[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5942 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5942
To improve the health of minority individuals, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 23, 2018
Ms. Lee (for herself, Mr. Aguilar, Ms. Barragan, Ms. Bass, Ms.
Bonamici, Ms. Bordallo, Mr. Brown of Maryland, Mr. Carbajal, Mr.
Cardenas, Mr. Carson of Indiana, Mr. Castro of Texas, Ms. Judy Chu of
California, Ms. Clarke of New York, Mr. Correa, Mr. Danny K. Davis of
Illinois, Mr. Ellison, Ms. Eshoo, Mr. Espaillat, Ms. Fudge, Mr.
Gallego, Mr. Gomez, Mr. Al Green of Texas, Mr. Grijalva, Mr. Gutierrez,
Ms. Hanabusa, Mr. Hastings, Ms. Jayapal, Ms. Eddie Bernice Johnson of
Texas, Ms. Kelly of Illinois, Mr. Khanna, Mr. Lewis of Georgia, Mr. Ted
Lieu of California, Ms. Lofgren, Mr. Lowenthal, Ms. Michelle Lujan
Grisham of New Mexico, Ms. Matsui, Mr. Meeks, Ms. Meng, Mrs.
Napolitano, Ms. Norton, Mr. Payne, Mr. Raskin, Mr. Richmond, Ms.
Roybal-Allard, Mr. Rush, Mr. Sablan, Ms. Sanchez, Mr. Schiff, Mr. Scott
of Virginia, Mr. Serrano, Ms. Sewell of Alabama, Mr. Swalwell of
California, Mr. Takano, Mrs. Torres, Ms. Velazquez, Ms. Wilson of
Florida, Mrs. Watson Coleman, and Mr. Krishnamoorthi) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committees on Ways and Means,
Agriculture, Education and the Workforce, the Budget, the Judiciary,
Veterans' Affairs, Armed Services, and Natural Resources, 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 2018''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Findings.
TITLE I--DATA COLLECTION AND REPORTING
Sec. 101. Amendment to the Public Health Service Act.
Sec. 102. Elimination of prerequisite of direct appropriations for data
collection and analysis.
Sec. 103. Collection of race and ethnicity data by the Social Security
Administration.
Sec. 104. Revision of HIPAA claims standards.
Sec. 105. National Center for Health Statistics.
Sec. 106. Disparities data collected by the Federal Government.
Sec. 107. Data collection and analysis grants to minority-serving
institutions.
Sec. 108. Standards for measuring sexual orientation and gender
identity in collection of health data.
Sec. 109. Standards for measuring socioeconomic status in collection of
health data.
Sec. 110. Safety and effectiveness of drugs with respect to racial and
ethnic background.
Sec. 111. Improving health data regarding Native Hawaiians and other
Pacific Islanders.
Sec. 112. Clarification of simplified administrative reporting
requirement.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH
CARE
Sec. 201. Definitions.
Sec. 202. Amendment to the Public Health Service Act.
Sec. 203. Pilot program for improvement and development of State
medical interpreting services.
Sec. 204. Training tomorrow's doctors for culturally and linguistically
appropriate care: graduate medical
education.
Sec. 205. Federal reimbursement for culturally and linguistically
appropriate services under the Medicare,
Medicaid, and State Children's Health
Insurance Programs.
Sec. 206. Increasing understanding of and improving health literacy.
Sec. 207. Assurances for receiving Federal funds.
Sec. 208. Report on Federal efforts to provide culturally and
linguistically appropriate health care
services.
Sec. 209. English for speakers of other languages.
Sec. 210. Implementation.
Sec. 211. Language access services.
TITLE III--HEALTH WORKFORCE DIVERSITY
Sec. 301. Amendment to the Public Health Service Act.
Sec. 302. Hispanic-serving health professions schools.
Sec. 303. Loan repayment program of Centers for Disease Control and
Prevention.
Sec. 304. Cooperative agreements for online degree programs at schools
of public health and schools of allied
health.
Sec. 305. Sense of Congress on the mission of the National Health Care
Workforce Commission.
Sec. 306. Scholarship and fellowship programs.
Sec. 307. McNair Postbaccalaureate Achievement Program.
Sec. 308. Rules for determination of full-time equivalent residents for
cost-reporting periods.
Sec. 309. Developing and implementing strategies for local health
equity.
Sec. 310. Loan forgiveness for mental and behavioral health social
workers.
Sec. 311. Health Professions Workforce Fund.
Sec. 312. Findings; sense of Congress relating to graduate medical
education.
Sec. 313. Career support for skilled, internationally educated health
professionals.
TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY
Subtitle A--Expansion of Coverage
Sec. 401. Amendment to the Public Health Service Act.
Sec. 402. Removing citizenship and immigration barriers to access to
affordable health care under ACA.
Sec. 403. Study on the uninsured.
Sec. 404. Medicaid in the territories.
Sec. 405. Extension of Medicare secondary payer.
Sec. 406. Border health grants.
Sec. 407. Removing Medicare barrier to health care.
Sec. 408. 100 percent FMAP for medical assistance provided by urban
Indian health centers.
Sec. 409. 100 percent FMAP for medical assistance provided to a Native
Hawaiian through a federally qualified
health center or a Native Hawaiian health
care system under the Medicaid program.
Subtitle B--Expansion of Access
Sec. 410. Protecting sensitive locations.
Sec. 411. Grants for racial and ethnic approaches to community health.
Sec. 412. Critical access hospital improvements.
Sec. 413. Establishment of Rural Community Hospital (RCH) Program.
Sec. 414. Medicare remote monitoring pilot projects.
Sec. 415. Rural health quality advisory commission and demonstration
projects.
Sec. 416. Rural health care services.
Sec. 417. Community health center collaborative access expansion.
Sec. 418. Facilitating the provision of telehealth services across
State lines.
Sec. 419. Scoring of preventive health savings.
Sec. 420. Sense of Congress on Maintenance of Effort Provisions
Regarding Children's Health.
Sec. 421. Repeal of requirement for documentation evidencing
citizenship or nationality under the
Medicaid program.
Sec. 422. Protection of the HHS Offices of Minority Health.
Sec. 423. Office of Minority Health in Veterans Health Administration
of Department of Veterans Affairs.
Sec. 424. Indian defined in PPACA.
Sec. 425. Study of DSH payments to ensure hospital access for low-
income patients.
Sec. 426. Assistant Secretary of the Indian Health Service.
Sec. 427. Reauthorization of the Native Hawaiian Health Care
Improvement Act.
Sec. 428. Availability of non-English language speaking providers.
Sec. 429. Access to essential community providers.
Sec. 430. Provider network adequacy in communities of color.
Sec. 431. Improving access to dental care.
Subtitle C--Advancing Health Equity Through Payment and Delivery Reform
Sec. 441. Sense of Congress.
Sec. 442. Centers for Medicare & Medicaid Services quality payment
program.
Sec. 443. Development and testing of disparity reducing delivery and
payment models.
Sec. 444. Supporting safety net and community-based providers to
compete in value-based payment systems.
Subtitle D--Health Empowerment Zones
Sec. 451. Short title.
Sec. 452. Findings.
Sec. 453. Designation of health empowerment zones.
Sec. 454. Assistance to those seeking designation.
Sec. 455. Benefits of designation.
Sec. 456. Definition.
Sec. 457. Authorization of appropriations.
Subtitle E--At-Risk Community Coverage
Sec. 461. Medicaid coverage for citizens of Freely Associated States.
Sec. 462. At-risk youth Medicaid protection.
TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES
Subtitle A--In General
Sec. 501. Grants to promote health for underserved communities.
Sec. 502. Removing barriers to health care and nutrition assistance for
children, pregnant persons, and lawfully
present individuals.
Sec. 503. Repeal of denial of benefits.
Sec. 504. Birth defects prevention, risk reduction, and awareness.
Sec. 505. Preventing maternal deaths.
Sec. 506. Eliminating disparities in maternity health outcomes.
Sec. 507. Decreasing the risk factors for sudden unexpected infant
death and sudden unexplained death in
childhood.
Sec. 508. Reducing unintended teenage pregnancies.
Sec. 509. Gestational diabetes.
Sec. 510. Emergency contraception education and information programs.
Sec. 511. Comprehensive sex education programs.
Sec. 512. Compassionate assistance for rape emergencies.
Sec. 513. Access to birth control duties of pharmacies to ensure
provision of FDA-approved contraception.
Sec. 514. Additional focus area for the Office on Women's Health.
Sec. 515. Interagency coordinating committee on the promotion of
optimal maternity outcomes.
Sec. 516. Consumer education campaign.
Sec. 517. Bibliographic database of systematic reviews for care of
childbearing individuals and newborns.
Sec. 518. Maternity care health professional shortage areas.
Sec. 519. Expansion of CDC prevention research centers program to
include centers on optimal maternity
outcomes.
Sec. 520. Expanding models allowed to be tested by Center for Medicare
& Medicaid Innovation to include maternity
care models.
Sec. 521. Development of interprofessional maternity care educational
models and tools.
Sec. 522. Including within inpatient hospital services under Medicare
services furnished by certain students,
interns, and residents supervised by
certified nurse midwives.
Sec. 523. Grants to professional organizations to increase diversity in
maternal, reproductive, and sexual health
professionals.
Sec. 524. Interagency update to the quality family planning guidelines.
Sec. 525. Dissemination of the quality family planning guidelines.
Subtitle B--Pregnancy Screening
Sec. 531. Pregnancy intention screening initiative demonstration
program.
TITLE VI--MENTAL HEALTH
Sec. 601. Mental health findings.
Sec. 602. Coverage of marriage and family therapist services, mental
health counselor services, and substance
abuse counselor services under part B of
the Medicare program.
Sec. 603. Integrated Health Care Demonstration Program.
Sec. 604. Addressing racial and ethnic minority mental health
disparities research gaps.
Sec. 605. Health professions competencies to address racial and ethnic
minority mental health disparities.
Sec. 606. Asian American, Native Hawaiian, and Pacific Islander
behavioral and mental health outreach and
education strategies.
Sec. 607. Mental health in schools.
Sec. 608. Geo-access study.
TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES
Subtitle A--Cancer
Sec. 701. Lung cancer mortality reduction.
Sec. 702. Expanding prostate cancer research, outreach, screening,
testing, access, and treatment
effectiveness.
Sec. 703. Improved Medicaid coverage for certain breast and cervical
cancer patients in the territories.
Sec. 704. Cancer prevention and treatment demonstration for ethnic and
racial minorities.
Sec. 705. Reducing cancer disparities within Medicare.
Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention
Sec. 711. Viral hepatitis and liver cancer control and prevention.
Subtitle C--Acquired Bone Marrow Failure Diseases
Sec. 721. Acquired bone marrow failure diseases.
Subtitle D--Cardiovascular Disease, Chronic Disease, and Other Disease
Issues
Sec. 731. Guidelines for disease screening for minority patients.
Sec. 732. CDC Wisewoman Screening Program.
Sec. 733. Report on cardiovascular care for women and minorities.
Sec. 734. Coverage of comprehensive tobacco cessation services in
Medicaid and private health insurance.
Sec. 735. Clinical research funding for oral health.
Sec. 736. Participation by Medicaid beneficiaries in approved clinical
trials.
Subtitle E--HIV/AIDS
Sec. 741. Statement of policy.
Sec. 742. Findings.
Sec. 743. Additional funding for AIDS drug assistance program
treatments.
Sec. 744. Enhancing the national HIV surveillance system.
Sec. 745. Evidence-based strategies for improving linkage to and
retention in appropriate care.
Sec. 746. Improving entry into and retention in care and antiretroviral
adherence for persons with HIV.
Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority
communities.
Sec. 748. Minority AIDS initiative.
Sec. 749. Health care professionals treating individuals with HIV/AIDS.
Sec. 750. HIV/AIDS provider loan repayment program.
Sec. 751. Dental education loan repayment program.
Sec. 752. Reducing new HIV infections among injecting drug users.
Sec. 753. Report on impact of HIV/AIDS in vulnerable populations.
Sec. 754. National HIV/AIDS observance days.
Sec. 755. Review of all Federal and State laws, policies, and
regulations regarding the criminal
prosecution of individuals for HIV-related
offenses.
Sec. 756. Expanding support for condoms in prisons.
Sec. 757. Automatic reinstatement or enrollment in Medicaid for people
who test positive for HIV before reentering
communities.
Sec. 758. Stop AIDS in prison.
Sec. 759. Support data system review and indicators for monitoring HIV
care.
Sec. 760. Transfer of funds for implementation of national HIV/AIDS
strategy.
Sec. 761. Report on the implementation of goal 4 (improved
coordination) of the national HIV/AIDS
strategy.
Subtitle F--Diabetes
Sec. 771. Research, treatment, and education.
Sec. 772. Research, education, and other activities.
Sec. 773. Research, education, and other activities.
Sec. 774. Research, education, and other activities.
Sec. 775. Updated report on health disparities.
Subtitle G--Lung Disease
Sec. 776. Expansion of the National Asthma Education and Prevention
Program.
Sec. 777. Asthma-related activities of the Centers for Disease Control
and Prevention.
Sec. 778. Influenza and pneumonia vaccination campaign.
Sec. 779. Chronic obstructive pulmonary disease action plan.
Subtitle H--Tuberculosis
Sec. 781. Elimination of all forms of tuberculosis.
Sec. 782. Additional funding for States in combating and eliminating
tuberculosis.
Sec. 783. Strengthening clinical research funding for tuberculosis.
Subtitle I--Osteoarthritis and Musculoskeletal Diseases
Sec. 785. Findings.
Sec. 786. Osteoarthritis and other musculoskeletal health-related
activities of the Centers for Disease
Control and Prevention.
Sec. 787. Grants for comprehensive osteoarthritis and musculoskeletal
disease health education within health
professions schools.
Subtitle J--Sleep and Circadian Rhythm Disorders
Sec. 791. Short title; findings.
Sec. 792. Sleep and circadian rhythm disorders research activities of
the National Institutes of Health.
Sec. 793. Sleep and circadian rhythm health disparities-related
activities of the Centers for Disease
Control and Prevention.
Sec. 794. Grants for comprehensive sleep and circadian health education
within health professions schools.
Sec. 795. Report on impact of sleep and circadian health disorders in
vulnerable and racial/ethnic populations.
Subtitle K--Sickle Cell Disease Research, Surveillance, Prevention, and
Treatment
Sec. 796. Short title.
Sec. 796A. Sickle cell disease research.
Sec. 796B. Sickle cell disease surveillance.
Sec. 796C. Sickle cell disease prevention and treatment.
Sec. 796D. Collaboration with community-based entities.
TITLE VIII--HEALTH INFORMATION TECHNOLOGY
Sec. 800. Definitions.
Subtitle A--Reducing Health Disparities Through Health IT
Sec. 801. HRSA assistance to health centers for promotion of Health IT.
Sec. 802. Assessment of impact of Health IT on racial and ethnic
minority communities; outreach and adoption
of Health IT in such communities.
Subtitle B--Modifications To Achieve Parity in Existing Programs
Sec. 811. Extending funding to strengthen the Health IT infrastructure
in racial and ethnic minority communities.
Sec. 812. Extending competitive grants for the development of loan
programs to facilitate adoption of
Certified Electronic Health Record
Technology by providers serving racial and
ethnic minority groups.
Sec. 813. Authorization of appropriations.
Subtitle C--Additional Research and Studies
Sec. 821. Data collection and assessments conducted in coordination
with minority-serving institutions.
Sec. 822. Study of health information technology in medically
underserved communities.
Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs
Sec. 831. Extending Medicaid EHR incentive payments to rehabilitation
facilities, long-term care facilities, and
home health agencies.
Sec. 832. Extending physician assistant eligibility for Medicaid
electronic health record incentive
payments.
TITLE IX--ACCOUNTABILITY AND EVALUATION
Sec. 901. Prohibition on discrimination in Federal assisted health care
services and research programs on the basis
of sex, race, color, national origin,
marital status, familial status, sexual
orientation, gender identity, or disability
status.
Sec. 902. Treatment of Medicare payments under title VI of the Civil
Rights Act of 1964.
Sec. 903. Accountability and transparency within the Department of
Health and Human Services.
Sec. 904. United States Commission on Civil Rights.
Sec. 905. Sense of Congress concerning full funding of activities to
eliminate racial and ethnic health
disparities.
Sec. 906. GAO and NIH reports.
TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
JUSTICE
Subtitle A--In General
Sec. 1001. Definitions.
Sec. 1002. Findings.
Sec. 1003. Health impact assessments.
Sec. 1004. Implementation of recommendations by Environmental
Protection Agency.
Sec. 1005. Grant program to conduct environmental health improvement
activities and to improve social
determinants of health.
Sec. 1006. Additional research on the relationship between the built
environment and the health of community
residents.
Sec. 1007. Environment and public health restoration.
Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig
explosion in the Gulf Coast.
Subtitle B--Gun Violence
Sec. 1011. Findings.
Sec. 1012. Reaffirming research authority of the Centers for Disease
Control and Prevention.
Sec. 1013. National violent death reporting system.
Sec. 1014. Report on effects of gun violence on public health.
Sec. 1015. Report on effects of gun violence on mental health in
minority communities.
SEC. 3. FINDINGS.
The Congress finds as follows:
(1) The population of racial and ethnic minorities is
expected to increase over the next few decades, yet racial and
ethnic minorities have the poorest health status and face
substantial cultural, social, and economic barriers to
obtaining quality health care.
(2) 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, sex, geography,
language preference, immigrant or citizenship status, sexual
orientation, gender identity, socioeconomic status, or
disability status--that directly and indirectly affect the
health, health care, and wellness of individuals and
communities.
(3) By 2020, the Nation will face a shortage of health care
providers and allied health workers and this shortage
disproportionately affects health professional shortage areas
where many racial and ethnic minority populations reside.
(4) All efforts to reduce health disparities and barriers
to quality health services require better and more consistent
data.
(5) A full range of culturally and linguistically
appropriate health care and public health services must be
available and accessible in every community.
(6) Racial and ethnic minorities and underserved
populations must be included early and equitably in health
reform innovations.
(7) Efforts to improve minority health have been limited by
inadequate resources in funding, staffing, stewardship, and
accountability. Targeted investments that are focused on
disparities elimination must be made in providing care and
services that are community-based, including prevention and
policies addressing social determinants of health.
(8) In 2011, the Department of Health and Human Services
developed the HHS Action Plan to Reduce Racial and Ethnic
Health Disparities and the National Stakeholder Strategy for
Achieving Health Equity, two strategic plans that represent the
country's first coordinated roadmap to reducing health
disparities. Along with the National Prevention Strategy,
Healthy People 2020, and the National Health Care Quality
Strategy, as well as critical resources such as the 2012
National Healthcare Quality and Disparities Reports, these
comprehensive plans will work to increase the number of
Americans who are healthy at every stage of life.
(9) The Department of Health and Human Services has also
reviewed and advanced updated clinical guidelines and developed
other strategic planning documents--
(A) to combat health disparities with a high impact
on minority populations including the National HIV/AIDS
Strategy, the Action Plan for the Prevention, Care, and
Treatment of Viral Hepatitis; and
(B) to provide high-quality family planning
services including recommendations of the Centers for
Disease Control and Prevention and the Office of
Population Affairs.
(10) The Patient Protection and Affordable Care Act, as
amended by the Health Care and Education Reconciliation Act,
represents the biggest advancement for minority health in the
last 40 years.
TITLE I--DATA COLLECTION AND REPORTING
SEC. 101. 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, sex, primary
language, sexual orientation, disability status, gender identity, and
socioeconomic status among federally supported health programs.
(b) Amendment.--Title XXXIV of the Public Health Service Act, as
added by titles II and III of this Act, is further amended by inserting
after subtitle A the following:
``Subtitle B--Strengthening Data Collection, Improving Data Analysis,
and Expanding Data Reporting
``SEC. 3431. HEALTH DISPARITY DATA.
``(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, sex,
primary language, sexual orientation, disability
status, gender identity, and socioeconomic status of
each applicant for and recipient of health-related
assistance under such program--
``(i) using, at a minimum, standards for
data collection on race, ethnicity, sex,
primary language, sexual orientation,
disability status, gender identity, and
socioeconomic status developed under section
3101;
``(ii) collecting data for additional
population groups if such groups can be
aggregated into the race and ethnicity
categories outlined by standards developed
under section 3101;
``(iii) additionally referring, where
practicable, to the standards developed by the
Institute of Medicine in `Race, Ethnicity, and
Language Data: Standardization for Health Care
Quality Improvement'; and
``(iv) where practicable, through self-
reporting;
``(B) with respect to the collection of the data
described in subparagraph (A), for applicants and
recipients who are minors, require communication
assistance in speech or writing, and for applicants and
recipients who are 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 primary 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 the lines of primary language, sex,
disability status, sexual orientation, gender identity,
and socioeconomic status in health and health care, and
report the results of such analysis to the Secretary,
the Director of the Office for Civil Rights, each
agency listed in section 3101(c)(1), 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, sex, sexual orientation, disability
status, gender identity, and socioeconomic status 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; or
``(B) diminish existing or future requirements on
health care providers to collect data.
``(3) No compelled disclosure of data.--This title does not
authorize any health care provider, Federal official, or other
entity to compel the disclosure of any data collected under
this title. The disclosure of any such data by an individual
pursuant to this title shall be strictly voluntary.
``(b) Protection of Data.--The Secretary shall ensure (through the
promulgation of regulations or otherwise) that all data collected
pursuant to subsection (a) are 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, to improve the
collection, analysis, and reporting of racial, ethnic, sex, primary
language, sexual orientation, disability status, gender identity, and
socioeconomic status data at the Federal, State, territorial, Tribal,
and local levels, including data to be collected under subsection (a),
and to ensure that data collection activities carried out under this
section are in compliance with standards developed under section 3101.
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, Office on Women's 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 knowledge among Federal agencies, States,
territories, Indian Tribes, counties, municipalities, health
providers, health plans, and the general public that data
collection, analysis, and reporting by race, ethnicity, primary
language, sexual orientation, disability status, gender
identity, and socioeconomic status is legal and necessary to
assure equity and nondiscrimination in the quality of health
care services;
``(3) ensure that future patient record systems follow
Federal standards promulgated under the HITECH Act for the
collection and meaningful use of electronic health data on
race, ethnicity, primary language, sexual orientation,
disability status, gender identity, and socioeconomic status;
``(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, counties, and municipalities for racial and
ethnic groups that comprise a significant proportion of the
population of the State, county, or municipality;
``(5) provide researchers with greater access to racial,
ethnic, primary language, sexual orientation, disability
status, gender identity, and socioeconomic status 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 standards developed under
section 3101.
``(e) Analysis of Health Disparity Data.--The Secretary, acting
through the Director of the Agency for Healthcare Research and Quality
and in coordination with the Assistant Secretary for Planning and
Evaluation, Administrator of the Centers for Medicare & Medicaid
Services, the Director of the National Center for Health Statistics,
and the Director of the National Institutes of Health, shall provide
technical assistance to agencies of the Department of Health and Human
Services in meeting Federal standards for health disparity data
collection and for analysis of racial, ethnic, and other 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 and their overlap with other disparity
factors 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.
