disability, and are more likely to have multiple conditions.
            (9) White children are half as likely as Black and Latino 
        children not to be in excellent or very good health.
            (10) As of 2012, 38.9 percent of United States adults were 
        obese, with the highest rate among African-Americans at 47.9 
        percent, followed by Hispanics at 42.5 percent, Whites at 32.6 
        percent, and Asians at 10.8 percent.
            (11) The risk of stroke is twice as high for African-
        Americans as for Whites, and African-Americans are more likely 
        to die of stroke. Other ethnic minorities also have higher risk 
        than Whites. Overall, strokes are most prevalent in the 
        Southeast United States, and less so in the Northeast.
            (12) African-Americans accounted for 44 percent of all 
        those infected with HIV, despite being only 12 percent of the 
        United States population.
            (13) Black men who have sex with men (MSM) ages 13 to 24 
        had the most new infections among youth.
            (14) One study found that among heterosexuals living in the 
        same urban community, those below the poverty line were twice 
        as likely to contract human immunodeficiency virus (HIV).
            (15) Persons with less than a high school diploma (6.7 
        percent) and high school graduates (4.0 percent) were more 
        likely to report major depression than those with at least some 
        college education (2.5 percent).
            (16) Only about 10 percent of physicians practice in rural 
        America despite the fact that nearly one-fourth of the 
        population lives in these areas.
            (17) Rural residents are less likely to have employer-
        provided health care coverage or prescription drug coverage, 
        and the rural poor are less likely to be covered by Medicaid 
        benefits than their urban counterparts.
            (18) Twenty percent of nonmetropolitan counties lack mental 
        health services versus 5 percent of metropolitan counties.
            (19) Fifteen percent of persons with disabilities report 
        not seeing a doctor due to cost in comparison to 6 percent of 
        the general population.

SEC. 3. INSTITUTE OF MEDICINE STUDY.

    (a) In General.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary shall enter into an arrangement 
with the Institute of Medicine under which the Institute agrees to 
study--
            (1) the extent of health disparities in the type and 
        quality of preventive interventions, health services, and 
        outcomes in the United States;
            (2) the factors that may contribute to inequities in such 
        disparities;
            (3) existing programs and policies intended to reduce such 
        disparities;
            (4) best practices and successful strategies in programs 
        that aim to reduce such disparities;
            (5) priorities for successful intervention programs 
        targeting such disparities; and
            (6) potential opportunities for expanding or replicating 
        such programs.
    (b) Report.--The arrangement under subsection (a) shall provide for 
submission by the Institute of Medicine to the Secretary and Congress, 
not later than 20 months after the date of enactment of this Act, of a 
report on the results of the study.

SEC. 4. GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF HEALTH 
              DISPARITIES REDUCTION PROGRAMS AND ACTIVITIES.

    (a) Guidelines.--Not later than 90 days after the submission of the 
report described in section 3(b), and taking such report into 
consideration, the Secretary shall develop guidelines for entities to 
develop and implement programs and activities to reduce health 
disparities.
    (b) Use by HHS.--The Secretary shall, where appropriate, 
incorporate the use of the guidelines developed under subsection (a) 
into the programs and activities of the Department of Health and Human 
Services.
    (c) Grants for Disparities Reduction Activities.--
            (1) In general.--The Secretary may award grants to entities 
        for the development and implementation of programs and 
        activities to reduce health disparities in accordance with the 
        guidelines described in subparagraph (a).
            (2) Applications.--To seek a grant under this subsection, 
        an entity shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require.
            (3) Minimum contents.--The Secretary shall require that an 
        application for a grant under this subsection contains at a 
        minimum--
                    (A) a description of the population and public 
                health concern the program will target and an outreach 
                plan to ensure that the most in need populations will 
                benefit;
                    (B) a description of the strategies the entity will 
                use--
                            (i) to develop and implement its programs 
                        and activities in accordance with the 
                        guidelines developed under subsection (a); and
                            (ii) to make the interventions sustainable; 
                        and
                    (C) an agreement by the entities to periodically 
                provide data with respect to--
                            (i) the population served;
                            (ii) improvements in reducing health 
                        disparities; and
                            (iii) effectiveness of the interventions 
                        used.
    (d) Appropriations.--To carry out this section, there are 
authorized to be appropriated $5,000,000 for fiscal year 2016 and such 
sums as may be necessary for each of fiscal years 2017 through 2020.

SEC. 5. TESTING ALTERNATIVE PAYMENT AND DELIVERY MODELS TO REDUCE 
              HEALTH DISPARITIES.

    (a) In General.--The Secretary acting through the Centers for 
Medicare and Medicaid Innovation under section 1115A of the Social 
Security Act (42 U.S.C. 1315a) shall provide for the testing of a 
payment and service delivery model that includes incentives for 
reducing health disparities consistent with the cost and quality 
criteria otherwise applicable to the testing of models under such 
section.
    (b) Documentation Requirement for Model Testing.--In carrying out 
subsection (a), the Secretary shall require that an application to 
conduct such testing of such a model include at least--
            (1) documentation of at least one health disparity targeted 
        for reduction;
            (2) a root-cause analysis of the health disparity targeted 
        for reduction;
            (3) identification and selection of performance targets for 
        such reduction;
            (4) a proposal to make payments in some way contingent on a 
        reduction in health disparities; and
            (5) a reliable method for monitoring progress in achieving 
        such a reduction.

SEC. 6. DEFINITIONS.

    In this Act:
            (1) The term ``health disparity'' means significant 
        disparity in the overall rate of disease incidence, prevalence, 
        morbidity, mortality, or survival rates in a population as 
        compared to the health status of the general population.
            (2) The term ``intervention'' means an activity taken by an 
        entity on behalf of individuals or populations to reduce health 
        disparities.
            (3) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
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