``(f) Primary Language.--References in this section--
``(1) to primary language data, include spoken and written
primary language data; and
``(2) to primary language data collection activities,
include 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.
``(g) 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 pays for health care and services; and
``(2) under this Act that provides Federal financial
assistance for health care, biomedical research, or health
services research and or is designed to improve the public's
health.
``(h) 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 2019 through 2024.
``SEC. 3432. ESTABLISHING GRANTS FOR DATA COLLECTION IMPROVEMENT
ACTIVITIES.
``(a) In General.--The Secretary, acting through the Director of
the Agency for Healthcare Research and Quality and in consultation with
the Deputy Assistant Secretary for Minority Health, the Director of the
National Institutes of Health, the Assistant Secretary for Planning and
Evaluation, and the Director of the National Center for Health
Statistics, shall establish a technical assistance program under which
the Secretary provides grants to eligible entities to assist such
entities in complying with section 3431.
``(b) Types of Assistance.--Grants provided under this section may
include grants to--
``(1) enhance or upgrade computer technology that will
facilitate racial, ethnic, primary language, sexual
orientation, disability status, gender identity, and
socioeconomic status data collection, analysis, and reporting;
``(2) improve methods for health data collection and
analysis, including additional population groups if such groups
can be aggregated into the race and ethnicity categories
outlined by standards developed under section 3101;
``(3) develop mechanisms for submitting collected data
subject to existing privacy and confidentiality regulations;
and
``(4) develop educational programs to inform health plans,
health providers, health-related agencies, and the general
public that data collection and reporting by race, ethnicity,
primary language, sexual orientation, disability status, gender
identity, and socioeconomic status are legal and essential for
eliminating health and health care disparities.
``(c) Eligible Entity.--To be eligible for grants under this
section, an entity shall be a State, territory, Indian Tribe,
municipality, county, health provider, health care organization, or
health plan making a demonstrated effort to bring data collections into
compliance with section 3431.
``(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 2019 through 2024.
``SEC. 3433. OVERSAMPLING OF UNDERREPRESENTED GROUPS IN FEDERAL HEALTH
SURVEYS.
``(a) National Strategy.--
``(1) In general.--The Secretary of Health and Human
Services, acting through the Director of the National Center
for Health Statistics of the Centers for Disease Control and
Prevention, and other agencies within the Department of Health
and Human Services as the Secretary determines appropriate,
shall develop and implement an ongoing and sustainable national
strategy for oversampling underrepresented populations within
the categories of race, ethnicity, sex, primary language,
sexual orientation, disability status, gender identity, and
socioeconomic status as determined appropriate by the Secretary
in Federal health surveys and program data collections. Such
national strategy shall include a strategy for oversampling of
Asian Americans, Native Hawaiians and Pacific Islanders.
``(2) Consultation.--In developing and implementing a
national strategy, as described in paragraph (1), not later
than 180 days after the date of the enactment of the this
section, the Secretary shall--
``(A) consult with representatives of community
groups, nonprofit organizations, nongovernmental
organizations, and government agencies working with
underrepresented populations;
``(B) solicit the participation of representatives
from other Federal departments and agencies, including
subagencies of the Department of Health and Human
Services; and
``(C) consult on, and use as models, the 2014
National Health Interview Survey oversample of Native
Hawaiian and Pacific Islander populations and the 2017
Behavioral Risk Factor Surveillance System oversample
of American Indian and Alaska Native communities.
``(b) Progress Report.--Not later than 2 years after the date of
the enactment of this section, the Secretary shall submit to the
Congress a progress report, which shall include the national strategy
described in subsection (a)(1).
``(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2024.''.
SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT APPROPRIATIONS FOR DATA
COLLECTION AND ANALYSIS.
Section 3101 of the Public Health Service Act (42 U.S.C. 300kk) is
amended--
(1) by striking subsection (h); and
(2) by redesignating subsection (i) as subsection (h).
SEC. 103. 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:
``collection of race and ethnicity data by the social security
administration
``Sec. 1150C. (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, primary language, and disability status 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, standards for data
collection on race, ethnicity, primary language, and
disability status developed under section 3101 of the
Public Health Service Act;
``(B) where practicable, collecting data for
additional population groups if such groups can be
aggregated into the race and ethnicity categories
outlined by standards developed under section 3101 of
the Public Health Service Act; and
``(C) additionally referring, where practicable, to
the standards developed by the Institute of Medicine in
`Race, Ethnicity, and Language Data: Standardization
for Health Care Quality Improvement' (released August
31, 2009);
``(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 in
collecting the data;
``(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,
primary language, and disability status data.
``(b) Protection of Data.--The Commissioner of Social Security
shall ensure (through the promulgation of regulations or otherwise)
that all data collected pursuant to subsection (a) are 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 2019 through 2024.''.
SEC. 104. 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.), 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 standards for data collection
on race, ethnicity, primary language, disability, sex, sexual
orientation, and gender identity developed under section 3101
of the Public Health Service Act (42 U.S.C. 300kk); and
(2) in consultation with the Office of the National
Coordinator for Health Information Technology, the designation
of the appropriate racial, ethnic, primary language,
disability, sex, and other 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. 105. 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
``2022'';
(2) in paragraph (2), in the first sentence, by striking
``2003'' and inserting ``2022''; and
(3) in paragraph (3), by striking ``2002'' and inserting
``2022''.
SEC. 106. DISPARITIES DATA COLLECTED BY THE FEDERAL GOVERNMENT.
(a) Collection; Submission.--Not later than 180 days after the date
of the enactment of this Act, and January 31 of each year thereafter,
each department, agency, and office of the Federal Government that has
collected data on race, ethnicity, sex, primary language, sexual
orientation, disability status, gender identity, or socioeconomic
status during the preceding calendar year shall submit such data to a
centralized electronic repository of Government data on factors related
to the health and well-being of the American population.
(b) Analysis; Public Availability; Reporting.--Not later than April
30, 2018, and each April 30 thereafter, the Secretary of Health and
Human Services, acting through the Assistant Secretary for Planning and
Evaluation, the Assistant Secretary for Health, the Director of the
Agency for Healthcare Research and Quality, the Director of the
National Center for Health Statistics, the Administrator of the Centers
for Medicare & Medicaid Services, the Director of the National
Institute on Minority Health and Health Disparities, and the Deputy
Assistant Secretary for Minority Health, shall--
(1) prepare and make available datasets for public use that
relate to disparities in health status, health care access,
health care quality, health outcomes, public health, and other
areas of health and well-being by factors that include race,
ethnicity, sex, primary language, sexual orientation,
disability status, gender identity, and socioeconomic status;
(2) ensure that these data sets are publicly identified on
a centralized electronic repository of Government data as
``disparities'' data; and
(3) submit a report to the Congress on the availability and
use of such data by public stakeholders.
SEC. 107. DATA COLLECTION AND ANALYSIS GRANTS TO MINORITY-SERVING
INSTITUTIONS.
(a) Authority.--The Secretary of Health and Human Services, acting
through the National Institute on Minority Health and Health
Disparities and the Deputy Assistant Secretary for Minority Health,
shall award grants to access and analyze racial and ethnic, and where
possible other health disparity data, to monitor and report on progress
to reduce and eliminate disparities in health and health care.
(b) Eligible Entity.--In this section, the term ``eligible entity''
means a historically Black college or university, a Hispanic-serving
institution, a Tribal college or university, or an Asian American,
Native American, or Pacific Islander-serving institution with an
accredited public health, health policy, or health services research
program.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2024.
SEC. 108. STANDARDS FOR MEASURING SEXUAL ORIENTATION AND GENDER
IDENTITY IN COLLECTION OF HEALTH DATA.
Section 3101(a) of the Public Health Service Act (42 U.S.C.
300kk(a)) is amended--
(1) in paragraph (1)(A), by inserting ``sexual orientation,
gender identity,'' before ``and disability status'';
(2) in paragraph (1)(C), by inserting ``sexual orientation,
gender identity,'' before ``and disability status''; and
(3) in paragraph (2)(B), by inserting ``sexual orientation,
gender identity,'' before ``and disability status''.
SEC. 109. STANDARDS FOR MEASURING SOCIOECONOMIC STATUS IN COLLECTION OF
HEALTH DATA.
Section 3101(a) of the Public Health Service Act (42 U.S.C.
300kk(a)), as amended, is amended--
(1) in paragraph (1)(A), by inserting ``socioeconomic
status,'' before ``and disability status'';
(2) in paragraph (1)(C), by inserting ``socioeconomic
status,'' before ``and disability status''; and
(3) in paragraph (2)(B), by inserting ``socioeconomic
status,'' before ``and disability status''.
SEC. 110. 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 505F the
following:
``SEC. 505G. SAFETY AND EFFECTIVENESS OF DRUGS WITH RESPECT TO RACIAL
AND ETHNIC BACKGROUND.
``(a) Preapproval 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) Postmarket 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,
postmarketing studies to investigate the disparity.
``(2) Labeling.--If the Secretary determines that the
postmarket 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, and the other demographic characteristics of
study participants included, in the order requiring postmarket
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 Sections 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:
``(ee) 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 505G.''.
(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 505G''.
SEC. 111. IMPROVING HEALTH DATA REGARDING NATIVE HAWAIIANS AND OTHER
PACIFIC ISLANDERS.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317U, as added, the
following:
``SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER HEALTH DATA.
``(a) Definitions.--In this section:
``(1) Community group.--The term `community group' means a
group of NHOPI who are organized at the community level, and
may include a church group, social service group, national
advocacy organization, or cultural group.
``(2) Nonprofit, nongovernmental organization.--The term
`nonprofit, nongovernmental organization' means a group of
NHOPI with a demonstrated history of addressing NHOPI issues,
including a NHOPI coalition.
``(3) Designated organization.--The term `designated
organization' means an entity established to represent NHOPI
populations and which has statutory responsibilities to
provide, or has community support for providing, health care.
``(4) Government representatives.--The term `government
representatives' means representatives from Hawaii, American
Samoa, the Commonwealth of the Northern Mariana Islands, the
Federated States of Micronesia, Guam, the Republic of Palau,
and the Republic of the Marshall Islands.
``(5) Native hawaiians and other pacific islanders
(nhopi).--The term `Native Hawaiians and Other Pacific
Islanders' or `NHOPI' means people having origins in any of the
original peoples of American Samoa, the Commonwealth of the
Northern Mariana Islands, the Federated States of Micronesia,
Guam, Hawaii, the Republic of the Marshall Islands, the
Republic of Palau, or any other Pacific island.
``(6) Insular area.--The term `insular area' means Guam,
the Commonwealth of Northern Mariana Islands, American Samoa,
the United States Virgin Islands, the Federated States of
Micronesia, the Republic of Palau, or the Republic of the
Marshall Islands.
``(b) National Strategy.--
``(1) In general.--The Secretary, acting through the
Director of the National Center for Health Statistics (referred
to in this section as `NCHS') of the Centers for Disease
Control and Prevention, and other agencies within the
Department of Health and Human Services as the Secretary
determines appropriate, shall develop and implement an ongoing
and sustainable national strategy for identifying and
evaluating the health status and health care needs of NHOPI
populations living in the continental United States, Hawaii,
American Samoa, the Commonwealth of the Northern Mariana
Islands, the Federated States of Micronesia, Guam, the Republic
of Palau, and the Republic of the Marshall Islands.
``(2) Consultation.--In developing and implementing a
national strategy, as described in paragraph (1), not later
than 180 days after the date of enactment of the Health Equity
and Accountability Act of 2018, the Secretary--
``(A) shall consult with representatives of
community groups, designated organizations, and
nonprofit, nongovernmental organizations and with
government representatives of NHOPI populations; and
``(B) may solicit the participation of
representatives from other Federal departments.
``(c) Preliminary Health Survey.--
``(1) In general.--The Secretary, acting through the
Director of NCHS, shall conduct a preliminary health survey in
order to identify the major areas and regions in the
continental United States, Hawaii, American Samoa, the
Commonwealth of the Northern Mariana Islands, the Federated
States of Micronesia, Guam, the Republic of Palau, and the
Republic of the Marshall Islands in which NHOPI people reside.
``(2) Contents.--The health survey described in paragraph
(1) shall include health data and any other data the Secretary
determines to be--
``(A) useful in determining health status and
health care needs; or
``(B) required for developing or implementing a
national strategy.
``(3) Methodology.--Methodology for the health survey
described in paragraph (1), including plans for designing
questions, implementation, sampling, and analysis, shall be
developed in consultation with community groups, designated
organizations, nonprofit, nongovernmental organizations, and
government representatives of NHOPI populations, as determined
by the Secretary.
``(4) Timeframe.--The survey required under this subsection
shall be completed not later than 18 months after the date of
enactment of the Health Equity and Accountability Act of 2018.
``(d) Progress Report.--Not later than 2 years after the date of
enactment of the Health Equity and Accountability Act of 2018, the
Secretary shall submit to Congress a progress report, which shall
include the national strategy described in subsection (b)(1).
``(e) Study and Report by the IOM.--
``(1) In general.--The Secretary shall enter into an
agreement with the Institute of Medicine (IOM) to conduct a
study, with input from stakeholders in insular areas, on the
following:
``(A) The standards and definitions of health care
applied to health care systems in insular areas and the
appropriateness of such standards and definitions.
``(B) The status and performance of health care
systems in insular areas, evaluated based upon
standards and definitions, as the Secretary determines.
``(C) The effectiveness of donor aid in addressing
health care needs and priorities in insular areas.
``(D) The progress toward implementation of
recommendations of the Committee on Health Care
Services in the United States--Associated Pacific Basin
of the Institute of Medicine that are set forth in the
1998 report, `Pacific Partnerships for Health: Charting
a New Course for the 21st Century'.
``(2) Report.--An agreement described in paragraph (1)
shall require the Institute of Medicine to submit to the
Secretary and to Congress, not later than 2 years after the
date of the enactment of the Health Equity and Accountability
Act of 2018, a report containing a description of the results
of the study conducted under paragraph (1), including the
conclusions and recommendations of the Institute of Medicine
for each of the items described in subparagraphs (A) through
(D) of such paragraph.
``(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2024.''.
SEC. 112. CLARIFICATION OF SIMPLIFIED ADMINISTRATIVE REPORTING
REQUIREMENT.
Section 11(a) of the Food and Nutrition Act of 2008 (7 U.S.C.
2020(a)) is amended by adding at the end the following:
``(5) Simplified administrative reporting requirement.--The
administrative notification requirement under section 421(e)(2)
of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (8 U.S.C. 1631(e)(2)) shall be
satisfied by the submission by an agency of a report on the
aggregate number of exceptions granted under such section by
such agency in each year.''.
TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH
CARE
SEC. 201. DEFINITIONS.
In this title, the definitions contained in section 3400 of the
Public Health Service Act, as added by section 202, shall apply.
SEC. 202. 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 indicates that the lack of appropriate
language services creates language barriers that result in
increased risk of misdiagnosis, ineffective treatment plans and
poor health outcomes for limited-English-proficient individuals
and individuals with communication disabilities such as
hearing, vision, or print impairments.
(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 and individuals with
communication disabilities such as hearing, vision, or print
impairments is a societal one that cannot fairly be visited
solely upon the health care, public health, or social services
community.
(5) Title VI of the Civil Rights Act of 1964 prohibits
discrimination based on the grounds of race, color, or national
origin by any entity receiving Federal financial assistance. In
order to avoid discrimination on the grounds of national
origin, all programs or activities administered by the
Department must take adequate steps to ensure that their
policies and procedures do not deny or have the effect of
denying limited-English-proficient individuals with equal
access to benefits and services for which such persons qualify.
(6) Both the Americans with Disabilities Act and the
Rehabilitation Act of 1973 prohibit discrimination on the basis
of disability and require the provision of appropriate
auxiliary aids and services necessary to ensure effective
communication with individuals with disabilities. The type of
auxiliary aid or service necessary to ensure effective
communication will vary in accordance with the method of
communication used by the individual; the nature, length, and
complexity of the communication involved; and the context in
which the communication is taking place. A public accommodation
should consult with individuals with disabilities whenever
possible to determine what type of auxiliary aid is needed to
ensure effective communication, but the ultimate decision as to
what measures to take rests with the public accommodation,
provided that the method chosen results in effective
communication. In order to be effective, auxiliary aids and
services must be provided in accessible formats, in a timely
manner, and in such a way as to protect the privacy and
independence of the individual with a disability.
(7) 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.
(8) All members of the health care and health-care-related-
services community should continue to educate their staff and
constituents about limited-English-proficient and disability
communication issues and help them identify resources to
improve access to quality care for limited-English-proficient
individuals and individuals with communication disabilities
such as hearing, vision, or print impairments.
(9) Access to English as a second language, and sign
language instructions, readers, and other auxiliary aids and
services, are essential to ensure effective communication and
eliminate the language barriers that impede access to health
care.
(10) Competent language 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 XXXIV--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE
``SEC. 3400. 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) Cultural competence.--The term `cultural competence'
means a set of congruent behaviors, attitudes, and policies
that come together in a system, agency, or among professionals
that enables effective work in cross-cultural situations. In
the preceding sentence--
``(A) the term `cultural' refers to integrated
patterns of human behavior that include the language,
thoughts, communications, actions, customs, beliefs,
values, and institutions of racial, ethnic, religious,
or social groups, including lesbian, gay, bisexual,
transgender, queer, and questioning individuals, and
individuals with physical and mental disabilities; and
``(B) the term `competence' implies having the
capacity to function effectively as an individual and
an organization within the context of the cultural
beliefs, behaviors, and needs presented by consumers
and their communities.
``(3) Effective communication.--The term `effective
communication' means an exchange of information between the
provider of health care or health-care-related services and the
recipient of such services who is limited in English
proficiency, or has a communication impairment such as a
hearing, vision, speaking, or learning impairment, that enables
access, understanding, and benefit from health care or health-
care-related services, and full participation in the
development of their treatment plan.
``(4) Grievance resolution process.--The term `grievance
resolution process' means all aspects of dispute resolution
including filing complaints, grievance and appeal procedures,
and court action.
``(5) 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.
``(6) Health educator.--The term `health educator' includes
a baccalaureate prepared professional responsible for
designing, implementing, and evaluating individual and
population health promotion and chronic disease prevention
programs.
``(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 an
interdisciplinary system that brings together providers from
the primary health, mental health, substance use and related
disciplines to improve the health outcomes of an individual.
Providers may include but are not limited to hospitals, health,
mental health or substance use clinics and providers, home
health agencies, ambulatory surgery centers, skilled nursing
facilities, rehabilitation centers, and employed, independent,
or contracted physicians.
``(11) Individual with a disability.--The term `individual
with a disability' means any individual who has a disability as
defined for the purpose of section 504 of the Rehabilitation
Act of 1973. Where this title references regulatory provisions
applicable to a `handicapped individual', the term `handicapped
individual' in such provisions shall be treated to have the
same meaning as the term `individual with a disability' as
defined in this section.
``(12) Individual with limited-english proficiency.--The
term `individual with limited-English proficiency' means an
individual whose primary language for communication is not
English and who has a limited ability to read, write, speak, or
understand English.
``(13) Interpreting; interpretation.--The terms
`interpreting' and `interpretation' mean the transmission of a
spoken, written, or signed message from one language or format
into another, faithfully, accurately, and objectively.
``(14) Language access.--The term `language access' means
the provision of language services to an individual with
limited-English proficiency or an individual with communication
disabilities designed to enhance that individual's access to,
understanding of, or benefit from health care or health-care-
related services.
``(15) Language assistance services.--The term `language
assistance services' includes--
``(A) oral language assistance, including
interpretation in non-English languages provided in-
person or remotely by a qualified interpreter for an
individual with limited-English proficiency, and the
use of qualified bilingual or multilingual staff to
communicate directly with individuals with limited-
English proficiency;
``(B) written translation, performed by a qualified
translator, of written content in paper or electronic
form into languages other than English; and
``(C) taglines.
``(16) Medicare, medicaid, and schip.--The terms
`Medicare', `Medicaid', and `SCHIP' mean 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, members of sexual and gender minority
groups, and individuals with a disability.
``(18) Minority group.--The term `minority group' has the
meaning given the term `racial and ethnic minority group'.
``(19) Qualified interpreter for an individual with
limited-english proficiency.--The term `qualified interpreter
for an individual with limited-English proficiency' means an
interpreter who via a remote interpreting service or an on-site
appearance--
``(A) adheres to generally accepted interpreter
ethics principles, including client confidentiality;
``(B) has demonstrated proficiency in speaking and
understanding both spoken English and one or more other
spoken languages; and
``(C) is able to interpret effectively, accurately,
and impartially, both receptively and expressly, to and
from such languages and English, using any necessary
specialized vocabulary, terminology, and phraseology.
``(20) Qualified translator.--The term `qualified
translator' means a translator who--
``(A) adheres to generally accepted translator
ethics principles, including client confidentiality;
``(B) has demonstrated proficiency in writing and
understanding both written English and one or more
other written non-English languages; and
``(C) is able to translate effectively, accurately,
and impartially to and from such languages and English,
using any necessary specialized vocabulary,
terminology, and phraseology.
``(21) 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.
``(22) Sexual and gender minority group.--The term `sexual
and gender minority group' encompasses lesbian, gay, bisexual,
and transgender populations, as well as those whose sexual
orientation, gender identity and expression, or reproductive
development varies from traditional, societal, cultural, or
physiological norms.
``(23) Onsite interpretation.--The term `onsite
interpretation' means a method of interpreting or
interpretation for which the interpreter is in the physical
presence of the provider of health care or health-care-related
services and the recipient of such services who is limited in
English proficiency or has a communication impairment such as
hearing, vision, or learning.
``(24) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(25) Sight translation.--The term `sight translation'
means the transmission of a written message in one language
into a spoken or signed message in another language, or an
alternative format in English or another language.
``(26) State.--The term `State' means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Indian Tribes, the United States Virgin Islands,
Guam, American Samoa, and the Commonwealth of the Northern
Mariana Islands.
``(27) Telephonic interpretation.--The term `telephonic
interpretation' (also known as over the phone interpretation or
OPI) means a method of 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.
``(28) Translation.--The term `translation' means the
transmission of a written message in one language into a
written or signed message in another language, and includes
translation into another language or alternative format, such
as large print font, Braille, audio recording, or CD.
``(29) Video remote interpreting services.--The term `video
remote interpreting services' means the provision, through a
qualified interpreter for an individual with limited-English
proficiency, of video remote interpreting services in health
programs and activities.
``(A) in real-time, full-motion video, and audio
over a dedicated high-speed, wide-bandwidth video
connection or wireless connection that delivers high
quality video images that do not produce lags, choppy,
blurry, or grainy images, or irregular pauses in
communication; and
``(B) in a sharply delineated image that is large
enough to display.
``(30) 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 (such as
prescriptions, referrals to other providers, and 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 and individuals with
communication disabilities of the availability of free language
services, alternative formats, and other outreach materials.
``SEC. 3401. 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
cultural competence and 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 cultural
competence and 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 cultural competence and 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 cultural competence to the federally conducted,
health-care-related programs and activities of the agency by
limited-English-proficient individuals. Not later than one year
after the date of enactment of this title, each such Federal
agency shall ensure that such plan is fully implemented.
``(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 and cultural
competence 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 improve
cultural competence 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;
``(E) the resources the agency will provide to
improve cultural competence to assist recipients of
Federal funds to improve access to health care or
health-care-related programs and activities for
limited-English-proficient individuals;
``(F) the resources the agency will provide to
ensure that competent language assistance is provided
to limited-English-proficient patients by interpreters
or trained bilingual staff; and
``(G) the resources the agency will provide to
ensure that family, particularly minor children, and
friends are not used to provide interpretation
services, except--
``(i) in the case of a medical emergency
where delay directly associated with obtaining
a competent interpreter would jeopardize the
health of the patient; or
``(ii) on request of the patient, who has
been informed in his or her preferred language
of the availability of free interpretation
services, if the health care services provider
has determined that the family or friend can
provide competent interpreter services as
defined in section 3400.
``(3) Submission of plan to doj.--Each agency that is
required to prepare a plan under paragraph (1) shall send a
copy of such plan to the Department of Justice, which shall
serve as the central repository of such plans.
``(4) Rule of construction.--Paragraph (2)(G)(i) shall not
be construed to mean that emergency rooms or similar entities
that regularly provide health care services in medical
emergencies are exempt from legal or regulatory requirements
related to competent interpreter services.
``(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 agency's 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. 3402. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES IN HEALTH CARE.
``(a) Applicability.--This section applies to any health program or
activity, any part of which is receiving Federal financial assistance,
including credits, subsidies, or contracts of insurance, or any program
or activity that is administered by an executive agency or any entity
established under title I of the Patient Protection and Affordable Care
Act (or amendments made thereby), as such programs, activities,
agencies, and entities are described in section 1557(a) of the Patient
Protection and Affordable Care Act.
``(b) Standards.--The programs, activities, agencies, and entities
described in subsection (a)--
``(1) shall implement strategies to recruit, retain, and
promote individuals at all levels 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 programs, activities, agencies, and entities;
``(2) shall educate and train governance, leadership, and
workforce at all levels and across all disciplines of the
programs, activities, agencies, and entities in culturally and
linguistically appropriate policies and practices on an ongoing
basis;
``(3) shall offer and provide language assistance,
including trained bilingual staff and interpreter services, to
individuals who have limited-English proficiency or other
communication needs, at no cost to them at all points of
contact, and during all hours of operation, to facilitate
timely access to all health care and services;
``(4) shall notify patients, in a culturally appropriate
manner, of their right to receive language assistance services
in their primary language, verbally and in writing;
``(5) shall not--
``(A) require an individual with limited-English
proficiency to provide his or her own interpreter;
``(B) rely on an adult accompanying an individual
with limited-English proficiency to interpret or
facilitate communication, except--
``(i) in an emergency involving an imminent
threat to the safety or welfare of an
individual or the public where there is no
qualified interpreter for the individual with
limited-English proficiency immediately
available; or
``(ii) where the individual with limited-
English proficiency specifically requests that
the accompanying adult interpret or facilitate
communication, the accompanying adult agrees to
provide such assistance, and reliance on that
adult for such assistance is appropriate under
the circumstances;
``(C) rely on a minor child to interpret or
facilitate communication, except in an emergency
involving an imminent threat to the safety or welfare
of an individual or the public where there is no
qualified interpreter for the individual with limited-
English proficiency immediately available; or
``(D) rely on staff other than qualified bilingual
or multilingual staff to communicate directly with
individuals;
``(6) shall for each eligible LEP language group that
constitutes 5 percent or 500 individuals, whichever is less, of
the population of persons eligible to be served or likely to be
affected or encountered in the service area of the
organization, make available--
``(A) easily understood patient-related materials,
including print and multimedia materials;
``(B) information or notices about termination of
benefits; and
``(C) signage;
``(7) shall develop and implement clear goals, policies,
operational plans, and management, accountability, and
oversight mechanisms to provide culturally and linguistically
appropriate services and infuse them throughout the
organization's planning and operations;
``(8) shall conduct initial and ongoing organizational
assessments of culturally and linguistically appropriate
services-related activities and integrate valid linguistic,
competence-related National Standards for Culturally and
Linguistically Appropriate Services (CLAS) measures into the
internal audits, performance improvement programs, patient
satisfaction assessments, continuous quality improvement
activities, and outcomes-based evaluations of the organization
and develop ways to standardize the assessments;
``(9) shall 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, data on an individual required to
be collected pursuant to section 3101, including the
individual's alternative format preferences and policy
modification needs, are--
``(A) collected in health records;
``(B) integrated into the organization's management
information systems; and
``(C) periodically updated;
``(10) shall maintain a current demographic, cultural, and
epidemiological profile of the community, conduct regular
assessments of community health assets and needs, and use the
results to accurately plan for and implement services that
respond to the cultural and linguistic characteristics of the
service area of the organization;
``(11) shall develop participatory, collaborative
partnerships with communities and utilize a variety of formal
and informal mechanisms to facilitate community and patient
involvement in designing, implementing, and evaluating policies
and practices to ensure culturally and linguistically
appropriate service-related activities;
``(12) shall 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) shall 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) shall, 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. 3403. 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. 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, to improve cultural
competence, 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.--In 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 3404 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) Availability of Language Access.--The Director shall
collaborate with the Deputy Assistant Secretary for 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.
``(d) Education.--The Secretary, directly or through contract,
shall undertake a national education campaign to inform providers, LEP
individuals, health professionals, graduate schools, and community
health centers 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.
``(e) 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 $5,000,000 for each of fiscal
years 2019 through 2023.
``SEC. 3404. 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 cultural
competence and 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 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 and
exempt from tax under section 501(a) of such Code;
``(C) a community health, mental health, or
substance use center or clinic;
``(D) a solo or group physician practice;
``(E) an integrated health care delivery system;
``(F) a public hospital;
``(G) a 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
competent interpretation services through onsite
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;
``(7) develop short-term medical mental health
interpretation training courses and incentives for bilingual
health care staff who are asked to interpret in the workplace;
``(8) develop formal training programs, including continued
professional development and education programs as well as
supervision, 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 nonnative speakers;
``(10) develop policies that address compensation in salary
for staff who receive training to become either a staff
interpreter or bilingual provider;
``(11) develop other language assistance services as
determined appropriate by the Secretary;
``(12) develop, implement, and evaluate models of improving
cultural competence, including cultural competence programs for
community health workers; and
``(13) 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 in improving
language access.
``(e) Evaluation.--
``(1) By grantees.--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 3403. 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) By secretary.--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 2019 through 2023.
``SEC. 3405. 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 $5,000,000 for each of fiscal
years 2019 through 2023.''.
SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DEVELOPMENT OF STATE
MEDICAL INTERPRETING SERVICES.
(a) Grants Authorized.--The Secretary shall award one grant in
accordance with this section to each of three States to assist each
such State in designing, implementing, and evaluating a statewide
program to provide onsite interpreter services under Medicaid.
(b) Grant Period.--A grant awarded under this section is authorized
for a period of three fiscal years beginning on October 1, 2019.
(c) Preference.--In awarding a grant under this section, the
Secretary shall give preference to a State--
(1) that has a high proportion of qualified LEP enrollees,
as determined by the Secretary;
(2) that has a large number of qualified LEP enrollees, as
determined by the Secretary;
(3) that has a high growth rate of the population of LEP
individuals, as determined by the Secretary; and
(4) that has a population of qualified LEP enrollees that
is linguistically diverse, requiring interpreter services in at
least 200 non-English languages.
(d) Use of Funds.--A State receiving a grant under this section
shall use the grant funds to--
(1) ensure that all health care providers in the State
participating in the State plan under Medicaid have access to
onsite interpreter services, for the purpose of enabling
effective communication between such providers and qualified
LEP enrollees during the furnishing of items and services and
administrative interactions;
(2) establish, expand, procure, or contract for--
(A) a statewide health care information technology
system that is designed to achieve efficiencies and
economies of scale with respect to onsite interpreter
services provided to health care providers in the State
participating in the State plan under Medicaid; and
(B) an entity to administer such system, the duties
of which shall include--
(i) procuring and scheduling interpreter
services for qualified LEP enrollees;
(ii) procuring and scheduling interpreter
services for LEP individuals seeking to enroll
in the State plan under Medicaid;
(iii) ensuring that interpreters receive
payment for interpreter services rendered under
the system; and
(iv) consulting regularly with
organizations representing consumers,
interpreters, and health care providers; and
(3) develop mechanisms to establish, improve, and
strengthen the competency of the medical interpretation
workforce that serves qualified LEP enrollees in the State,
including a national certification process that is valid,
credible, and vendor-neutral.
(e) Application.--To receive a grant under this section, a State
shall submit an application at such time and containing such
information as the Secretary may require, which shall include the
following:
(1) A description of the language access needs of
individuals in the State enrolled in the State plan under
Medicaid.
(2) A description of the extent to which the program will--
(A) use the grant funds for the purposes described
in subsection (d);
(B) meet the health care needs of rural populations
of the State; and
(C) collect information that accurately tracks the
language services requested by consumers as compared to
the language services provided by health care providers
in the State participating in the State plan under
Medicaid.
(3) A description of how the program will be evaluated,
including a proposal for collaboration with organizations
representing interpreters, consumers, and LEP individuals.
(f) Definitions.--In this section:
(1) Qualified lep enrollee.--The term ``qualified LEP
enrollee'' means an individual--
(A) who is limited-English proficient; and
(B) who is enrolled in a State plan under Medicaid.
(2) State.--The term ``State'' has the meaning given the
term in section 1101(a)(1) of the Social Security Act (42
U.S.C. 1301(a)(1)), for purposes of title XIX of such Act.
(3) United states.--The term ``United States'' has the
meaning given the term in section 1101(a)(2) of the Social
Security Act (42 U.S.C. 1301(a)(2)), for purposes of title XIX
of such Act.
(g) Funding.--
(1) Authorization of appropriations.--There is authorized
to be appropriated $5,000,000 to carry out this section.
(2) Availability of funds.--The funds authorized by
paragraph (1) shall be available without fiscal year
limitation.
(3) Increased federal financial participation.--Section
1903(a)(2)(E) of the Social Security Act (42 U.S.C.
1396b(a)(2)(E)), as amended by section 205(d)(1) of this Act,
is further amended by inserting ``(or, in the case of a State
receiving a grant under section 203 of the Health Equity and
Accountability Act of 2018, 100 percent for each quarter
occurring during the grant period)'' after ``90 percent''.
(h) Limitation.--No Federal funds under this section may be used to
provide interpreter services from a location outside the United States.
SEC. 204. TRAINING TOMORROW'S DOCTORS FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE CARE: GRADUATE MEDICAL EDUCATION.
(a) Direct Graduate Medical Education.--Section 1886(h)(4) of the
Social Security Act (42 U.S.C. 1395ww(h)(4)) is amended by adding at
the end the following new subparagraph:
``(L) Treatment of culturally competency
training.--In determining a hospital's number of full-
time equivalent residents for purposes of this
subsection, all the time that is spent by an intern or
resident in an approved medical residency training
program for education and training in cultural
competency and linguistically appropriate service
delivery shall be counted toward the determination of
full-time equivalency.''.
(b) Indirect Medical Education.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
(1) by redesignating the clause (x) added by section
5505(b) of the Patient Protection and Affordable Care Act as
clause (xi); and
(2) by adding at the end the following new clause:
``(xii) The provisions of subparagraph (L) of subsection
(h)(4) shall apply under this subparagraph in the same manner
as they apply under such subsection.''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall apply with respect to payments made to hospitals on or after the
date that is one year after the date of the enactment of this Act.
SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY AND LINGUISTICALLY
APPROPRIATE SERVICES UNDER THE MEDICARE, MEDICAID, AND
STATE CHILDREN'S HEALTH INSURANCE PROGRAMS.
(a) Language Access Grants for Medicare Providers.--
(1) Establishment.--
(A) In general.--Not later than 6 months after the
date of the enactment of this Act, the Secretary of
Health and Human Services, acting through the Centers
for Medicare & Medicaid Services and in consultation
with the Center for Medicare and Medicaid Innovation,
shall establish a demonstration program under which the
Secretary shall award grants to eligible Medicare
service providers to improve communication between such
providers and Medicare beneficiaries who are English
learners, including beneficiaries who live in diverse
and underserved communities.
(B) Application of innovation rules.--The
demonstration project under subparagraph (A) shall be
conducted in a manner that is consistent with the
applicable provisions of subsections (b), (c), and (d)
of section 1115A of the Social Security Act (42 U.S.C.
1315a).
(C) Number of grants.--To the extent practicable,
the Secretary shall award not less than 24 grants under
this subsection.
(D) Grant period.--Except as provided under
paragraph (2)(D), each grant awarded under this
subsection shall be for a 3-year period.
(2) Eligibility requirements.--To be eligible for a grant
under this subsection, an entity must meet the following
requirements:
(A) Medicare provider.--The entity must be--
(i) a provider of services under part A of
title XVIII of the Social Security Act;
(ii) a provider of services under part B of
such title;
(iii) a Medicare Advantage organization
offering a Medicare Advantage plan under part C
of such title; or
(iv) a PDP sponsor offering a prescription
drug plan under part D of such title.
(B) Underserved communities.--The entity must serve
a community that, with respect to necessary language
services for improving access and utilization of health
care among English learners, is disproportionally
underserved.
(C) Application.--The entity must 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.
(D) Reporting.--In the case of a grantee that
received a grant under this subsection in a previous
year, such grantee is only eligible for continued
payments under a grant under this subsection if the
grantee met the reporting requirements under paragraph
(9) for such year. If a grantee fails to meet the
requirement of such paragraph for the first year of a
grant, the Secretary may terminate the grant and
solicit applications from new grantees to participate
in the demonstration program.
(3) Distribution.--To the extent feasible, the Secretary
shall award--
(A) at least 6 grants to providers of services
described in paragraph (2)(A)(i);
(B) at least 6 grants to service providers
described in paragraph (2)(A)(ii);
(C) at least 6 grants to organizations described in
paragraph (2)(A)(iii); and
(D) at least 6 grants to sponsors described in
paragraph (2)(A)(iv).
(4) Considerations in awarding grants.--
(A) Variation in grantees.--In awarding grants
under this subsection, the Secretary shall select
grantees to ensure the following:
(i) The grantees provide many different
types of language services.
(ii) The grantees serve Medicare
beneficiaries who speak different languages,
and who, as a population, have differing needs
for language services.
(iii) The grantees serve Medicare
beneficiaries in both urban and rural settings.
(iv) The grantees serve Medicare
beneficiaries in at least two geographic
regions, as defined by the Secretary.
(v) The grantees serve Medicare
beneficiaries in at least two large
metropolitan statistical areas with racial,
ethnic, sexual, gender, disability, and
economically diverse populations.
(B) Priority for partnerships with community
organizations and agencies.--In awarding grants under
this subsection, the Secretary shall give priority to
eligible entities that have a partnership with--
(i) a community organization; or
(ii) a consortia of community
organizations, State agencies, and local
agencies,
that has experience in providing language services.
(5) Use of funds for competent language services.--
(A) In general.--Subject to subparagraph (E), a
grantee may only use grant funds received under this
subsection to pay for the provision of competent
language services to Medicare beneficiaries who are
English learners.
(B) Competent language services defined.--For
purposes of this subsection, the term ``competent
language services'' means--
(i) interpreter and translation services
that--
(I) subject to the exceptions under
subparagraph (C)--
(aa) if the grantee
operates in a State that has
statewide health care
interpreter standards, meet the
State standards currently in
effect; or
(bb) if the grantee
operates in a State that does
not have statewide health care
interpreter standards, utilizes
competent interpreters who
follow the National Council on
Interpreting in Health Care's
Code of Ethics and Standards of
Practice; and
(II) that, in the case of
interpreter services, are provided
through--
(aa) onsite interpretation;
(bb) telephonic
interpretation; or
(cc) video interpretation;
and
(ii) the direct provision of health care or
health-care-related services by a competent
bilingual health care provider.
(C) Exceptions.--The requirements of subparagraph
(B)(i)(I) do not apply, with respect to interpreter and
translation services and a grantee--
(i) in the case of a Medicare beneficiary
who is an English learner if--
(I) such beneficiary has been
informed, in the beneficiary's primary
language, of the availability of free
interpreter and translation services
and the beneficiary instead requests
that a family member, friend, or other
person provide such services; and
(II) the grantee documents such
request in the beneficiary's medical
record; or
(ii) in the case of a medical emergency
where the delay directly associated with
obtaining a competent interpreter or
translation services would jeopardize the
health of the patient.
Clause (ii) shall not be construed to exempt emergency
rooms or similar entities that regularly provide health
care services in medical emergencies to patients who
are English learners from any applicable legal or
regulatory requirements related to providing competent
interpreter and translation services without undue
delay.
(D) Medicare advantage organizations and pdp
sponsors.--If a grantee is a Medicare Advantage
organization offering a Medicare Advantage plan under
part C of title XVIII of the Social Security Act or a
PDP sponsor offering a prescription drug plan under
part D of such title, such entity must provide at least
50 percent of the grant funds that the entity receives
under this subsection directly to the entity's network
providers (including all health providers and
pharmacists) for the purpose of providing support for
such providers to provide competent language services
to Medicare beneficiaries who are English learners.
(E) Administrative and reporting costs.--A grantee
may use up to 10 percent of the grant funds to pay for
administrative costs associated with the provision of
competent language services and for reporting required
under paragraph (9).
(6) Determination of amount of grant payments.--
(A) In general.--Payments to grantees under this
subsection shall be calculated based on the estimated
numbers of Medicare beneficiaries who are English
learners in a grantee's service area utilizing--
(i) data on the numbers of English learners
who speak English less than ``very well'' from
the most recently available data from the
Bureau of the Census or other State-based study
the Secretary determines likely to yield
accurate data regarding the number of such
individuals in such service area; or
(ii) data provided by the grantee, if the
grantee routinely collects data on the primary
language of the Medicare beneficiaries that the
grantee serves and the Secretary determines
that the data is accurate and shows a greater
number of English learners than would be
estimated using the data under clause (i).
(B) Discretion of secretary.--Subject to
subparagraph (C), the amount of payment made to a
grantee under this subsection may be modified annually
at the discretion of the Secretary, based on changes in
the data under subparagraph (A) with respect to the
service area of a grantee for the year.
(C) Limitation on amount.--The amount of a grant
made under this subsection to a grantee may not exceed
$500,000 for the period under paragraph (1)(D).
(7) Assurances.--Grantees under this subsection shall, as a
condition of receiving a grant under this subsection--
(A) ensure that clinical and support staff receive
appropriate ongoing education and training in
linguistically appropriate service delivery;
(B) ensure the linguistic competence of bilingual
providers;
(C) offer and provide appropriate language services
at no additional charge to each patient who is an
English learner for all points of contact between the
patient and the grantee, in a timely manner during all
hours of operation;
(D) notify Medicare beneficiaries of their right to
receive language services in their primary language;
(E) post signage in the primary languages commonly
used by the patient population in the service area of
the organization; and
(F) ensure that--
(i) primary language data are collected for
recipients of language services and such data
are consistent with standards developed under
title XXXIV of the Public Health Service Act,
as added by section 202 of this Act, to the
extent such standards are available upon the
initiation of the demonstration program; and
(ii) consistent with the privacy
protections provided under the regulations
promulgated pursuant to section 264(c) of the
Health Insurance Portability and Accountability
Act of 1996 (42 U.S.C. 1320d-2 note), if the
recipient of language services is a minor or is
incapacitated, primary language data are
collected on the parent or legal guardian of
such recipient.
(8) No cost sharing.--Medicare beneficiaries who are
English learners shall not have to pay cost sharing or co-
payments for competent language services provided under this
demonstration program.
(9) Reporting requirements for grantees.--Not later than
the end of each calendar year, a grantee that receives funds
under this subsection in such year shall submit to the
Secretary a report that includes the following information:
(A) The number of Medicare beneficiaries to whom
competent language services are provided.
(B) The primary languages of those Medicare
beneficiaries.
(C) The types of language services provided to such
beneficiaries.
(D) Whether such language services were provided by
employees of the grantee or through a contract with
external contractors or agencies.
(E) The types of interpretation services provided
to such beneficiaries, and the approximate length of
time such service is provided to such beneficiaries.
(F) The costs of providing competent language
services.
(G) An account of the training or accreditation of
bilingual staff, interpreters, and translators
providing services funded by the grant under this
subsection.
(10) Evaluation and report to congress.--Not later than 1
year after the completion of a 3-year grant under this
subsection, the Secretary shall conduct an evaluation of the
demonstration program under this subsection and shall submit to
the Congress a report that includes the following:
(A) An analysis of the patient outcomes and the
costs of furnishing care to the Medicare beneficiaries
who are English learners participating in the project
as compared to such outcomes and costs for such
Medicare beneficiaries not participating, based on the
data provided under paragraph (9) and any other
information available to the Secretary.
(B) The effect of delivering language services on--
(i) Medicare beneficiary access to care and
utilization of services;
(ii) the efficiency and cost effectiveness
of health care delivery;
(iii) patient satisfaction;
(iv) health outcomes; and
(v) the provision of culturally appropriate
services provided to such beneficiaries.
(C) The extent to which bilingual staff,
interpreters, and translators providing services under
such demonstration were trained or accredited and the
nature of accreditation or training needed by type of
provider, service, or other category as determined by
the Secretary to ensure the provision of high-quality
interpretation, translation, or other language services
to Medicare beneficiaries if such services are expanded
pursuant to subsection (c) of section 1907 of this Act.
(D) Recommendations, if any, regarding the
extension of such project to the entire Medicare
Program, subject to the provisions of section 1115A(c)
of the Social Security Act (42 U.S.C. 1315a(c)).
(11) Appropriations.--There is appropriated to carry out
this subsection, in equal parts from the Federal Hospital
Insurance Trust Fund under section 1817 of the Social Security
Act (42 U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42 U.S.C.
1395t), $16,000,000 for each fiscal year of the demonstration
program.
(12) English learner defined.--In this subsection, the term
``English learner'' has the meaning given such term in section
8101(20) of the Elementary and Secondary Education Act of 1965,
except that subparagraphs (A), (B), and (D) of such section
shall not apply.
(b) Language Services Under the Medicare Program.--
(1) Inclusion as rural health clinic services.--Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (aa)(1)--
(i) in subparagraph (B), by striking
``and'' at the end;
(ii) by adding ``and'' at the end of
subparagraph (C); and
(iii) by inserting after subparagraph (C)
the following new subparagraph:
``(D) language assistance services as defined in subsection
(iii)(1),''; and
(B) by adding at the end the following new
subsection:
``Language Assistance Services and Related Terms
``(iii)(1) The term `language assistance services' has the same
meaning given the term `language or language assistance services' in
section 3400 of the Public Health Service Act.
``(2) The term `interpreter services' has the meaning given the
term `qualified interpreter for an individual with limited-English
proficiency' in section 3400(3) of the Public Health Service Act.
``(3) The term `qualified interpreter for an individual with
limited-English proficiency' means an interpreter who via a remote
interpreting service or an onsite appearance--
``(A) adheres to generally accepted interpreter ethics
principles, including client confidentiality;
``(B) has demonstrated proficiency in speaking and
understanding both spoken English and at least one other spoken
language; and
``(C) is able to interpret effectively, accurately, and
impartially and in a culturally competent manner, both
receptively and expressly, to and from such language(s) and
English, using any necessary specialized vocabulary,
terminology, and phraseology.
``(4) The term `qualified translator' means a translator who--
``(A) adheres to generally accepted translator ethics
principles, including client confidentiality;
``(B) has demonstrated proficiency in writing and
understanding both written English and at least one other
written non-English language; and
``(C) is able to translate effectively, accurately, and
impartially to and from such language(s) and English, using any
necessary specialized vocabulary, terminology, and phraseology.
``(5) The term `English learner' has the meaning given such term in
section 8101(20) of the Elementary and Secondary Education Act of 1965,
except that subparagraphs (A), (B), and (D) of such section shall not
apply.''.
(2) Coverage.--Section 1832(a)(2) of the Social Security
Act (42 U.S.C. 1395k(a)(2)) is amended--
(A) by striking ``and'' at the end of subparagraph
(I);
(B) by striking the period at the end of
subparagraph (J) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(K) language services (as defined in paragraph
(1) of section 1861(iii)) furnished by an interpreter
(as defined in paragraph (3) of such section) or
translator.''.
(3) Payment.--Section 1833(a) of the Social Security Act
(42 U.S.C. 1395l(a)) is amended--
(A) by striking ``and'' at the end of paragraph
(8);
(B) by striking the period at the end of paragraph
(9) and inserting ``; and''; and
(C) by inserting after paragraph (9) the following
new paragraph:
``(10) in the case of language services described in
section 1861(iii)(1), 100 percent of the reasonable charges for
such services, as determined in consultation with the Medicare
Payment Advisory Commission; and''.
(4) Waiver of budget neutrality.--For the 3-year period
beginning on the date of enactment 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
with respect to language services (as such term is defined in
section 1861(iii)(1) of such Act).
(c) Medicare Parts C and D.--
(1) In general.--Medicare Advantage plans under part C of
the Social Security Act and prescription drug plans under part
D of such Act shall comply with title VI of the Civil Rights
Act of 1964 and section 1557 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18116) to provide effective
language services to enrollees of such plans.
(2) Medicare advantage plans and prescription drug plans
reporting requirement.--Section 1857(e) of the Social Security
Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the
following new paragraph:
``(5) Reporting requirements relating to effective language
services.--A contract under this part shall require a Medicare
Advantage organization (and, through application of section
1860D-12(b)(3)(D), a contract under section 1860D-12 shall
require a PDP sponsor) to annually submit (for each year of the
contract) a report that contains information on the plan's
internal policies and procedures related to recruitment and
retention efforts directed to workforce diversity and
linguistically and culturally appropriate provision of services
in each of the following contexts:
``(A) The collection of data in a manner that meets
the requirements of title I of the Health Equity and
Accountability Act of 2018, regarding the enrollee
population.
``(B) Education of staff and contractors who have
routine contact with enrollees regarding the various
needs of the diverse enrollee population.
``(C) Evaluation of the health plan's language
services programs and services with respect to the
plan's enrollee population, such as through analysis of
complaints or satisfaction survey results.
``(D) Methods by which the plan provides to the
Secretary information regarding the ethnic diversity of
the plan's enrollee population.
``(E) The periodic provision of educational
information to plan enrollees on the plan's language
services and programs.''.
(d) Improving Language Services in Medicaid and CHIP.--
(1) Payments to states.--Section 1903(a)(2)(E) of the
Social Security Act (42 U.S.C. 1396b(a)(2)(E)) is amended by--
(A) striking ``75'' and inserting ``90'';
(B) striking ``translation or interpretation
services'' and inserting ``language services''; and
(C) striking ``children of families'' and inserting
``individuals''.
(2) State plan requirements.--Section 1902(a)(10)(A) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended by
striking ``and (28)'' and inserting ``(28), and (29)''.
(3) Definition of medical assistance.--Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended by--
(A) in paragraph (28), by striking ``and'' at the
end;
(B) by redesignating paragraph (29) as paragraph
(30); and
(C) by inserting after paragraph (28) the following
new paragraph:
``(29) language services, as such term is defined in
section 1861(iii)(1), provided in a timely manner to English
learners (as defined in section 1861(iii)(5)) who need such
services; and''.
(4) Use of deductions and cost sharing.--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)(29); and''.
(5) CHIP coverage requirements.--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 ``and (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, as such term is defined in section
1861(iii)(1), provided in a timely manner to English learners
(as defined in section 1861(iii)(5)) who need such 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)(D)''.
(6) Definition of child health assistance.--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)(9)''.
(7) State data collection.--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 require that States collect data on--
(A) the primary language of individuals receiving
child health assistance under title XXI of the Social
Security Act; and
(B) in the case of such individuals who are minors
or incapacitated, the primary language of the
individual's parent or guardian.
(8) CHIP payments to states.--Section 2105 of the Social
Security Act (42 U.S.C. 1397ee(c)) is amended--
(A) in subsection (a)(1), by striking ``75'' and
inserting ``90''; and
(B) in subsection (c)(2)(A), by inserting before
the period at the end the following: ``, except that
expenditures pursuant to clause (iv) of subparagraph
(D) of such paragraph shall not count towards this
total''.
(e) 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 English learners in an amount equal to an eligible
entity's eligible costs for such services for the
quarter.
(B) 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 2017 through
2021.
(C) 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.
(2) Methodology for payment of claims.--
(A) In general.--The Secretary shall establish a
methodology to determine the average per person cost of
language services.
(B) Different entities.--In establishing such
methodology, the Secretary may establish different
methodologies for different types of eligible entities.
(C) No individual claims.--The Secretary may not
require eligible entities to submit individual claims
for language services for individual patients as a
requirement for payment under this subsection.
(3) Data collection instrument.--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.
(4) Guidelines.--Not later than 6 months after the date of
enactment of this Act, the Secretary of Health and Human
Services shall establish and distribute guidelines concerning
the implementation of this subsection.
(5) Reporting requirements.--
(A) Report to secretary.--Entities receiving
payment under this subsection shall provide the
Secretary with a quarterly report on how the entity
used such funds. Such report shall contain aggregate
(and may not contain individualized) data collected
using the instrument under paragraph (3) and shall
otherwise be in a form and manner determined by the
Secretary.
(B) Report to congress.--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 this
subsection.
(6) Definitions.--In this subsection:
(A) Eligible costs.--The term ``eligible costs''
means, with respect to an eligible entity that provides
language services to English learners, the product of--
(i) the average per person cost of language
services, determined according to the
methodology devised under paragraph (2); and
(ii) the number of English learners 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), (c), or (d) or by private
health insurance.
(B) Eligible entity.--The term ``eligible entity''
means an entity that--
(i) is a Medicaid provider that is--
(I) a physician;
(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)));
(ii) provide language services to at least
8 percent of the entity's total number of
patients, not later than 6 months after the
date of the enactment of the Act; and
(iii) 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 entity's
eligibility for funding under this subsection.
(C) English learner.--The term ``English learner''
has the meaning given such term in section 8101(20) of
the Elementary and Secondary Education Act of 1965,
except that subparagraphs (A), (B), and (D) of such
section shall not apply.
(D) Language services.--The term ``language
services'' has the meaning given such term in section
1861(iii)(1) of the Social Security Act.
(f) Application of Civil Rights Act of 1964 and Other Laws.--
Nothing in this section 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 other
laws that protect the civil rights of individuals.
(g) Effective Date.--
(1) In general.--Except as otherwise provided and subject
to paragraph (2), the amendments made by this section shall
take effect on January 1, 2017.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
SEC. 206. 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
Director of the National Institute on Minority Health and Health
Disparities and the Deputy Assistant Secretary for 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 2019 through 2023.
SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS.
(a) In General.--Any health program or activity, any part of which
is receiving Federal financial assistance, including credits,
subsidies, or contracts of insurance, and any program or activity that
is administered by an executive agency or any entity established under
title I of the Patient Protection and Affordable Care Act (or
amendments made thereby), as such programs, activities, agencies, and
entities are described in section 1557(a) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18116), 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 assistance
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 qualified interpreters for an individual
with limited-English proficiency or qualified translators, as
defined in section 3400 of the Public Health Service Act.
(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 or her without charge, or of using
his or 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
the recipient's 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 1 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.
(c) Rule of Construction.--Subsection (b)(2) shall not be construed
to mean that emergency rooms or similar entities that regularly provide
health care services in medical emergencies are exempt from legal or
regulatory requirements related to competent interpreter services.
SEC. 208. 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 National Academy 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 culturally competent 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) recommend guidelines or standards for health literacy
and plain language, informed consent, discharge instructions,
and written communications, and for improvement of health care
access;
(5) a description of the effect of providing language
services on quality of health care and access to care; and
(6) 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 2019 through 2023.
SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES.
(a) Grants Authorized.--The Secretary of Education is authorized to
provide grants to eligible entities for the provision of English as a
second language (in this section referred to ``ESL'') instruction and
shall determine, after consultation with appropriate stakeholders, the
mechanism for administering and distributing such grants.
(b) Eligible Entity Defined.--For purposes of this section, the
term ``eligible entity'' means a State or community-based organization
that employs, and serves, minority populations.
(c) Application.--An eligible entity 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.
(d) Use of Grant.--As a condition of receiving a grant under this
section, an eligible entity 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,
2019.
(e) 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 preferred written and spoken language of
such English language learners;
(B) 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;
(C) the availability of programs to geographically
isolated communities;
(D) the impact of course enrollment policies,
including open enrollment, on the availability of ESL
instruction;
(E) the number individuals in the State and each
participating locality;
(F) the effectiveness of the instruction in meeting
the needs of individuals receiving instruction and
those needing instruction;
(G) as assessment of the need for programs that
integrate job training and ESL instruction, to assist
individuals to obtain better jobs; and
(H) 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) not later than 1 year after the date of enactment of
this Act, issue a report to Congress that assesses the
information collected in paragraphs (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.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to the Secretary of Education $250,000,000 for each of
fiscal years 2019 through 2022 to carry out this section.
SEC. 210. 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 title.
(2) In a suit against a State for a violation of this
title, 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 title 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.
SEC. 211. LANGUAGE ACCESS SERVICES.
(a) Essential Benefits.--Section 1302(b)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(b)(1)) is amended
by adding at the end the following:
``(K) Language access services, including oral
interpretation and written translations.''.
(b) Employer-Sponsored Minimum Essential Coverage.--
(1) In general.--Section 36B(c)(2)(C) of the Internal
Revenue Code of 1986 is amended by redesignating clauses (iii)
and (iv) as clauses (iv) and (v), respectively, and by
inserting after clause (ii) the following new clause:
``(iii) Coverage must include language
access and services.--Except as provided in
clause (iv), an employee shall not be treated
as eligible for minimum essential coverage if
such coverage consists of an eligible employer-
sponsored plan (as defined in section
5000A(f)(2)) and the plan does not provide
coverage for language access services,
including oral interpretation and written
translations.''.
(2) Conforming amendments.--
(A) Section 36B(c)(2)(C) of such Code is amended by
striking ``clause (iii)'' each place it appears in
clauses (i) and (ii) and inserting ``clause (iv)''.
(B) Section 36B(c)(2)(C)(iv) of such Code, as
redesignated by this subsection, is amended by striking
``(i) and (ii)'' and inserting ``(i), (ii), and
(iii)''.
(c) Quality Reporting.--Section 2717(a)(1) of the Public Health
Service Act (42 U.S.C. 300gg-17(a)(1)) is amended--
(1) by striking ``and'' at the end of subparagraph (C);
(2) by striking the period at the end of subparagraph (D)
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(E) reduce health disparities through the
provision of language access services, including oral
interpretation and written translations.''.
(d) Regulations Regarding Internal Claims and Appeals and External
Review Processes for Health Plans and Health Insurance Issuers.--The
Secretary of the Treasury, the Secretary of Labor, and the Secretary of
Health and Human Services shall amend the regulations in section
54.9815-2719T(e) of title 26, Code of Federal Regulations, section
2590.715-2719(e) of title 29, Code of Federal Regulations, and section
147.136(e) of title 45, Code of Federal Regulations, respectively, to
require group health plans and health insurance issuers offering group
or individual health insurance coverage to which such sections apply--
(1) to provide oral interpretation services without any
threshold requirements;
(2) to provide in the English versions of all notices a
statement prominently displayed in not less than 15 non-English
languages clearly indicating how to access the language
services provided by the plan or issuer; and
(3) with respect to written translations of notices, to
apply a threshold that 5 percent of the population or at least
500 individuals per service area are literate only in the same
non-English language in lieu of 10 percent or more residing in
a county.
(e) Data Collection and Reporting.--The Secretary of Health and
Human Services shall--
(1) amend the single streamlined application form developed
pursuant to section 1413 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18083) to collect the preferred
spoken and written language for each household member applying
for coverage under a qualified health plan through an Exchange
under title I of the Patient Protection and Affordable Care
Act;
(2) require navigators, certified application counselors,
and other enrollment assisters to collect and report requests
for language assistance; and
(3) require the Federal and State call centers established
pursuant to section 1311(d)(4)(b) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(d)(4)(b)) to submit an
annual report documenting the number of language assistance
requests, the types of languages requested, the range and
average wait time for a consumer to speak with an interpreter,
and any steps the call center and language line have taken to
actively address some of the consumer complaints.
(f) Effective Date.--The amendments made by this section shall
apply to plan years beginning after the date of the enactment of this
Act.
TITLE III--HEALTH WORKFORCE DIVERSITY
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as added by section
202, is amended by adding at the end the following:
``Subtitle A--Diversifying the Health Care Workplace
``SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Bureau of
Health Workforce 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):
``(1) The grantee shall ensure that the group has
representatives of the following:
``(A) The Health Resources and Services
Administration.
``(B) The Department of Health and Human Services
Data Council.
``(C) The Office of Minority Health of the
Department of Health and Human Services.
``(D) The Substance Abuse and Mental Health
Services Administration.
``(E) The Bureau of Labor Statistics of the
Department of Labor.
``(F) The Public Health Practice Program Office--
Office of Workforce Policy and Planning.
``(G) The National Institute on Minority Health and
Health Disparities.
``(H) The Agency for Healthcare Research and
Quality.
``(I) The Institute of Medicine Study Committee for
the 2004 workforce diversity report.
``(J) The Indian Health Service.
``(K) The Department of Education.
``(L) Minority-serving academic institutions.
``(M) Consumer organizations.
``(N) Health professional associations, including
those that represent underrepresented minority
populations.
``(O) Researchers in the area of health workforce.
``(P) Health workforce accreditation entities.
``(Q) Private (including nonprofit) foundations
that have sponsored workforce diversity initiatives.
``(R) Local and State health departments.
``(S) Representatives of community members to be
included on admissions committees for health profession
schools pursuant to subsection (c)(8).
``(T) National community-based organizations that
serve as a national intermediary to their urban
affiliate members and have demonstrated capacity to
train health care professionals.
``(U) Other entities determined appropriate by the
Secretary.
``(V) The Veterans Health Administration.
``(2) The grantee shall ensure that, in addition to the
representatives under paragraph (1), the group has 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 guidelines to train health professionals to
care for a diverse population.
``(8) Develop a workforce data collection or tracking
system to identify where racial and ethnic minority health
professionals practice.
``(9) Develop a strategy for the inclusion of community
members on admissions committees for health profession schools.
``(10) Helping with monitoring and implementation of
standards for diversity, equity, and inclusion.
``(11) 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 2019 through 2024.
``SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH WORKFORCE DIVERSITY.
``(a) In General.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health, and in collaboration with the
Bureau of Health Workforce within the Health Resources and Services
Administration, the National Institute 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, including integrated models of care.
``(4) Admissions policies that promote health workforce
diversity and are in compliance with Federal and State laws.
``(5) Retainment policies that promote completion of health
profession degrees for underserved populations.
``(6) Lists of scholarship, loan repayment, and loan
cancellation grants as well as fellowship information for
underserved populations for health professions schools.
``(7) 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 and minority sections of major 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 2019 through 2024.
``SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO WORKFORCE DIVERSITY,
EQUITY, AND INCLUSION.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration and the Centers for
Disease Control and Prevention, 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, Native 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, including national and regional
community-based organizations with demonstrated
commitment to a diversified workforce--
``(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) postbaccalaureate 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,
Native American, and Pacific Islander-serving institutions' has the
same meaning as the term `Asian American and Native American Pacific
Islander-serving institution' as defined in section 371(c) of the
Higher Education Act of 1965 (20 U.S.C. 1067q(c)).
``(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 2019 through 2024.
``SEC. 3414. 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, the
Director of the Agency for Healthcare Research and Quality, and the
Administrator of the Health Resources and Services Administration,
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 2019 through 2024.
``SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH PROFESSIONALS.
``(a) In General.--The Secretary, acting through the Director of
the Centers for Disease Control and Prevention, the Administrator of
the Substance Abuse and Mental Health Services Administration, the
Administrator of the Health Resources and Services Administration, and
the Administrator of the Centers for Medicare & Medicaid Services,
shall establish a program to award grants to eligible individuals for
career support in nonresearch-related health and wellness professions.
``(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, an individual working in a health or wellness
profession (including mental and behavioral health), 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;
``(3) to pay, or as reimbursement for payments of, student
loans or training or credentialing costs for individuals who
are health professionals and are focused on health issues
affecting underserved communities, including racial and ethnic
minority communities; and
``(4) to establish and promote leadership training programs
to decrease health disparities and to increase cultural
competence with the goal of increasing diversity in leadership
positions.
``(d) Definition.--In this section, the term `career in
nonresearch-related health and wellness professions' means employment
or intended employment in the field of public health, health policy,
health management, health administration, medicine, nursing, pharmacy,
psychology, social work, psychiatry, other mental and behavioral
health, allied health, community health, social work, 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 2019 through 2024.
``SEC. 3416. 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 Deputy Assistant
Secretary for Minority Health and the Director of the National
Institute on Minority Health and Health Disparities, shall award grants
to eligible entities to expand research on the link between health
workforce diversity and quality health care.
``(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) compliance of care; or
``(13) other topics determined appropriate by the Director.
``(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 2019 through 2024.
``SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM.
``(a) Establishment.--The Secretary, acting through the National
Institute 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 & Medicaid Services, the Health Resources and Services
Administration, and other appropriate public and private entities,
shall establish and coordinate a health and health care disparities
education program to support, develop, and implement educational
initiatives and outreach strategies that inform health care
professionals and the public about the existence of and methods to
reduce racial and ethnic disparities in health and health care.
``(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 health care,
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 entitled `Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care', as
well as the impact of disparities related to age, disability
status, socioeconomic status, sex, gender identity, and sexual
orientation on racial and ethnic minorities;
``(2) disseminate new research findings to health care
providers and patients to assist them in understanding,
reducing, and eliminating health and health care disparities;
``(3) disseminate information about the impact of
linguistic and cultural barriers on health care 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, disability status, socioeconomic
status, sex, gender identity, and sexual orientation, 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;
``(6) assess the impact of the programs established under
this section in raising awareness of health and health care
disparities and providing information on available resources;
and
``(7) design and implement specific educational initiatives
to educate the health care workforce relating to unconscious
bias.
``(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 2019 through 2024.''.
SEC. 302. 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 INSTITUTIONS, HISTORICALLY BLACK COLLEGES
& UNIVERSITIES, AND TRIBAL COLLEGES.
``(a) In General.--The Secretary, acting through the Administrator
of the Health and Human Resources and Services Administration, shall
establish grants from the Department of Education to Hispanic-serving
Institutions, Historically Black Colleges & Universities, and Tribal
Colleges, including Regional community based organizations and national
minority medical associations, for scholarships and counseling services
to prepare underrepresented minority individuals to enroll in and
graduate from health professional schools and to increase services for
qualified students, including--
``(1) mentoring with underrepresented health professionals;
and
``(2) providing financial assistance information for
continued education and applications to health professional
schools.
``(b) Eligibility.--In subsection (a), the term `Hispanic-serving
Institutions' 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;
``(5) has a significant number of graduates who are
providing health services to medically underserved populations
or to individuals in health professional shortage areas; and
``(6) is a Regional Hispanic Center of Excellence.
``(c) Certain Loan Repayment Programs.--In carrying out the
National Health Service Corps loan repayment program and loan repayment
programs of the Centers for Disease Control and Prevention, the
Secretary shall ensure that loan repayments of not less than $50,000
per year are awarded for repayment of loans incurred for enrollment or
participation in schools and programs described in this section.''.
SEC. 303. 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 at the end the
following: ``, $750,000 for fiscal year 2019, and such sums as
may be necessary for each of the fiscal years 2020 through
2024''.
SEC. 304. 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 302, 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 Deputy Assistant Secretary for 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.--Recipients of cooperative agreements under
this section shall design and implement an online degree program that
meets 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.
``(3) Achieving a high completion rate of enrolled
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 2019 through 2024.''.
SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE NATIONAL HEALTH CARE
WORKFORCE COMMISSION.
It is the sense of Congress that the National Health Care Workforce
Commission established by section 5101 of the Patient Protection and
Affordable Care Act (42 U.S.C. 294q) should, in carrying out its
assigned duties under that section, give attention to the needs of
racial and ethnic minorities, individuals with lower socioeconomic
status, individuals with mental, developmental, and physical
disabilities, lesbian, gay, bisexual, transgender, queer, and
questioning populations, and individuals who are members of multiple
minority or special population groups.
SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS.
Subtitle A of title XXXIV of the Public Health Service Act, as
added by section 301, is further amended by inserting after section
3417 the following:
``SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH SERVICES CORPS.
``(a) In General.--The Administrator of the Health Resources and
Services Administration and the Director of the Centers for Disease
Control and Prevention, in collaboration with the Deputy Assistant
Secretary for Minority Health, shall award grants to eligible entities
to increase awareness among postprimary and postsecondary 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 nonprofit 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, 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) Community health, patient navigation, and peer
support.
``(15) 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 postsecondary 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 2019 through 2024.
``SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS PROGRAM.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, in collaboration with the Deputy Assistant Secretary
for 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 interest, knowledge, or skill 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) demonstrate promise for becoming a leader in public
health;
``(4) secure admission to a 4-year institution of higher
education;
``(5) comply with subsection (e); 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 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 2019 through 2024.
``SEC. 3420. 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 Deputy Assistant Secretary
for 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 2019 through 2024.
``SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL HEALTH FELLOWSHIP
PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, in collaboration with the Deputy Assistant
Secretary for 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 (e); 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 health care 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
health care 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 2019 through 2024.
``SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PROGRAM.
``(a) In General.--The Director of the Agency for Healthcare
Research and Quality, the Director of the Centers for Medicare and
Medicaid Services, and the Administrator for Health Resources and
Services Administration, in collaboration with the Deputy Assistant
Secretary for 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, academic, or nonprofit 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) health care and pharmaceutical policy;
``(3) health care administration and management;
``(4) health economics; and
``(5) other professions determined appropriate by the
Director of the Agency for Healthcare Research and Quality, the
Director of the Centers for Medicare and Medicaid Services, and
the Administrator for Health Resources and Services
Administration.
``(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 postsecondary 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 2019 through 2024.
``SEC. 3420C. LEADERSHIP FELLOWSHIP PROGRAMS.
``The Secretary of Health and Human Services shall award grants to
entities to develop leadership fellowship programs for underrepresented
health professionals to become future leaders in public health and
health care delivery institutions.''.
SEC. 307. 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 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 students participating in projects assisted
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 2019
through 2025.''.
SEC. 308. RULES FOR DETERMINATION OF FULL-TIME EQUIVALENT RESIDENTS FOR
COST-REPORTING PERIODS.
(a) DGME Determinations.--Section 1886(h)(4) of the Social Security
Act (42 U.S.C. 1395ww(h)(4)), as amended by section 204(a), is
amended--
(1) in subparagraph (E), by striking ``Subject to
subparagraphs (J) and (K), such rules'' and inserting ``Subject
to subparagraphs (J), (K), and (M), such rules'';
(2) in subparagraph (J), by striking ``Such rules'' and
inserting ``Subject to subparagraph (M), such rules'';
(3) in subparagraph (K), by striking ``In determining'' and
inserting ``Subject to subparagraph (M), in determining''; and
(4) by adding at the end the following new subparagraph:
``(M) Treatment of certain residents and interns.--
For purposes of cost-reporting periods beginning on or
after October 1, 2016, in determining the hospital's
number of full-time equivalent residents for purposes
of this paragraph, all the time spent by an intern or
resident in an approved medical residency training
program shall be counted toward the determination of
full-time equivalency if the hospital--
``(i) is recognized as a subsection (d)
hospital;
``(ii) is recognized as a subsection (d)
Puerto Rico hospital;
``(iii) is reimbursed under a reimbursement
system authorized under section 1814(b)(3); or
``(iv) is a provider-based hospital
outpatient department.''.
(b) IME Determinations.--Section 1886(d)(5)(B)(x) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(x)) is amended--
(1) in subclause (II), by striking ``In determining'' and
inserting ``Subject to subclause (IV), in determining'';
(2) in subclause (III), by striking ``In determining'' and
inserting ``Subject to subclause (IV), in determining''; and
(3) by inserting after subclause (III) the following new
subclause:
``(IV) The provisions of subparagraph (L) of
subsection (h)(4) shall apply under this subparagraph
in the same manner as they apply under such
subsection.''.
SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES FOR LOCAL HEALTH
EQUITY.
(a) Grants.--The Secretaries of Health and Human Services,
Education, and Labor, acting jointly, shall make grants to academic
institutions for the purposes of--
(1) in accordance with subsection (b), developing
capacity--
(A) to build an evidence base for successful
strategies for increasing local health equity; and
(B) to serve as national models of driving local
health equity;
(2) in accordance with subsection (c), developing a
strategic partnership with the community in which the academic
institution is located; and
(3) collecting data on, and periodically evaluating, the
effectiveness of the institution's programs funded through this
section to enable the institution to adapt accordingly for
maximum efficiency and success.
(b) Developing Capacity for Increasing Local Health Equity.--As a
condition on receipt of a grant under subsection (a), an academic
institution shall agree to use the grant to build an evidence base for
successful strategies for increasing local health equity, and to serve
as a national model of driving local health equity, by supporting--
(1) resources to strengthen institutional metrics and
capacity to execute institutionwide health workforce goals that
can serve as models for increasing health equity in communities
across the country;
(2) collaborations among a cohort of institutions in
implementing systemic change, partnership development, and
programmatic efforts supportive of health equity goals across
disciplines and populations; and
(3) enhanced or newly developed data systems and research
infrastructure capable of informing current and future
workforce efforts and building a foundation for a broader
research agenda targeting urban health disparities.
(c) Strategic Partnerships.--As a condition on receipt of a grant
under subsection (a), an academic institution shall agree to use the
grant to develop a strategic partnership with the community in which
the institution is located for the purposes of--
(1) strengthening connections between the institution and
the community--
(A) to improve evaluation of and address the
community's health and health workforce needs; and
(B) to engage the community in health workforce
development;
(2) developing, enhancing, or accelerating innovative
undergraduate and graduate programs in the biomedical sciences
and health professions; and
(3) strengthening pipeline programs in the biomedical
sciences and health professions, including by developing
partnerships between institutions of higher education and
elementary and secondary schools to recruit the next generation
of health professionals earlier in the pipeline to a health
care career.
SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAVIORAL HEALTH SOCIAL
WORKERS.
Section 455 of the Higher Education Act of 1965 (20 U.S.C. 1087e)
is amended by adding at the end the following new subsection:
``(r) Repayment Plan for Mental and Behavioral Health Social
Workers.--
``(1) In general.--The Secretary shall cancel the balance
of interest and principal due on any eligible Federal Direct
Loan not in default for a borrower who--
``(A) has made 120 monthly payments on the eligible
Federal Direct Loan after October 1, 2016, pursuant to
any one or a combination of the following--
``(i) payments under an income-based
repayment plan under section 493C;
``(ii) payments under a standard repayment
plan under subsection (d)(1)(A), based on a 10-
year repayment period;
``(iii) monthly payments under a repayment
plan under subsection (d)(1) or (g) of not less
than the monthly amount calculated under
subsection (d)(1)(A), based on a 10-year
repayment period; or
``(iv) payments under an income contingent
repayment plan under subsection (d)(1)(D); and
``(B)(i) is employed as a mental health or
behavioral health social worker, as defined by the
Secretary by regulation, at the time of such
forgiveness; and
``(ii) has been employed as such a mental health or
behavioral health social worker during the period in
which the borrower makes each of the 120 payments as
described in subparagraph (A).
``(2) Loan cancellation amount.--After the conclusion of
the employment period described in paragraph (1), the Secretary
shall cancel the obligation to repay the balance of principal
and interest due as of the time of such cancellation, on the
eligible Federal Direct Loans made to the borrower under this
part.
``(3) Ineligibility for double benefits.--No borrower may,
for the same employment as a mental health or behavioral health
social worker, receive a reduction of loan obligations under
both this subsection and subsection (m), 428J, 428K, 428L, or
460.
``(4) Definition of eligible federal direct loan.--In this
subsection, the term `eligible Federal Direct Loan' means a
Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal
Direct Unsubsidized Stafford Loan, or a Federal Direct
Consolidation Loan.''.
SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND.
(a) Purpose.--It is the purpose of this section to establish a
Health Professions Workforce Fund to be administered through the Health
Resources and Services Administration within the Department of Health
and Human Services to provide for expanded and sustained national
investment in the health professions and nursing workforce development
programs under title VII and title VIII of the Public Health Service
Act.
(b) Establishing the Health Professions Workforce Fund.--There is
authorized to be appropriated, and there is appropriated, out of any
monies in the Treasury not otherwise appropriated, to the Health
Professions Workforce Fund--
(1) $355,000,000 for fiscal year 2019;
(2) $375,000,000 for fiscal year 2020;
(3) $392,000,000 for fiscal year 2021;
(4) $412,000,000 for fiscal year 2022;
(5) $432,000,000 for fiscal year 2023;
(6) $454,000,000 for fiscal year 2024;
(7) $476,000,000 for fiscal year 2025;
(8) $500,000,000 for fiscal year 2026;
(9) $525,000,000 for fiscal year 2027; and
(10) $552,000,000 for fiscal year 2028.
(c) Funding.--
(1) For the purpose of carrying out health professions
education programs authorized under title VII of the Public
Health Service Act, in addition to any other amounts authorized
to be appropriated for such purpose, there is authorized to be
appropriated out of any monies in the Health Professions
Workforce Fund, the following:
(A) $240,000,000 for fiscal year 2019.
(B) $253,000,000 for fiscal year 2020.
(C) $265,000,000 for fiscal year 2021.
(D) $278,000,000 for fiscal year 2022.
(E) $292,000,000 for fiscal year 2023.
(F) $307,000,000 for fiscal year 2024.
(G) $322,000,000 for fiscal year 2025.
(H) $338,000,000 for fiscal year 2026.
(I) $355,000,000 for fiscal year 2027.
(J) $373,000,000 for fiscal year 2028.
(2) For the purpose of carrying out nursing workforce
development programs authorized under Title VIII of the Public
Health Service Act, in addition to any other amounts authorized
to be appropriated for such purpose, there is authorized to be
appropriated out of any monies in the Health Professions
Workforce Fund, the following:
(A) $115,000,000 for fiscal year 2019.
(B) $122,000,000 for fiscal year 2020.
(C) $127,000,000 for fiscal year 2021.
(D) $134,000,000 for fiscal year 2022.
(E) $140,000,000 for fiscal year 2023.
(F) $147,000,000 for fiscal year 2024.
(G) $154,000,000 for fiscal year 2025.
(H) $162,000,000 for fiscal year 2026.
(I) $170,000,000 for fiscal year 2027.
(J) $179,000,000 for fiscal year 2028.
SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO GRADUATE MEDICAL
EDUCATION.
(a) Findings.--Congress finds the following:
(1) Projections by the Association of American Medical
Colleges (AAMC) and other expert entities, such as the Health
Resources and Services Administration (HRSA), have indicated a
nationwide shortage of up to 104,900 physicians, split evenly
between primary care and specialists, by 2030.
(2) Primarily due to the growing and aging population, over
the next decade, physician demand is expected to grow up to 17
percent.
(3) The United States Census Bureau estimates that the
United States population will grow from 321 million in 2015 to
347 million in 2025. Further, the number of Medicare
beneficiaries is estimated to increase from 47.8 million in
2015 to approximately 66 million in 2025.
(4) Approximately 36 percent of practicing physicians are
over the age of 55 and are likely to retire within the next
decade.
(5) A nationwide physician shortage will result in many
Americans waiting longer and traveling farther for health care;
seeking nonemergent care in emergency departments; and delaying
treatment until their health care needs become more serious,
complex, and costly.
(6) Changing demographics (such as an aging population),
new health care delivery models (such as medical homes), and
other factors (such as disaster preparedness) are contributing
to a shortage of both generalist and specialist physicians.
(7) These shortages will have the most severe impact on
vulnerable and underserved populations, including racial/ethnic
minorities and the approximately 20 percent of Americans who
live in rural or inner-city locations designated as health
professional shortage areas.
(8) The AAMC's Health Care Utilization Equity model
estimates that if racial and ethnic minorities and individuals
from rural areas utilized health care in a similar way to their
Caucasian counterparts living in metropolitan areas, the
physician shortage would require an additional 96,000
physicians.
(9) To address the physician shortage, medical education
and training need to be accessible for students and physicians
from all backgrounds. International graduates play an important
role in U.S. health care, representing roughly 25 percent of
the health care workforce. Immigration pathways like student,
exchange-visitor, and employment visas, and programs like the
National Interest Waiver and Conrad 30 J-1 Visa Waiver, help
improve health access across the country.
(10) United States medical schools have committed to and
have initiated a 30 percent increase in enrollment by 2017 to
help reduce the Nation's shortage of quality physicians.
(11) An increase in United States medical school graduates
must be accompanied by an increase of 4,000 graduate medical
education (GME) training positions each year.
(12) Graduate medical education programs and teaching
hospitals provide venues in which the next generation of
physicians learns to work collaboratively with other physicians
and health professionals, adopt more efficient care delivery
models (such as care coordination and medical homes),
incorporate health information technology and electronic health
records in every aspect of their work, apply new methods of
assuring quality and safety, and participate in groundbreaking
clinical and public health research.
(13) The Medicare Program under title XVIII of the Social
Security Act (having more beneficiaries than any other health
care program), supports its ``fair share'' of the costs
associated with graduate medical education (GME).
(14) In general, the level of support of graduate medical
education by the Medicare Program has been capped since 1997
and has not been increased to support the expansion of graduate
medical education programs needed to avert the projected
physician shortage or to accommodate the increase in United
States medical school graduates.
(b) Sense of Congress.--It is the sense of Congress that
eliminating the limit of the number of residency positions that receive
some level of Medicare support under section 1886(h) of the Social
Security Act (42 U.S.C. 1395ww(h)), also referred to as the Medical
graduate medical education cap, is critical to--
(1) ensuring an appropriate supply of physicians to meet
the Nation's health care needs;
(2) facilitating equitable access for all who seek health
care; and
(3) mitigating disparities in health and health care.
SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATIONALLY EDUCATED HEALTH
PROFESSIONALS.
(a) Findings.--Congress finds the following:
(1) According to the Association of Schools of Public
Health, projections indicate a nationwide shortage of up to
250,000 public health workers needed by 2020.
(2) Similar trends are projected for other health
professions indicating shortages across disciplines, including
within the fields of nursing (500,000 by 2025), dentistry
(15,000 by 2025), pharmacy (38,000 by 2030), mental and
behavioral health, primary care (46,000 by 2025), and community
and allied health.
(3) A nationwide health workforce shortage will result in
serious health threats and more severe and costly health care
needs, due to, in part, a delayed response to food-borne
outbreaks, emerging infectious diseases, natural disasters,
fewer cancer screenings, and delayed treatment.
(4) Vulnerable and underserved populations and health
professional shortage areas will be most severely impacted by
the health workforce shortage.
(5) According to the Migration Policy Institute, over
2,000,000 college-educated immigrants in the United States
today are unemployed or underemployed in low- or semi-skilled
jobs that fail to draw on their education and expertise.
(6) Approximately 2 out of every 5 internationally educated
immigrants are unemployed or underemployed.
(7) According to Drexel University Center for Labor Markets
and Policy, underemployment for internationally educated
immigrant women is 28 percent higher than for their male
counterparts.
(8) According to the Drexel University Center for labor
markets and policy, the mean annual earnings of underemployed
immigrants were $32,000, or 43 percent less than United States
born college graduates employed in the college labor market.
(9) According to Upwardly Global and the Welcome Back
Initiative, with proper guidance and support, underemployed
skilled immigrants typically increase their income by 215
percent to 900 percent.
(10) According to the Brookings Institution and the
Partnership for a New American Economy, immigrants working in
the health workforce are, on average, better educated than
United States-born workers in the health workforce.
(b) Grants to Eligible Entities.--
(1) Authority to provide grants.--The Secretary of Health
and Human Services acting through the Bureau of Health
Workforce within the Health Resources and Services
Administration, the National Institute on Minority Health and
Health Disparities, or the Office of Minority Health (in this
section referred to as the ``Secretary'') may award grants to
eligible entities to carry out activities described in
subsection (c).
(2) Eligibility.--To be eligible to receive a grant under
this section, an entity shall--
(A) be a clinical, public health, or health
services organization, a community-based or nonprofit
entity, an academic institution, a faith-based
organization, a State, county, or local government, an
Area Health Education Center, or another entity
determined appropriate by the Secretary; and
(B) submit to the Secretary an application at such
time, in such manner, and containing such information
as the Secretary may require.
(c) Authorized Activities.--A grant awarded under this section
shall be used--
(1) to provide services to assist unemployed and
underemployed skilled immigrants, residing in the United
States, who have legal, permanent work authorization and who
are internationally educated health professionals, enter into
the American health workforce with employment matching their
health professional skills and education, and advance in
employment to positions that better match their health
professional education and expertise;
(2) to provide training opportunities to reduce barriers to
entry and advancement in the health workforce for skilled,
internationally educated immigrants;
(3) to educate employers regarding the abilities and
capacities of internationally educated health professionals;
(4) to assist in the evaluation of foreign credentials;
(5) to support preceptorships for international medical
graduates in hospital primary care training; and
(6) to facilitate access to contextualized and accelerated
courses on English as a second language.
TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY
Subtitle A--Expansion of Coverage
SEC. 401. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
Title XXXIV of the Public Health Service Act, as amended by titles
I, II, III, and IX of this Act, is further amended by inserting after
subtitle C the following:
``Subtitle D--Reconstruction and Improvement Grants for Public Health
Care Facilities Serving Pacific Islanders and the Insular Areas
``SEC. 3451. 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, mentally and physically;
``(C) living effectively with illness or
disability;
``(D) coping with end-of-life issues; and
``(E) shared decisionmaking.
``(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 2019 through 2024.
``SEC. 3452. 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 3451(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 2019 through 2024.
``SEC. 3453. 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 in a culturally competent and sustainable
manner.
``(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,
the Commonwealth of the Northern Mariana Islands, the United States
Virgin Islands, Puerto Rico, or Hawaii that--
``(1) is owned or operated by--
``(A) the Government of American Samoa, Guam, the
Commonwealth of the Northern Mariana Islands, the
United States Virgin Islands, Puerto Rico, or 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, 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;
``(4) include a strategic plan for addressing the needs of
each jurisdiction identified in the report; and
``(5) evaluate the effectiveness of the care provided by
measuring patient outcomes and cost measures.
``(d) Authorization of Appropriations.--There are authorized to be
appropriated such sums as necessary to carry out this section.''.
SEC. 402. REMOVING CITIZENSHIP AND IMMIGRATION BARRIERS TO ACCESS TO
AFFORDABLE HEALTH CARE UNDER ACA.
(a) In General.--
(1) Premium tax credits.--Section 36B of the Internal
Revenue Code of 1986 is amended--
(A) in subsection (c)(1)(B)--
(i) by amending the heading to read as
follows: ``Special rule for certain individuals
ineligible for medicaid due to status'', and
(ii) in clause (ii), by striking ``lawfully
present in the United States, but'' and
inserting ``who'', and
(B) by striking subsection (e).
(2) Cost-sharing reductions.--Section 1402 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071) is amended
by striking subsection (e).
(3) Basic health program eligibility.--Section
1331(e)(1)(B) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18051(e)(1)(B)) is amended by striking ``lawfully
present in the United States''.
(4) Restrictions on federal payments.--Section 1412 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18082) is
amended by striking subsection (d).
(5) Requirement to maintain minimum essential coverage.--
Section 5000A(d) of the Internal Revenue Code of 1986 is
amended by striking paragraph (3) and by redesignating
paragraph (4) as paragraph (3).
(b) Conforming Amendments.--
(1) Section 1411(a) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18081(a)) is amended by striking
paragraph (1) and redesignating paragraphs (2), (3), and (4) as
paragraphs (1), (2), and (3), respectively.
(2) Section 1312(f) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18032(f)) is amended--
(A) in the heading, by striking ``; Access Limited
to Citizens and Lawful Residents''; and
(B) by striking paragraph (3).
SEC. 403. STUDY ON THE UNINSURED.
(a) In General.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall--
(1) conduct a study, in accordance with the standards under
section 3101 of the Public Health Service Act (42 U.S.C.
300kk), on the demographic characteristics of the population of
individuals who do not have health insurance coverage or oral
health coverage; and
(2) predict, based on such study, the demographic
characteristics of the population of individuals who would
remain without health insurance coverage after the end of any
annual open enrollment or any special enrollment period or upon
enactment and implementation of any legislative changes to the
Patient Protection and Affordable Care Act that affect the
number of persons eligible for coverage.
(b) Reporting Requirements.--
(1) In general.--Not later than 12 months after the date of
the enactment of this Act, the Secretary shall submit to the
Congress the results of the study under subsection (a)(1) and
the prediction made under subsection (a)(2).
(2) Reporting of demographic characteristics.--The
Secretary shall--
(A) report the demographic characteristics under
paragraphs (1) and (2) of subsection (a) on the basis
of racial and ethnic group, and shall stratify the
reporting on each racial and ethnic group by other
demographic characteristics that can impact access to
health insurance coverage, such as sexual orientation,
gender identity, primary language, disability status,
sex, socioeconomic status, age group, and citizenship
and immigration status, in a manner consistent with
title I of this Act; and
(B) not use such report to engage in or anticipate
any deportation or immigration related enforcement
action by any entity, including the Department of
Homeland Security.
SEC. 404. MEDICAID IN THE TERRITORIES.
(a) Elimination of General Medicaid Funding Limitations (``cap'')
for Territories.--
(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 ``paragraphs (3) and (5)''; and
(C) by adding at the end the following new
subsection:
``(h) Sunset of Medicaid Funding Limitations for Puerto Rico, the
Virgin Islands of the United States, Guam, the Northern Mariana
Islands, and American Samoa.--Subsections (f) and (g) shall not apply
to Puerto Rico, the Virgin Islands of the United States, Guam, the
Northern Mariana Islands, and American Samoa beginning with fiscal year
2019.''.
(2) Conforming amendments.--
(A) Section 1902(j) of the Social Security Act (42
U.S.C. 1396a(j)) is amended by striking ``, the
limitation in section 1108(f),''.
(B) Section 1903(u) of the Social Security Act (42
U.S.C. 1396b(u)) is amended by striking paragraph (4).
(C) Section 1323(c)(1) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18043(c)(1)) is
amended by striking ``2019'' and inserting ``2018''.
(3) Effective date.--The amendments made by this section
shall apply beginning with fiscal year 2019.
(b) Elimination of Specific Federal Medical Assistance Percentage
(FMAP) Limitation for Territories.--Section 1905(b) of the Social
Security Act (42 U.S.C. 1396d(b)) is amended, in clause (2), by
inserting ``for fiscal years before fiscal year 2019'' after ``American
Samoa''.
(c) Application of Medicaid Waiver Authority to All of the
Territories.--
(1) In general.--Section 1902(j) of the Social Security Act
(42 U.S.C. 1396a(j)) is amended--
(A) by striking ``American Samoa and the Northern
Mariana Islands'' and inserting ``Puerto Rico, the
Virgin Islands of the United States, Guam, the Northern
Mariana Islands, and American Samoa'';
(B) by striking ``American Samoa or the Northern
Mariana Islands'' and inserting ``Puerto Rico, the
Virgin Islands of the United States, Guam, the Northern
Mariana Islands, or American Samoa'';
(C) by inserting ``(1)'' after ``(j)'';
(D) by inserting ``except as otherwise provided in
this subsection,'' after ``Notwithstanding any other
requirement of this title''; and
(E) by adding at the end the following:
``(2) The Secretary may not waive under this subsection the
requirement of subsection (a)(10)(A)(i)(IX) (relating to coverage of
adults formerly under foster care) with respect to any territory.''.
(2) Effective date.--The amendments made by this section
shall apply beginning October 1, 2018.
(d) Permitting Medicaid DSH Allotments for Territories.--Section
1923(f) of the Social Security Act (42 U.S.C. 1396) is amended--
(1) in paragraph (6), by adding at the end the following
new subparagraph:
``(C) Territories.--
``(i) Fiscal year 2019.--For fiscal year
2019, the DSH allotment for Puerto Rico, the
Virgin Islands of the United States, Guam, the
Northern Mariana Islands, and American Samoa
shall bear the same ratio to $150,000,000 as
the ratio of the number of individuals who are
low-income or uninsured and residing in such
respective territory (as estimated from time to
time by the Secretary) bears to the sums of the
number of such individuals residing in all of
the territories.
``(ii) Subsequent fiscal year.--For each
subsequent fiscal year, the DSH allotment for
each such territory is subject to an increase
in accordance with paragraph (2).''; and
(2) in paragraph (9), by inserting before the period at the
end the following: ``, and includes, beginning with fiscal year
2019, Puerto Rico, the Virgin Islands of the United States,
Guam, the Northern Mariana Islands, and American Samoa''.
SEC. 405. 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, 2019'' 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, 2019 (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 section 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
subsection (a), 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 subsection (a)(2).
SEC. 406. 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) musculoskeletal health and obesity;
(E) health education and promotion;
(F) oral health;
(G) mental and behavioral health;
(H) substance abuse;
(I) health conditions that have a high prevalence
in the border area;
(J) medical and health services research;
(K) workforce training and development;
(L) community health workers, patient navigators,
and promotoras;
(M) health care infrastructure problems in the
border area (including planning and construction
grants);
(N) health disparities in the border area;
(O) environmental health; and
(P) 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
2019, and such sums as may be necessary for each succeeding fiscal
year.
SEC. 407. REMOVING MEDICARE BARRIER TO HEALTH CARE.
(a) Part A.--Section 1818(a)(3) of the Social Security Act (42
U.S.C. 1395i-2(a)(3)) is amended by striking ``an alien'' and all that
follows through ``under this section'' and inserting ``an individual
who is lawfully present in the United States''.
(b) Part B.--Section 1836(2) of the Social Security Act (42 U.S.C.
1395o(2)) is amended by striking ``an alien'' and all that follows
through ``under this part'' and inserting ``an individual who is
lawfully present in the United States''.
SEC. 408. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED BY URBAN
INDIAN HEALTH CENTERS.
(a) In General.--The third sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396(b)) is amended by inserting ``or
are received through a program operated by an urban Indian organization
through a grant or contract under title V of such Act'' after ``(as
defined in section 4 of the Indian Health Care Improvement Act)''.
(b) Effective Date.--The amendment made by this section shall apply
to medical assistance provided on or after the date of enactment of
this Act.
SEC. 409. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE PROVIDED TO A NATIVE
HAWAIIAN THROUGH A FEDERALLY QUALIFIED HEALTH CENTER OR A
NATIVE HAWAIIAN HEALTH CARE SYSTEM UNDER THE MEDICAID
PROGRAM.
(a) In General.--The third sentence of section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), as amended by section 418(a),
is amended by inserting before the period the following: ``; and, with
respect to medical assistance provided to a Native Hawaiian (as defined
in section 12(2) of the Native Hawaiian Health Care Improvement Act)
through a federally qualified health center or a Native Hawaiian health
care system (as defined in section 12(6) of such Act), whether
directly, by referral, or under contract or other arrangement between
such federally qualified health center or Native Hawaiian health care
system and another health care provider''.
(b) Effective Date.--The amendment made by this section shall apply
to medical assistance provided on or after the date of enactment of
this Act.
Subtitle B--Expansion of Access
SEC. 410. PROTECTING SENSITIVE LOCATIONS.
Section 287 of the Immigration and Nationality Act (8 U.S.C. 1357)
is amended by adding at the end the following:
``(i)(1) In this subsection:
``(A) The term `appropriate committees of Congress' means--
``(i) the Committee on Homeland Security and
Governmental Affairs of the Senate;
``(ii) the Committee on the Judiciary of the
Senate;
``(iii) the Committee on Homeland Security of the
House of Representatives; and
``(iv) the Committee on the Judiciary of the House
of Representatives.
``(B) The term `enforcement action'--
``(i) means an apprehension, arrest, interview,
request for identification, search, or surveillance for
the purposes of immigration enforcement; and
``(ii) includes an enforcement action at, or
focused on, a sensitive location that is part of a
joint case led by another law enforcement agency.
``(C) The term `exigent circumstances' means a situation
involving--
``(i) the imminent risk of death, violence, or
physical harm to any person or property, including a
situation implicating terrorism or the national
security of the United States;
``(ii) the immediate arrest or pursuit of a
dangerous felon, terrorist suspect, or other individual
presenting an imminent danger; or
``(iii) the imminent risk of destruction of
evidence that is material to an ongoing criminal case.
``(D) The term `prior approval' means--
``(i) in the case of officers and agents of U.S.
Immigration and Customs Enforcement, prior written
approval to carry out an enforcement action involving a
specific individual or individuals authorized by--
``(I) the Assistant Director of Operations,
Homeland Security Investigations;
``(II) the Executive Associate Director of
Homeland Security Investigations;
``(III) the Assistant Director for Field
Operations, Enforcement and Removal Operations;
or
``(IV) the Executive Associate Director for
Field Operations, Enforcement and Removal
Operations;
``(ii) in the case of officers and agents of U.S.
Customs and Border Protection, prior written approval
to carry out an enforcement action involving a specific
individual or individuals authorized by--
``(I) a Chief Patrol Agent;
``(II) the Director of Field Operations;
``(III) the Director of Air and Marine
Operations; or
``(IV) the Internal Affairs Special Agent
in Charge; and
``(iii) in the case of other Federal, State, or
local law enforcement officers, to carry out an
enforcement action involving a specific individual or
individuals authorized by--
``(I) the head of the Federal agency
carrying out the enforcement action; or
``(II) the head of the State or local law
enforcement agency carrying out the enforcement
action.
``(E) The term `sensitive location' includes all of the
physical space located within 1,000 feet of--
``(i) any medical treatment or health care
facility, including any hospital, doctor's office,
accredited health clinic, alcohol or drug treatment
center, or emergent or urgent care facility;
``(ii) any public or private school, including any
known and licensed day care facility, preschool, other
early learning program facility, primary school,
secondary school, postsecondary school (including
colleges and universities), or other institution of
learning (including vocational or trade schools);
``(iii) any scholastic or education-related
activity or event, including field trips and
interscholastic events;
``(iv) any school bus or school bus stop during
periods when school children are present on the bus or
at the stop;
``(v) any organization that--
``(I) assists children, pregnant women,
victims of crime or abuse, or individuals with
significant mental or physical disabilities; or
``(II) provides disaster or emergency
social services and assistance;
``(vi) any church, synagogue, mosque, or other
place of worship, including buildings rented for the
purpose of religious services, retreats, counseling,
workshops, instruction, and education;
``(vii) any Federal, State, or local courthouse,
including the office of an individual's legal counsel
or representative, and a probation, parole, or
supervised release office;
``(viii) the site of a funeral, wedding, or other
religious ceremony or observance;
``(ix) any public demonstration, such as a march,
rally, or parade;
``(x) any domestic violence shelter, rape crisis
center, supervised visitation center, family justice
center, or victim services provider; or
``(xi) any other location specified by the
Secretary of Homeland Security for purposes of this
subsection.
``(2)(A) An enforcement action may not take place at, or be focused
on, a sensitive location unless--
``(i) the action involves exigent circumstances; and
``(ii) prior approval for the enforcement action was
obtained from the appropriate official.
``(B) If an enforcement action is initiated pursuant to
subparagraph (A) and the exigent circumstances permitting the
enforcement action cease, the enforcement action shall be discontinued
until such exigent circumstances reemerge.
``(C) If an enforcement action is carried out in violation of this
subsection--
``(i) no information resulting from the enforcement action
may be entered into the record or received into evidence in a
removal proceeding resulting from the enforcement action; and
``(ii) the alien who is the subject of such removal
proceeding may file a motion for the immediate termination of
the removal proceeding.
``(3)(A) This subsection shall apply to any enforcement action by
officers or agents of the Department of Homeland Security, including--
``(i) officers or agents of U.S. Immigration and Customs
Enforcement;
``(ii) officers or agents of U.S. Customs and Border
Protection; and
``(iii) any individual designated to perform immigration
enforcement functions pursuant to subsection (g).
``(B) While carrying out an enforcement action at a sensitive
location, officers and agents referred to in subparagraph (A) shall
make every effort--
``(i) to limit the time spent at the sensitive location;
``(ii) to limit the enforcement action at the sensitive
location to the person or persons for whom prior approval was
obtained; and
``(iii) to conduct themselves discreetly.
``(C) If, while carrying out an enforcement action that is not
initiated at or focused on a sensitive location, officers or agents are
led to a sensitive location, and no exigent circumstance and prior
approval with respect to the sensitive location exists, such officers
or agents shall--
``(i) cease before taking any further enforcement action;
``(ii) conduct themselves in a discreet manner;
``(iii) maintain surveillance; and
``(iv) immediately consult their supervisor in order to
determine whether such enforcement action should be
discontinued.
``(D) The limitations under this paragraph shall not apply to the
transportation of an individual apprehended at or near a land or sea
border to a hospital or health care provider for the purpose of
providing medical care to such individual.
``(4)(A) Each official specified in subparagraph (B) shall ensure
that the employees under his or her supervision receive annual training
on compliance with--
``(i) the requirements under this subsection in enforcement
actions at or focused on sensitive locations and enforcement
actions that lead officers or agents to a sensitive location;
and
``(ii) the requirements under section 239 of this Act and
section 384 of the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996 (8 U.S.C. 1367).
``(B) The officials specified in this subparagraph are--
``(i) the Chief Counsel of U.S. Immigration and Customs
Enforcement;
``(ii) the Field Office Directors of U.S. Immigration and
Customs Enforcement;
``(iii) each Special Agent in Charge of U.S. Immigration
and Customs Enforcement;
``(iv) each Chief Patrol Agent of U.S. Customs and Border
Protection;
``(v) the Director of Field Operations of U.S. Customs and
Border Protection;
``(vi) the Director of Air and Marine Operations of U.S.
Customs and Border Protection;
``(vii) the Internal Affairs Special Agent in Charge of
U.S. Customs and Border Protection; and
``(viii) the chief law enforcement officer of each State or
local law enforcement agency that enters into a written
agreement with the Department of Homeland Security pursuant to
subsection (g).
``(5) The Secretary of Homeland Security shall modify the Notice to
Appear form (I-862)--
``(A) to provide the subjects of an enforcement action with
information, written in plain language, summarizing the
restrictions against enforcement actions at sensitive locations
set forth in this subsection and the remedies available to the
alien if such action violates such restrictions;
``(B) so that the information described in subparagraph (A)
is accessible to individuals with limited-English proficiency;
and
``(C) so that subjects of an enforcement action are not
permitted to verify that the officers or agents that carried
out such action complied with the restrictions set forth in
this subsection.
``(6)(A) The Director of U.S. Immigration and Customs Enforcement
and the Commissioner of U.S. Customs and Border Protection shall each
submit an annual report to the appropriate committees of Congress that
includes the information set forth in subparagraph (B) with respect to
the respective agency.
``(B) Each report submitted under subparagraph (A) shall include,
with respect to the submitting agency during the reporting period--
``(i) the number of enforcement actions that were carried
out at, or focused on, a sensitive location;
``(ii) the number of enforcement actions in which officers
or agents were subsequently led to a sensitive location; and
``(iii) for each enforcement action described in clause (i)
or (ii)--
``(I) the date on which it occurred;
``(II) the specific site, city, county, and State
in which it occurred;
``(III) the components of the agency involved in
the enforcement action;
``(IV) a description of the enforcement action,
including the nature of the criminal activity of its
intended target;
``(V) the number of individuals, if any, arrested
or taken into custody;
``(VI) the number of collateral arrests, if any,
and the reasons for each such arrest;
``(VII) a certification whether the location
administrator was contacted before, during, or after
the enforcement action; and
``(VIII) the percentage of all of the staff members
and supervisors reporting to the officials listed in
paragraph (4)(B) who completed the training required
under paragraph (4)(A).
``(7) Nothing in the subsection may be construed--
``(A) to affect the authority of Federal, State, or local
law enforcement agencies--
``(i) to enforce generally applicable Federal or
State criminal laws unrelated to immigration; or
``(ii) to protect residents from imminent threats
to public safety; or
``(B) to limit or override the protections provided in--
``(i) section 239; or
``(ii) section 384 of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996 (8
U.S.C. 1367).''.
SEC. 411. GRANTS FOR RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH.
(a) Purpose.--It is the purpose of this section to provide for the
awarding of grants to assist communities in mobilizing and organizing
resources in support of effective and sustainable programs that will
reduce or eliminate disparities in health and health care experienced
by racial and ethnic minority individuals.
(b) Authority To Award Grants.--The Secretary of Health and Human
Services, acting through the Administrator of the Health Resources and
Services Administration, 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 health
care disparities.
(c) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall--
(1) represent a coalition--
(A) whose principal purpose is to develop and
implement interventions to reduce or eliminate a health
or health care disparity in a targeted racial or ethnic
minority group in the community served by the
coalition; and
(B) that includes--
(i) 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
health care providers or organizations
as deemed appropriate by the Secretary;
and
(ii) at least 1 member from a community-
based organization that represents the targeted
racial or ethnic minority group; and
(2) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require, which shall include--
(A) a description of the targeted racial or ethnic
populations in the community to be served under the
grant;
(B) a description of at least 1 health disparity
that exists in the racial or ethnic targeted
populations, including health issues such as infant
mortality, breast and cervical cancer screening and
management, musculoskeletal diseases and obesity,
prostate cancer screening and management,
cardiovascular disease, diabetes, child and adult
immunization levels, oral disease, or other health
priority areas as designated by the Secretary; and
(C) a demonstration of a proven record of
accomplishment of the coalition members in serving and
working with the targeted community.
(d) Sustainability.--The Secretary shall give priority to an
eligible entity under this section if the entity agrees that, with
respect to the costs to be incurred by the entity in carrying out the
activities for which the grant was awarded, the entity (and each of the
participating partners in the coalition represented by the entity) will
maintain its expenditures of non-Federal funds for such activities at a
level that is not less than the level of such expenditures during the
fiscal year immediately preceding the first fiscal year for which the
grant is awarded.
(e) Nonduplication.--Funds provided through this grant program
should supplement, not supplant, existing Federal funding, and the
funds should not be used to duplicate the activities of the other
health disparity grant programs in this Act.
(f) Technical Assistance.--The Secretary may, either directly or by
grant or contract, provide any entity that receives a grant under this
section with technical and other 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) Definition.--In this section, the term ``Secretary'' means the
Secretary of Health and Human Services.
(j) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section.
SEC. 412. 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, 2015.
(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. 413. 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 205(b)(1), is amended by adding at the
end of the following new subsection:
``Rural Community Hospital; Rural Community Hospital Services
``(jjj)(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) Paragraph (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, 2012) 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, 2012.
``(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(jjj)(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:
``(p) 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(jjj)(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(p) 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 ``(p)''; 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)), as amended by section 205(b)(3), 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
(9);
(C) by striking the period at the end of paragraph
(10) and inserting ``; and''; and
(D) by adding at the end the following:
``(11) in the case of outpatient services furnished by a
rural community hospital, the amounts described in section
1834(p).''.
(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
(jjj)(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(p)(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, 2016.
SEC. 414. 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. 415. 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
Healthcare 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 6 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 nonprofit 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 1 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
2019 through 2023.
(2) Availability.--
(A) In general.--Funds appropriated under paragraph
(1) shall remain available for expenditure through
fiscal year 2023.
(B) Report.--For purposes of carrying out
subsection (b)(8), funds appropriated under paragraph
(1) shall remain available for expenditure through
fiscal year 2024.
(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. 416. 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, 2020, 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
2019, and such sums as may be necessary for each of fiscal years 2020
through 2023.''.
SEC. 417. 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.--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 and other mental, dental, and physical
health 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 and other mental,
dental, and physical health services available in that rural
health clinic.
``(2) Enabling services.--To the extent possible, enabling
services such as transportation and language assistance
(including translation and interpretation) shall be provided by
rural health clinics described in paragraph (1).
``(3) Assurances.--In order for a rural health clinic to
receive funds under this section through a contract with a
community health center for the delivery of primary health care
and other services described in paragraph (1), such rural
health clinic shall establish policies to ensure--
``(A) nondiscrimination based upon the ability of a
patient to pay;
``(B) the establishment of a sliding fee scale for
low-income patients; and
``(C) any such services should be subject to full
reimbursement according to the Prospective Payment
System scale.''.
SEC. 418. 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. 419. SCORING OF PREVENTIVE HEALTH SAVINGS.
Section 202 of the Congressional Budget and Impoundment Control Act
of 1974 (2 U.S.C. 602) is amended by adding at the end the following
new subsection:
``(h) Scoring of Preventive Health Savings.--
``(1) Determination by the director.--Upon a request by the
chairman or ranking minority member of the Committee on the
Budget of the Senate, or by the chairman or ranking minority
member of the Committee on the Budget of the House of
Representatives, the Director shall determine if a proposed
measure would result in reductions in budget outlays in
budgetary outyears through the use of preventive health and
preventive health services.
``(2) Projections.--If the Director determines that a
measure would result in substantial reductions in budget
outlays as described in paragraph (1), the Director--
``(A) shall include, in any projection prepared by
the Director, a description and estimate of the
reductions in budget outlays in the budgetary outyears
and a description of the basis for such conclusions;
and
``(B) may prepare a budget projection that includes
some or all of the budgetary outyears, notwithstanding
the time periods for projections described in
subsection (e) and sections 308, 402, and 424.
``(3) Definitions.--As used in this subsection--
``(A) the term `preventive health' means an action
that focuses on the health of the public, individuals,
and defined populations in order to protect, promote,
and maintain health, wellness, and functional ability,
and prevent disease, disability, and premature death
that is demonstrated by credible and publicly available
epidemiological projection models, incorporating
clinical trials or observational studies in humans, to
avoid future health care costs; and
``(B) the term `budgetary outyears' means the 2
consecutive 10-year periods beginning with the first
fiscal year that is 10 years after the budget year
provided for in the most recently agreed to concurrent
resolution on the budget.''.
SEC. 420. SENSE OF CONGRESS ON MAINTENANCE OF EFFORT PROVISIONS
REGARDING CHILDREN'S HEALTH.
It is the sense of the Congress that--
(1) the maintenance of effort provisions added to sections
1902 and 2105(d) of the Social Security Act by sections 2001(b)
and 2101(b) of the Patient Protection and Affordable Care Act
were written to maintain the eligibility standards for the
Medicaid program under title XIX of the Social Security Act and
Children's Health Insurance Program under title XXI of such Act
until the American Health Benefit Exchanges in the States are
fully operational;
(2) it is imperative that the maintenance of effort
provisions are enforced to the strict standard intended by the
Congress through September 30, 2022;
(3) waiving the maintenance of effort provisions should not
be permitted, except in the case of a request for a waiver that
meets the explicit nonapplication requirements;
(4) the maintenance of effort provisions ensure the
continued success of the Medicaid program and Children's Health
Insurance Program and were written deliberately to specifically
protect vulnerable and disabled individuals, children, and
senior citizens, many of whom are also members of communities
of color; and
(5) the maintenance of effort provisions must be strictly
enforced and proposals to weaken the maintenance of effort
provisions must not be considered.
SEC. 421. REPEAL OF REQUIREMENT FOR DOCUMENTATION EVIDENCING
CITIZENSHIP OR NATIONALITY UNDER THE MEDICAID PROGRAM.
(a) Repeal.--Subsections (i)(22) and (x) of section 1903 of the
Social Security Act (42 U.S.C. 1396b) are each repealed.
(b) Conforming Amendments.--
(1) Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(A) by amending paragraph (46) of subsection (a) to
read as follows:
``(46) provide that information is requested and exchanged
for purposes of income and eligibility verification in
accordance with a State system which meets the requirements of
section 1137 of this Act;'';
(B) in subsection (e)(13)(A)(i)--
(i) in the matter preceding subclause (I),
by striking ``sections 1902(a)(46)(B) and
1137(d)'' and inserting ``section 1137(d)'';
and
(ii) in subclause (IV), by striking
``1902(a)(46)(B) or''; and
(C) by striking subsection (ee).
(2) Section 1903 of the Social Security Act (42 U.S.C.
1396b) is amended--
(A) in subsection (i), by redesignating paragraphs
(23) through (26) as paragraphs (22) through (25),
respectively; and
(B) by redesignating subsections (y) and (z) as
subsections (x) and (y), respectively.
(3) Subsection (c) of section 6036 of the Deficit Reduction
Act of 2005 (42 U.S.C. 1396b note) is repealed.
(c) Effective Date.--The repeals and amendments made by this
section shall take effect as if included in the enactment of the
Deficit Reduction Act of 2005.
SEC. 422. PROTECTION OF THE HHS OFFICES OF MINORITY HEALTH.
(a) In General.--Pursuant to the Patient Protection and Affordable
Care Act (Public Law 111-148), the Offices of Minority Health
established within the Centers for Disease Control and Prevention, the
Health Resources and Services Administration, the Substance Abuse and
Mental Health Services Administration, the Agency for Healthcare
Research and Quality, the Food and Drug Administration, and the Centers
for Medicare & Medicaid Services, are offices that, regardless of
change in the structure of the Department of Health and Human Services,
shall report to the Secretary of Health and Human Services.
(b) Sense of Congress.--It is the sense of the Congress that any
effort to eliminate or consolidate such Offices of Minority Health
undermines the progress achieved so far.
SEC. 423. OFFICE OF MINORITY HEALTH IN VETERANS HEALTH ADMINISTRATION
OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Establishment and Functions.--Subchapter I of chapter 73 of
title 38, United States Code, is amended by adding at the end the
following new section:
``Sec. 7310. Office of Minority Health
``(a) Establishment.--There is established in the Department within
the Office of the Under Secretary for Health an office to be known as
the `Office of Minority Health' (in this section referred to as the
`Office').
``(b) Head.--The Director of the Office of Minority Health shall be
the head of the Office. The Director of the Office of Minority Health
shall be appointed by the Under Secretary of Health from among
individuals qualified to perform the duties of the position.
``(c) Functions.--The functions of the Office are as follows:
``(1) To establish short-range and long-range goals and
objectives and coordinate all other activities within the
Veterans Health Administration that relate to disease
prevention, health promotion, health care services delivery,
and health care research concerning veterans who are members of
a racial or ethnic minority group.
``(2) To support research, demonstrations, and evaluations
to test new and innovative models for the discharge of
activities described in paragraph (1).
``(3) To increase knowledge and understanding of health
risk factors for veterans who are members of a racial or ethnic
minority group.
``(4) To develop mechanisms that support better health care
information dissemination, education, prevention, and services
delivery to veterans from disadvantaged backgrounds, including
veterans who are members of a racial or ethnic minority group.
``(5) To enter into contracts or agreements with
appropriate public and nonprofit private entities to develop
and carry out programs to provide bilingual or interpretive
services to assist veterans who are members of a racial or
ethnic minority group and who lack proficiency in speaking the
English language in accessing and receiving health care
services through the Veterans Health Administration.
``(6) To carry out programs to improve access to health
care services through the Veterans Health Administration for
veterans with limited proficiency in speaking the English
language, including the development and evaluation of
demonstration and pilot projects for that purpose.
``(7) To advise the Under Secretary of Health on matters
relating to the development, implementation, and evaluation of
health professions education in decreasing disparities in
health care outcomes between veterans who are members of a
racial or ethnic minority group and other veterans, including
cultural competency as a method of eliminating such health
disparities.
``(8) To perform such other functions and duties as the
Secretary or the Under Secretary for Health considers
appropriate.
``(d) Definitions.--In this section:
``(1) The term `racial or ethnic minority group' means any
of the following:
``(A) American Indians (including Alaska Natives,
Eskimos, and Aleuts).
``(B) Asian Americans.
``(C) Native Hawaiians and other Pacific Islanders.
``(D) Blacks.
``(E) Hispanics.
``(2) The term `Hispanic' means individuals whose origin is
Mexican, Puerto Rican, Cuban, Central or South American, or any
other Spanish-speaking country.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
7309A the following new item:
``7310. Office of Minority Health.''.
SEC. 424. INDIAN DEFINED IN PPACA.
(a) Definition of Indian.--Section 1304 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the
end the following:
``(f) Indian.--
``(1) In general.--In this title, the term `Indian' means
any individual--
``(A) described in paragraph (13) or (28) of
section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603);
``(B) who is eligible for health services provided
by the Indian Health Service under section 809 of the
Indian Health Care Improvement Act (25 U.S.C. 1679);
``(C) who is of Indian descent and belongs to the
Indian community served by the local facilities and
program of the Indian Health Service; or
``(D) who is described in paragraph (2).
``(2) Included individuals.--The following individuals
shall be considered to be an `Indian':
``(A) A member of a federally recognized Indian
Tribe.
``(B) A resident of an urban center who meets 1 or
more of the following 4 criteria:
``(i) Membership in a Tribe, band, or other
organized group of Indians, including those
Tribes, bands, or groups terminated since 1940
and those recognized as of the date of
enactment of the Health Equity and
Accountability Act of 2018 or later by the
State in which they reside, or being a
descendant, in the first or second degree, of
any such member.
``(ii) Is an Eskimo or Aleut or other
Alaska Native.
``(iii) Is considered by the Secretary of
the Interior to be an Indian for any purpose.
``(iv) Is determined to be an Indian under
regulations promulgated by the Secretary.
``(C) An individual who is considered by the
Secretary of the Interior to be an Indian for any
purpose.
``(D) An individual who is considered by the
Secretary to be an Indian for purposes of eligibility
for Indian health care services, including as a
California Indian, Eskimo, Aleut, or other Alaska
Native.''.
(b) Conforming Amendments.--
(1) Affordable choices health benefit plans.--Section
1311(c)(6)(D) of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031(c)(6)(D)) is amended by striking ``section 4
of the Indian Health Care Improvement Act'' and inserting
``section 1304(f)''.
(2) Reduced cost-sharing for individuals enrolling in
qualified health plans.--Section 1402(d) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18071(d)) is
amended--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by striking ``section 4(d) of the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450b(d))'' and inserting ``section
1304(f)''; and
(B) in paragraph (2), in the matter preceding
subparagraph (A), by striking ``(as so defined)'' and
inserting ``(as defined in section 1304(f))''.
(3) Exemption from penalty for not maintaining minimum
essential coverage.--Section 5000A(e) of the Internal Revenue
Code of 1986 is amended by striking paragraph (3) and inserting
the following:
``(3) Indians.--Any applicable individual who is an Indian
(as defined in section 1304(f) of the Patient Protection and
Affordable Care Act).''.
SEC. 425. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL ACCESS FOR LOW-
INCOME PATIENTS.
(a) In General.--Not later than January 1, 2019, the Comptroller
General of the United States shall conduct a study on how certain
amendments made by the Patient Protection and Affordable Care Act
(Public Law 111-148) to titles XVIII and XIX of the Social Security Act
affect the timely access to health care services for low-income
patients. Such study shall--
(1) evaluate and examine whether States electing to make
medical assistance available under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(i)(VIII)) (including States making such an
election through a waiver of the State plan) to individuals
described in such section mitigates the need for payments to
disproportionate share hospitals under section 1886(d)(5)(F) of
the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
1923 of such Act (42 U.S.C. 1396r-4), including the impact of
such States electing to make medical assistance available to
such individuals on--
(A) the number of individuals in the United States
who are without health insurance and the distribution
of such individuals in relation to areas primarily
served by disproportionate share hospitals; and
(B) the low-income utilization rate of such
hospitals and the resulting fiscal sustainability of
such hospitals;
(2) evaluate the appropriate level and distribution of such
payments among disproportionate hospitals for purposes of--
(A) sufficiently accounting for the level of
uncompensated care provided by such hospitals to low-
income patients; and
(B) providing timely access to health services for
individuals in medically underserved areas; and
(3) assess, with respect to disproportionate hospitals--
(A) the role played by such hospitals in providing
critical access to emergency, inpatient, and outpatient
health services, as well as the location of such
hospitals in relation to medically underserved areas;
and
(B) the extent to which such hospitals satisfy the
requirements established for charitable hospital
organizations under section 501(r) of the Internal
Revenue Code of 1986 with respect to community health
needs assessments, financial assistance policy
requirements, limitations on charges, and billing and
collection requirements.
(b) Reports.--
(1) Report to congress.--Not later than 180 days after the
date on which the study under subsection (a) is completed, the
Comptroller General of the United States shall submit to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate a report that contains--
(A) the results of the study;
(B) recommendations to Congress for any legislative
changes to the payments to disproportionate share
hospitals under section 1886(d)(5)(F) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section
1923 of such Act (42 U.S.C. 1396r-4) that are needed to
ensure access to health services for low-income
patients that--
(i) are based on the number of individuals
without health insurance, the amount of
uncompensated care provided by such hospitals,
and the impact of reduced payments levels on
low-income communities; and
(ii) takes into account any reports
submitted by the Secretary of the Treasury, in
consultation with the Secretary of Health and
Human Services, to Congressional committees
regarding the costs incurred by charitable
hospital organizations for charity care, bad
debt, nonreimbursed expenses for services
provided to individuals under the Medicare
Program under title XVIII of the Social
Security Act and the Medicaid Program under
title XIX of such Act, and any community
benefit activities provided by such
organizations.
(2) Report to the secretary of health and human services.--
Not later than 180 days after the date on which the study under
subsection (a) is completed, the Comptroller General of the
United States shall submit to the Secretary of Health and Human
Services a report that contains--
(A) the results of the study; and
(B) any recommendations for purposes of assisting
in the development of the methodology for the
adjustment of payments to disproportionate share
hospitals, as required under section 1886(r) of the
Social Security Act (42 U.S.C. 1395ww(r)) and the
reduction of such payments section 1923(f)(7) of such
Act (42 U.S.C. 1396r-4(f)(7)), taking into account the
reports referred to in paragraph (1)(B)(ii).
SEC. 426. ASSISTANT SECRETARY OF THE INDIAN HEALTH SERVICE.
(a) References.--Any reference in a law, regulation, document,
paper, or other record of the United States to the Director of the
Indian Health Service shall be deemed to be a reference to the
Assistant Secretary of the Indian Health Service.
(b) Executive Schedule.--Section 5315 of title 5, United States
Code, is amended in the matter relating to the Assistant Secretaries of
Health and Human Services by striking ``(6)'' and inserting ``(7), 1 of
whom shall be the Assistant Secretary of the Indian Health Service''.
(c) Conforming Amendment.--Section 5316 of title 5, United States
Code, is amended by striking ``Director, Indian Health Service,
Department of Health and Human Services.''.
SEC. 427. REAUTHORIZATION OF THE NATIVE HAWAIIAN HEALTH CARE
IMPROVEMENT ACT.
(a) Native Hawaiian Health Care Systems.--Section 6(h)(1) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
(b) Administrative Grant for Papa Ola Lokahi.--Section 7(b) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
(c) Native Hawaiian Health Scholarships.--Section 10(c) of the
Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is
amended by striking ``may be necessary for fiscal years 1993 through
2019'' and inserting ``are necessary''.
SEC. 428. AVAILABILITY OF NON-ENGLISH LANGUAGE SPEAKING PROVIDERS.
(a) In General.--Section 1311(c)(1)(B) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)) is amended by
inserting before the semicolon the following: ``and, with respect to
such providers, a provider's ability to provide care in a language
other than English either through the provider speaking such language
or by the provider having a trained medical interpreter, as defined in
subsection (b) of this section, who speaks such language available
during office hours''.
(b) Qualified Interpreter for an Individual With Limited-English
Proficiency, Defined.--The term ``Qualified interpreter for an
individual with limited-English proficiency'' means an interpreter who
via a remote interpreting service or an on-site appearance--
(1) adheres to generally accepted interpreter ethics
principles, including client confidentiality;
(2) has demonstrated proficiency in speaking and
understanding both spoken English and at least one other spoken
language; and
(3) is able to interpret effectively, accurately, and
impartially, both receptively and expressly, to and from such
language(s) and English, using any necessary specialized
vocabulary, terminology and phraseology.
(c) Effective Date.--The amendment made by subsection (a) shall
apply for plan years beginning more than 1 year after the date of the
enactment of this Act.
SEC. 429. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS.
(a) Essential Community Providers.--Section 1311(c)(1)(C) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(1)(C))
is amended--
(1) by inserting ``(i)'' after ``(C)''; and
(2) by adding at the end the following new clauses:
``(ii) not later than 2018, increase the percentage
of essential community providers included in its
network by 10 percent annually (based on the level in
the plan for 2016) until 90 percent of all federally
qualified health centers and 75 percent of all other
essential community providers in the contract service
area are in-network; and
``(iii) include one of each type of essential
community provider in network in each county in their
service area, where available;''.
(b) Reporting Requirements.--Section 1311(e)(3) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)(A)) is
amended by adding at the end the following new subparagraph:
``(E) Data on essential community providers.--The
Secretary shall require qualified health plans to
submit annually to the Secretary data on the percentage
of essential community providers, by county, that
contract with each qualified health plan offered in
that county and the percentage of essential community
providers, by type, that contract with each qualified
health plan offered in that county. Data so submitted
shall be made available to the general public''.
(c) Essential Community Provider Provisions Applied Under Medicare
and Medicaid.--
(1) Medicare.--Section 1852(d)(1) of the Social Security
Act (42 U.S.C.1395w-22(d)(1)) is amended--
(A) by striking ``and'' at the end of subparagraph
(D);
(B) by striking the period at the end of
subparagraph (E) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(F) the plan meets the requirements of clauses
(ii) and (iii) of section 1311(c)(1)(C) of the Patient
Protection and Affordable Care Act (relating to
inclusion in networks of essential community
providers).''.
(2) Medicaid.--Section 1932(b)(5) of the Social Security
Act (42 U.S.C. 1396u-2(b)(5)) is amended--
(A) by striking ``and'' at the end of subparagraph
(A);
(B) by striking the period at the end of
subparagraph (B) and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(C) the plan meets the requirements of clauses
(ii) and (iii) of section 1311(c)(1)(C) of the Patient
Protection and Affordable Care Act (relating to
inclusion in networks of essential community providers)
with respect to services offered in the service area
involved.''.
SEC. 430. PROVIDER NETWORK ADEQUACY IN COMMUNITIES OF COLOR.
(a) In General.--Section 1311(c)(1)(B) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18031(c)(1)(B)) is amended--
(1) by inserting ``(i)'' after ``(B)''; and
(2) by adding at the end the following the following new
clauses:
``(ii) meet such network adequacy standards
as the Secretary may establish with regard to--
``(I) appointment wait time;
``(II) travel time and distance to
health care provider facilities and
providers by public and private
transit;
``(III) hours of operation to
accommodate individuals who cannot come
to provider appointments during
standard business hours; and
``(IV) other network adequacy
standards to ensure that care through
these plans is accessible to diverse
communities, including those who are
limited-English proficient; and
``(iii) provide coverage for services for
enrollees through out-of-network providers at
no additional cost to the enrollees in cases
where in-network providers are unable to comply
with the standards established under clause
subclause (III) or (IV) of clause (ii) for such
services and the out-of-network providers can
deliver such services in compliance with such
standards.
``(b) Effective Date.--The amendments made by subsection (a) shall
apply to plan years beginning more than 1 year after the date of the
enactment of this Act.''.
SEC. 431. IMPROVING ACCESS TO DENTAL CARE.
(a) Reports to Congress.--
(1) GAO report on dental therapist programs.--Not later
than 1 year after the date of the enactment of this Act, the
Comptroller General of the United States shall submit to
Congress a report on the Alaska Dental Health Aide Therapists
Program and the Dental Therapist and Advanced Dental Therapist
programs in Minnesota, to assess dental therapists'
effectiveness in--
(A) improving access to timely dental care among
communities of color;
(B) providing high quality care; and
(C) providing culturally competent care.
(2) GAO report of expanding scope of certain practices.--
The GAO shall also report on state variations in use of dental
hygienists and assess the effectiveness of expanding the scope
of practice for hygienists in--
(A) improving access to timely dental care among
communities of color;
(B) providing high quality care; and
(C) providing culturally competent care.
(3) HRSA report on dental shortage areas.--Not later than 1
year after the date of the enactment of this Act, the
Secretary, acting through the Administrator of the Health
Resources Service Administration, shall submit to Congress a
report which details geographic dental access shortages and the
preparedness of dental providers to offer culturally and
linguistically appropriate, affordable, accessible, and timely
services.
(b) Expansion of Dental Health Aid Therapists in Tribal
Communities.--Section 119(d) of the Indian Health Care Improvement Act
( U.S.C. 1616l(d)) is amended--
(1) in paragraph (2), by striking ``Subject to'' and all
that follows and inserting ``Subject to paragraph (3), in
establishing a national program under paragraph (1), the
Secretary shall not reduce the amounts provided for the
Community Health Aide Program described in subsections (a) and
(b).'';
(2) by striking paragraph (3); and
(3) by redesignating paragraph (4) as paragraph (3).
(c) Coverage of Dental Services Under the Medicare Program.--
(1) Coverage.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (EE), by striking ``and'' after
the semicolon at the end;
(B) in subparagraph (FF), by adding ``and'' after
the semicolon at the end; and
(C) by adding at the end the following new
subparagraph:
``(GG) oral health services (as defined in
subsection (kkk);''.
(2) Oral health services defined.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x), as amended by sections
205(b) and 433(a), is amended by adding at the end the
following new subsection:
``Oral Health Services
``(kkk)(1) The term `oral health services' means services (as
defined by the Secretary) that are necessary to prevent disease and
promote oral health, restore oral structures to health and function,
and treat emergency conditions.
``(2) For purposes of paragraph (1), such term shall include mobile
and portable oral health services (as defined by the Secretary) that--
``(A) are provided for the purpose of overcoming mobility,
transportation, and access barriers for individuals; and
``(B) satisfy the standards and certification requirements
established under section 1902(a)(82)(B) for the State in which
the services are provided.''.
(3) Payment and coinsurance.--Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(Z)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (AA) with respect to oral health
services (as defined in section 1861(kkk)), the amount
paid shall be (i) in the case of such services that are
preventive, 100 percent of the lesser of the actual
charge for the services or the amount determined under
the payment basis determined under section 1848, and
(ii) in the case of all other such services, 80 percent
of the lesser of the actual charge for the services or
the amount determined under the payment basis
determined under section 1848''.
(4) Payment under physician fee schedule.--Section
1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3))
is amended by inserting ``(2)(GG),'' after ``risk
assessment),''.
(5) Dentures.--Section 1861(s)(8) of the Social Security
Act (42 U.S.C. 1395x(s)(8)) is amended--
(A) by striking ``(other than dental)'' and
inserting ``(including dentures)''; and
(B) by striking ``internal body''.
(6) Repeal of ground for exclusion.--Section 1862(a) of the
Social Security Act (42 U.S.C. 1395y) is amended by striking
paragraph (12).
(7) Effective date.--The amendments made by this section
shall apply to services furnished on or after January 1, 2019.
(d) Coverage of Dental Services Under the Medicaid Program.--
(1) In general.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended--
(A) in subsection (a)(10), by striking ``dental
services'' and inserting ``oral health services (as
defined in subsection (ee)(1))''; and
(B) by adding at the end the following new
subsection:
``(ee)(1) Subject to paragraphs (2) and (3), for purposes of this
title, the term `oral health services' means services (as defined by
the Secretary) that are necessary to prevent disease and promote oral
health, restore oral structures to health and function, and treat
emergency conditions. These services shall include, in the case of
pregnant or postpartum women, such services as are necessary to address
oral health conditions that exist or are exacerbated by pregnancy or
childbirth or which, if left untreated, could adversely affect fetal or
child development.
``(2) For purposes of paragraph (1), such term shall include--
``(A) dentures; and
``(B) mobile and portable oral health services (as defined
by the Secretary) that--
``(i) are provided for the purpose of overcoming
mobility, transportation, and access barriers for
individuals; and
``(ii) satisfy the standards and certification
requirements established under section 1902(a)(82)(C)
for the State in which the services are provided.
``(3) For purposes of paragraph (1), such term shall not apply to
dental care or services provided to individuals under the age of 21
under subsection (r)(3).''.
(2) Conforming amendments.--
(A) State plan requirements.--Section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)) is
amended--
(i) in paragraph (10)(A), in the matter
preceding clause (i), by inserting ``(10),''
after ``(5),'';
(ii) in paragraph (80), by striking ``and''
at the end;
(iii) in paragraph (81), by striking the
period at the end and inserting ``; and''; and
(iv) by inserting after paragraph (81) the
following:
``(82) provide for--
``(A) informing, in writing, all individuals who
have been determined to be eligible for medical
assistance of the availability of oral health services
(as defined in section 1905(ee));
``(B) conducting targeted outreach to pregnant
women who have been determined to be eligible for
medical assistance about the availability of medical
assistance for such dental services and the importance
of receiving dental care while pregnant; and
``(C) establishing and maintaining standards for
and certification of mobile and portable oral health
services (as described in subsections (r)(3)(C) and
(ee)(2)(B) of section 1905).''.
(B) Definition of medical assistance.--Section
1905(a)(12) of the Social Security Act (42 U.S.C.
1396d(a)(12)) is amended by striking ``, dentures,''.
(3) Mobile and portable oral health services under epsdt.--
Section 1905(r)(3) of the Social Security Act (42 U.S.C.
1396d(r)(3)) is amended--
(A) in subparagraph (A)(ii), by striking ``; and''
and inserting a semicolon;
(B) in subparagraph (B), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(C) which shall include mobile and portable oral
health services (as defined by the Secretary) that--
``(i) are provided for the purpose of
overcoming mobility, transportation, or access
barriers for children; and
``(ii) satisfy the standards and
certification requirements established under
section 1902(a)(82)(C) for the State in which
the services are provided.''.
(e) Oral Health Services as an Essential Health Benefit.--Section
1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C.
18022(b)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (J), by striking ``oral and'';
and
(B) by adding at the end the following:
``(K) Oral health services for children and
adults.''; and
(2) by adding at the end the following:
``(6) Oral health services.--For purposes of paragraph
(1)(K), the term `oral health services' means services (as
defined by the Secretary), that are necessary to prevent
disease and promote oral health, restore oral structures to
health and function, and treat emergency conditions.''.
(f) Demonstration Program on Training and Employment of Alternative
Dental Health Care Providers for Dental Health Care Services for
Veterans in Rural and Other Underserved Communities.--
(1) Demonstration program authorized.--The Secretary of
Veterans Affairs may carry out a demonstration program to
establish programs to train and employ alternative dental
health care providers in order to increase access to dental
health care services for veterans who are entitled to such
services from the Department of Veterans Affairs and reside in
rural and other underserved communities.
(2) Telehealth.--For purposes of alternative dental health
care providers and other dental care providers who are licensed
to provide clinical care, dental services provided under the
demonstration program under this section may be administered by
such providers through telehealth-enabled collaboration and
supervision when appropriate and feasible.
(3) Alternative dental health care providers defined.--In
this section, the term ``alternative dental health care
providers'' has the meaning given that term in section 340G-
1(a)(2) of the Public Health Service Act (42 U.S.C. 256g-
1(a)(2)).
(4) Authorization of appropriations.--There are authorized
to be appropriated such sums as are necessary to carry out the
demonstration program under this subsection.
(g) Demonstration Program on Training and Employment of Alternative
Dental Health Care Providers for Dental Health Care Services for
Members of the Armed Forces and Dependents Lacking Ready Access to Such
Services.--
(1) Demonstration program authorized.--The Secretary of
Defense may carry out a demonstration program to establish
programs to train and employ alternative dental health care
providers in order to increase access to dental health care
services for members of the Armed Forces and their dependents
who lack ready access to such services, including the
following:
(A) Members and dependents who reside in rural
areas or areas otherwise underserved by dental health
care providers.
(B) Members of the National Guard and Reserves in
active status who are potentially deployable.
(2) Telehealth.--For purposes of alternative dental health
care providers and other dental care providers who are licensed
to provide clinical care, dental services provided under the
demonstration program under this section may be administered by
such providers through telehealth-enabled collaboration and
supervision when appropriate and feasible.
(3) Alternative dental health care providers defined.--In
this section, the term ``alternative dental health care
providers'' has the meaning given that term in section 340G-
1(a)(2) of the Public Health Service Act (42 U.S.C. 256g-
1(a)(2)).
(4) Authorization of appropriations.--There are authorized
to be appropriated such sums as are necessary to carry out the
demonstration program under this subsection.
(h) Demonstration Program on Training and Employment of Alternative
Dental Health Care Providers for Dental Health Care Services for
Prisoners Within the Custody of the Bureau of Prisons.--
(1) Demonstration program authorized.--The Attorney
General, acting through the Director of the Bureau of Prisons,
may carry out a demonstration program to establish programs to
train and employ alternative dental health care providers in
order to increase access to dental health services for
prisoners within the custody of the Bureau of Prisons.
(2) Telehealth.--For purposes of alternative dental health
care providers and any other dental care providers who are
licensed to provide clinical care, dental services provided
under the demonstration program under this section may be
administered by such providers through telehealth-enabled
collaboration and supervision when deemed appropriate and
feasible.
(3) Alternative dental health care providers defined.--In
this section, the term ``alternative dental health care
providers'' has the meaning given that term in section 340G-
1(a)(2) of the Public Health Service Act (42 U.S.C. 256g-
1(a)(2)).
(4) Authorization of appropriations.--There are authorized
to be appropriated such sums as are necessary to carry out the
demonstration program under this subsection.
(i) Demonstration Program on Training and Employment of Alternative
Dental Health Care Providers for Dental Health Care Services Under the
Indian Health Service.--
(1) Demonstration program authorized.--The Secretary of
Health and Human Services, acting through the Indian Health
Service, may carry out a demonstration program to establish
programs to train and employ alternative dental health care
providers in order to help eliminate oral health disparities
and increase access to dental services through health programs
operated by the Indian Health Service, Indian Tribes, Tribal
organizations, and urban Indian organizations (as those terms
are defined in section 4 of the Indian Health Care Improvement
Act (25 U.S.C. 1603)).
(2) Telehealth.--For purposes of alternative dental health
care providers and any other dental care providers who are
licensed to provide clinical care, dental services provided
under the demonstration program under this section may be
administered by such providers through telehealth-enabled
collaboration and supervision when deemed appropriate and
feasible.
(3) Alternative dental health care providers defined.--In
this section, the term ``alternative dental health care
providers'' has the meaning given that term in section 340G-
1(a)(2) of the Public Health Service Act (42 U.S.C. 256g-
1(a)(2)).
(4) Authorization of appropriations.--There are authorized
to be appropriated such sums as are necessary to carry out the
demonstration program under this subsection.
Subtitle C--Advancing Health Equity Through Payment and Delivery Reform
SEC. 441. SENSE OF CONGRESS.
It is the Sense of Congress that the sustainability of the U.S.
health care system hinges on restructuring how health care is paid for,
shifting away from paying for the volume of services provided to the
value the services provide. High value care is care that provides
higher quality care more efficiently, achieving greater health
improvement and better health outcomes at lower cost (per patient and
overall). A high value health care system must deliver timely,
accessible, well-coordinated, high quality, culturally centered, and
language appropriate care to everyone. Therefore, eliminating health
disparities and achieving health equity must be central to efforts to
achieve a high value health care system. This will require tailored
interventions and targeted investments to address inequities in health
and health care to make sure that health care delivery and payment
efforts are responsive to and inclusive of the needs of communities of
color and other communities experiencing disparities. New models of
value-based payment and care delivery should consider the holistic
needs of the patient population, including social determinants of
health and behavioral health needs.
SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES QUALITY PAYMENT
PROGRAM.
(a) In General.--The Centers for Medicare & Medicaid Services
Quality Payment Program, developed through implementation of the
Medicare Access and CHIP Reauthorization Act of 2015, should explicitly
integrate ``achieving health equity'' across all measures and
activities, including the Merit-based Payment Incentive System and
Alternative Payment Models. In addition, CMS should identify limited-
English proficient (LEP) persons as a specific underserved group within
the program and give high weight to providing language services for
non-English speakers. Clinicians can demonstrate performance in this
category by developing language assistance plans, providing oral
interpretation services, and providing translated documents for the
population served or eligible to be served.
(b) Stratified Data.--CMS should include an explicit reference that
data stratification and reporting is one way of working to achieve
health equity. CMS should require that in reporting this measure,
clinicians should stratify clinical quality measures by disparity
variables, including race, ethnicity, preferred language, disability
status, sexual orientation, and gender identity, psychological and
behavioral status. Clinicians can use existing demographic data
collection fields in CEHRT to do this. Stratified data can help
clinicians identify and distinguish efforts to improve quality from
efforts to reduce disparities, which may not correlate without
dedicated work. All participating entities in the Quality Payment
Program should adopt 2015 Certified Electronic Health Records
Technology as a condition of participating in the program.
(c) Quality Improvement Activities.--Further, CMS, upon yearly
review of the Quality Payment Program, should add quality improvement
activities that implement the Culturally and Linguistically Accessible
Standards (CLAS) standards as Improvement Activities.
SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY REDUCING DELIVERY AND
PAYMENT MODELS.
(a) In General.--The Center for Medicaid and Medicare Innovation
(CMMI) will establish a dedicated fund to identify, pilot, evaluate and
scale delivery and payment models that target health disparities among
racial and ethnic minorities, including models that support high-value
non-medical services that address socially-determined barriers to
health including: English proficiency, health literacy, case
management, transportation and enrollment assistance which will help to
reduce disparities and impact the overall cost of care.
(b) Pilot Programs.--Pilot and demonstration programs that include
partnerships with entities including community based organizations or
other non-profit entities to help address socially determined barriers
to health and health care will be given priority.
(c) Alternatives.--Require all CMMI funded alternative delivery and
payment models to include measures to assess and track their impact on
health disparities, using existing measures such as, but not limited
to, the National Quality Forum Healthcare Disparities and Cultural
Competency Measures, and stratified by race, ethnicity, English
proficiency, gender identity, sexual orientation, and disability
status.
SEC. 444. SUPPORTING SAFETY NET AND COMMUNITY-BASED PROVIDERS TO
COMPETE IN VALUE-BASED PAYMENT SYSTEMS.
(a) In General.--All proposed pay for performance and alternative
payment models, developed and tested by CMMI, or any other HHS agency
should be assessed for potential impact on safety net, community based,
and critical access providers, including federally qualified health
centers.
(b) New Models.--The rollout of new payment models should include
training and additional up front resources for community based and
safety net providers to enable them to participate in them.
Subtitle D--Health Empowerment Zones
SEC. 451. SHORT TITLE.
This subtitle may be cited as the ``Health Empowerment Zone Act of
2018''.
SEC. 452. FINDINGS.
The Congress finds the following:
(1) Numerous studies and reports, including the 2015
National Healthcare Disparities Report of the Administration on
Healthcare Research and Quality and the 2002 Unequal Treatment
Report of the Institute of Medicine, 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, musculoskeletal
disease, obesity, 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 and health literacy,
employment, race, ethnicity, immigration status, 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 are 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,
including national and regional intermediaries with
demonstrated capacity to serve low-income urban communities--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. 453. 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 members of the target community, State and
local governments, nonprofit organizations including
national and regional intermediaries with demonstrated
capacity to serve low-income urban communities, 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 affordable, high-quality health
services.
(B) The prevalence of disproportionate rates of
certain illnesses or diseases including the following:
(i) Arthritis, osteoporosis, chronic back
conditions, and other musculoskeletal diseases.
(ii) Cancer.
(iii) Chronic kidney disease.
(iv) Diabetes.
(v) Injury (intentional and unintentional).
(vi) Violence (intimate and nonintimate).
(vii) Maternal and paternal illnesses and
diseases.
(viii) Infant mortality.
(ix) Mental illness and other disabilities.
(x) Substance abuse treatment and
prevention, including underage drinking.
(xi) Nutrition, obesity, and overweight
conditions.
(xii) Heart disease.
(xiii) Hypertension.
(xiv) Cerebrovascular disease or stroke.
(xv) Tuberculosis.
(xvi) HIV/AIDS and other sexually
transmitted infections.
(xvii) Viral hepatitis.
(xviii) Asthma.
(xix) Tooth decay and other oral health
issues.
(C) Within the target community, the historical and
persistent presence of conditions that have been found
to contribute to health disparities including any such
conditions respecting the following:
(i) Poverty.
(ii) Educational status and the quality of
community schools.
(iii) Income.
(iv) Access to high-quality affordable
health care.
(v) Work and work environment.
(vi) Environmental conditions in the
community, including with respect to clean
water, clean air, and the presence or absence
of pollutants.
(vii) Language and English proficiency.
(viii) Access to affordable healthy food.
(ix) Access to ethnically and culturally
diverse health and human service providers and
practitioners.
(x) Access to culturally and linguistically
competent health and human services and health
and human service providers.
(xi) Health-supporting infrastructure.
(xii) Health insurance that is adequate and
affordable.
(xiii) Race, racism, and bigotry (conscious
and unconscious).
(xiv) Sexual orientation.
(xv) Health literacy.
(xvi) Place of residence (such as urban
areas, rural areas, and Tribal reservations).
(xvii) Stress.
(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 and an action 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. 454. ASSISTANCE TO THOSE SEEKING DESIGNATION.
At the request of any organization or entity seeking to submit a
request under section 453(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 453(b)(1);
(2) to complete a health assessment, including an
assessment of health disparities under section 453(c)(1)(D); or
(3) to prepare and submit a request, including a strategic
plan, in accordance with section 453.
SEC. 455. 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 453.
(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 454.
(4) Reporting.--The Secretary shall establish metrics for
measuring the progress of grantees under this subsection and,
based on such metrics, require each such grantee 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. 456. 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 Deputy Assistant
Secretary for 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. 457. AUTHORIZATION OF APPROPRIATIONS.
To carry out this subtitle, there is authorized to be appropriated
$100,000,000 for fiscal year 2019.
Subtitle E--At-Risk Community Coverage
SEC. 461. MEDICAID COVERAGE FOR CITIZENS OF FREELY ASSOCIATED STATES.
(a) In General.--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 new subparagraph:
``(G) Medicaid exception for citizens of freely
associated states.--With respect to eligibility for
benefits for the designated Federal program defined in
paragraph (3)(C) (relating to the Medicaid program),
section 401(a) and paragraph (1) shall not apply to any
individual who lawfully resides in 1 of the 50 States
or the District of Columbia in accordance with the
Compacts of Free Association between the Government of
the United States and the Governments of the Federated
States of Micronesia, the Republic of the Marshall
Islands, and the Republic of Palau and shall not apply,
at the option of the Governor of Puerto Rico, the
Virgin Islands, Guam, the Northern Mariana Islands, or
American Samoa as communicated to the Secretary of
Health and Human Services in writing, to any individual
who lawfully resides in the respective territory in
accordance with such Compacts.''.
(b) Exception to 5-Year Limited Eligibility.--Section 403(d) of
such Act (8 U.S.C. 1613(d)) is amended--
(1) in paragraph (1), by striking ``or'' at the end;
(2) in paragraph (2), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(3) an individual described in section 402(b)(2)(G), but
only with respect to the designated Federal program defined in
section 402(b)(3)(C).''.
(c) Definition of Qualified Alien.--Section 431(b) of such Act (8
U.S.C. 1641(b)) is amended--
(1) in paragraph (6), by striking ``; or'' at the end and
inserting a comma;
(2) in paragraph (7), by striking the period at the end and
inserting ``, or''; and
(3) by adding at the end the following new paragraph:
``(8) an individual who lawfully resides in the United
States in accordance with a Compact of Free Association
referred to in section 402(b)(2)(G), but only with respect to
the designated Federal program defined in section 402(b)(3)(C)
(relating to the Medicaid program).''.
(d) Conforming Amendments.--Section 1108 of the Social Security Act
(42 U.S.C. 1308) is amended--
(1) in subsection (f), in the matter preceding paragraph
(1), by striking ``subsection (g)'' and inserting ``subsections
(g) and (h)''; and
(2) by adding at the end the following:
``(h) Expenditures for medical assistance provided to an individual
described in section 431(b)(8) of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 shall not be taken into account
for purposes of applying payment limits under subsections (f) and
(g).''.
(e) Effective Date.--The amendments made by this section shall
apply to benefits for items and services furnished on or after the date
of the enactment of this Act.
SEC. 462. AT-RISK YOUTH MEDICAID PROTECTION.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)--
(A) by striking ``and'' at the end of paragraph
(82);
(B) by striking the period at the end of paragraph
(83) and inserting ``; and''; and
(C) by inserting after paragraph (83) the following
new paragraph:
``(84) provide that--
``(A) the State shall not terminate eligibility for
medical assistance under a State plan for an individual
who is an eligible juvenile (as defined in subsection
(nn)(2)) because the juvenile is an inmate of a public
institution (as defined in subsection (nn)(3)), but may
suspend coverage during the period the juvenile is such
an inmate;
``(B) the State shall restore coverage for such
medical assistance to such an individual upon the
individual's release from any such public institution,
without requiring a new application from the
individual, unless (and until such date as) there is a
determination that the individual no longer meets the
eligibility requirements for such medical assistance;
and
``(C) the State shall process any application for
medical assistance submitted by, or on behalf of, a
juvenile who is an inmate of a public institution
notwithstanding that the juvenile is such an inmate.'';
and
(2) by adding at the end the following new subsection:
``(nn) Juvenile; Eligible Juvenile; Public Institution.--For
purposes of subsection (a)(84) and this subsection:
``(1) Juvenile.--The term `juvenile' means an individual
who is--
``(A) under 21 years of age; or
``(B) is described in subsection (a)(10)(A)(i)(IX).
``(2) Eligible juvenile.--The term `eligible juvenile'
means a juvenile who is an inmate of a public institution and
was eligible for medical assistance under the State plan
immediately before becoming an inmate of such a public
institution or who becomes eligible for such medical assistance
while an inmate of a public institution.
``(3) Inmate of a public institution.--The term `inmate of
a public institution' has the meaning given such term for
purposes of applying the subdivision (A) following paragraph
(29) of section 1905(a), taking into account the exception in
such subdivision for a patient of a medical institution.''.
(b) No Change in Exclusion From Medical Assistance for Inmates of
Public Institutions.--Nothing in this section shall be construed as
changing the exclusion from medical assistance under the subdivision
(A) following paragraph (29) of section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)), including any applicable restrictions on a
State submitting claims for Federal financial participation under title
XIX of such Act for such assistance.
(c) No Change in Continuity of Eligibility Before Adjudication or
Sentencing.--Nothing in this section shall be construed to mandate,
encourage, or suggest that a State suspend or terminate coverage for
individuals before they have been adjudicated or sentenced.
(d) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by subsection (a) shall apply to eligibility of
juveniles who become inmates of public institutions on or after
the date that is 1 year after the date of the enactment of this
Act.
(2) Rule for changes requiring state legislation.--In the
case of a State plan for medical assistance under title XIX of
the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
subsection (a), the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
TITLE V--IMPROVING HEALTH OUTCOMES FOR WOMEN, CHILDREN, AND FAMILIES
Subtitle A--In General
SEC. 501. GRANTS TO PROMOTE HEALTH FOR UNDERSERVED COMMUNITIES.
Part Q of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399Z-3. GRANTS TO PROMOTE HEALTH FOR UNDERSERVED COMMUNITIES.
``(a) Grants Authorized.--The Secretary, in collaboration with the
Administrator of the Health Resources and Services Administration and
other Federal officials determined appropriate by the Secretary, is
authorized to award grants to eligible entities--
``(1) to promote health for underserved communities, with
preference given to projects that benefit racial and ethnic
minority women, racial and ethnic minority children,
adolescents, and lesbian, gay, bisexual, transgender, queer, or
questioning communities; and
``(2) to strengthen health outreach initiatives in
medically underserved communities, including linguistically
isolated populations.
``(b) Use of Funds.--Grants awarded pursuant to subsection (a) may
be used to support the activities of community health workers,
including such activities--
``(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 and provide outreach in a community
setting regarding health problems prevalent among underserved
communities, and especially among racial and ethnic minority
women, racial and ethnic minority children, adolescents, and
lesbian, gay, bisexual, transgender, queer, or questioning
communities;
``(3) to educate and provide experiential learning
opportunities and target risk factors and healthy behaviors
that impede or contribute to achieving positive health
outcomes, including--
``(A) healthy nutrition;
``(B) physical activity;
``(C) overweight or obesity;
``(D) tobacco use;
``(E) alcohol and substance use;
``(F) injury and violence;
``(G) sexual health;
``(H) mental health;
``(I) musculoskeletal health and arthritis;
``(J) dental and oral health;
``(K) understanding informed consent; and
``(L) stigma;
``(4) to promote community wellness and awareness; and
``(5) 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 in-
language training and supervision to community health
workers to enable such workers to provide authorized
program activities in (at least) the most commonly used
languages within a particular geographic region;
``(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 culturally competent services in the
linguistic context most appropriate for the individuals
served by the program;
``(E) contain a plan to document and disseminate
project descriptions 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, which
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 that--
``(A)(i) have a high percentage of residents who
are uninsured or underinsured (if the targeted
geographic area is located in a State that has elected
to make medical assistance available under section
1902(a)(10)(A)(i)(VIII) of the Social Security Act to
individuals described in such section);
``(ii) have a high percentage of underinsured
residents in a particular geographic area (if the
targeted geographic area is located in a State that has
not so elected); or
``(iii) have a high number of households
experiencing extreme poverty; and
``(B) have a high percentage of families for whom
English is not their primary language or including
smaller limited-English-proficient communities within
the region that are not otherwise reached by
linguistically appropriate health services;
``(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 ensuring the quality of the training and
supervision of community health workers under the programs funded under
this section and for ensuring 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;
``(F) by taking into consideration the needs of the
communities served, including the prevalence rates of
risk factors that impede achieving positive healthy
outcomes among women and children, especially among
racial and ethnic minority women and children; and
``(G) by providing referral and followup services.
``(2) Community setting.--The term `community setting'
means a home or a community organization that serves a
population.
``(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 village); 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);
``(B) a significant portion of which is a health
professional shortage area as designated under section
332; and
``(C) that includes populations that are
linguistically isolated, such as geographic areas with
a shortage of health professionals able to provide
linguistically appropriate services.
``(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, persons who identify as
lesbian, gay, bisexual, transgender, and/or queer, and people
under age 25.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $15,000,000 for each of fiscal
years 2019 through 2023.''.
SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NUTRITION ASSISTANCE FOR
CHILDREN, PREGNANT PERSONS, AND LAWFULLY PRESENT
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 and paragraph (1), payment shall be made to a State under this
section for medical assistance furnished to an alien under this title
(including an alien described in such paragraph) who meets any of the
following conditions:
``(i) The alien is otherwise eligible for such 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) within either or both of the
following eligibility categories:
``(I) Children under 21 years of age, including any
optional targeted low-income child (as such term is
defined in section 1905(u)(2)(B)).
``(II) Pregnant persons during pregnancy and during
the 60-day period beginning on the last day of the
pregnancy.
``(ii) The alien is lawfully present in the United States.
``(B) No debt shall accrue under an affidavit of support against
any sponsor of an alien who meets the conditions specified in
subparagraph (A) on the basis of the provision of medical assistance to
such alien under this paragraph and the cost of such assistance shall
not be considered as an unreimbursed cost.''.
(b) SCHIP.--Subparagraph (J) of section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
``(J) Paragraph (4) of section 1903(v) (relating to
coverage of categories of children, pregnant persons,
and other lawfully present individuals).''.
(c) 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.
(d) Eligibility for Families With Children.--Section 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''.
(e) 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--
(1) by redesignating clauses (vi) and (vii) as clauses
(vii) and (viii); and
(2) 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. 503. REPEAL OF DENIAL OF BENEFITS.
Section 115 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 (21 U.S.C. 862a) is amended--
(1) in subsection (a), by striking paragraph (2);
(2) in subsection (b), by striking paragraph (2); and
(3) in subsection (e), by striking paragraph (2).
SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, AND AWARENESS.
(a) In General.--The Secretary shall establish and implement a
birth defects prevention and public awareness program, consisting of
the activities described in subsections (c) and (d).
(b) Definitions.--In this section:
(1) The term ``maternal'' refers to persons who are
pregnant or breastfeeding of all gender identities.
(2) The term ``pregnancy and breastfeeding information
services'' includes only--
(A) information services to provide accurate,
evidence-based, clinical information regarding maternal
exposures during pregnancy that may be associated with
birth defects or other health risks, such as exposures
to medications, chemicals, infections, foodborne
pathogens, illnesses, nutrition, or lifestyle factors;
(B) information services to provide accurate,
evidence-based, clinical information regarding maternal
exposures during breastfeeding that may be associated
with health risks to a breast-fed infant, such as
exposures to medications, chemicals, infections,
foodborne pathogens, illnesses, nutrition, or lifestyle
factors;
(C) the provision of accurate, evidence-based
information weighing risks of exposures during
breastfeeding against the benefits of breastfeeding;
and
(D) the provision of information described in
subparagraph (A), (B), or (C) through counselors, Web
sites, fact sheets, telephonic or electronic
communication, community outreach efforts, or other
appropriate means.
(3) The term ``Secretary'' means the Secretary of Health
and Human Services, acting through the Director of the Centers
for Disease Control and Prevention.
(c) Nationwide Media Campaign.--In carrying out subsection (a), the
Secretary shall conduct or support a nationwide media campaign to
increase awareness among health care providers and at-risk populations
about pregnancy and breastfeeding information services.
(d) Grants for Pregnancy and Breastfeeding Information Services.--
(1) In general.--In carrying out subsection (a), the
Secretary shall award grants to State or regional agencies or
organizations for any of the following:
(A) Information services.--The provision of, or
campaigns to increase awareness about, pregnancy and
breastfeeding information services.
(B) Surveillance and research.--The conduct or
support of--
(i) surveillance of or research on--
(I) maternal exposures and maternal
health conditions that may influence
the risk of birth defects, prematurity,
or other adverse pregnancy outcomes;
and
(II) maternal exposures that may
influence health risks to a breastfed
infant; or
(ii) networking to facilitate surveillance
or research described in this subparagraph.
(2) Preference for certain states.--The Secretary, in
making any grant under this subsection, shall give preference
to States, otherwise equally qualified, that have a pregnancy
and breastfeeding information service in place.
(3) Matching funds.--The Secretary may only award a grant
under this subsection to a State or regional agency or
organization that agrees, with respect to the costs to be
incurred in carrying out the grant activities, to make
available (directly or through donations from public or private
entities) non-Federal funds toward such costs in an amount
equal to not less than 25 percent of the amount of the grant.
(4) Coordination.--The Secretary shall ensure that
activities funded through a grant under this subsection are
coordinated, to the maximum extent practicable, with other
birth defects prevention and environmental health activities of
the Federal Government, including with respect to pediatric
environmental health specialty units and children's
environmental health centers.
(e) Evaluation.--In furtherance of the program under subsection
(a), the Secretary shall provide for an evaluation of pregnancy and
breastfeeding information services to identify efficient and effective
models of--
(1) providing information;
(2) raising awareness and increasing knowledge about birth
defects prevention measures and targeting education to at-risk
groups;
(3) modifying risk behaviors; or
(4) other outcome measures as determined appropriate by the
Secretary.
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated $5,000,000 for fiscal year
2019, $6,000,000 for fiscal year 2020, $7,000,000 for fiscal year 2021,
$8,000,000 for fiscal year 2022, and $9,000,000 for fiscal year 2023.
SEC. 505. PREVENTING MATERNAL DEATHS.
(a) Program Authorized.--
(1) In general.--The Secretary of Health and Human
Services, through the Director of the Centers for Disease
Control and Prevention, shall establish a grant program under
which the Secretary may make grants to States for the purpose
of--
(A) carrying out the activities described in
subsection (b)(1);
(B) establishing and sustaining a State maternal
mortality review committee, in accordance with
subsection (b)(2);
(C) ensuring that the State department of health
carries out the activities described in subsection
(b)(3);
(D) disseminating the case abstraction form
developed under subsection (c); and
(E) providing for the public disclosure of
information, in accordance with subsection (d).
(2) Criteria.--The Secretary shall establish criteria for
determining eligibility for, and the amount of a grant awarded
to, a State under paragraph (1). Such criteria shall provide
that in the case of a State that receives a grant under
paragraph (1) for a fiscal year and is determined by the
Secretary to have not used such grant in accordance with this
section, such State may not be eligible for such a grant for
any subsequent fiscal year.
(b) Use of Funds.--
(1) Review of pregnancy-related and pregnancy-associated
deaths.--With respect to a State that receives a grant under
subsection (a)(1), the following shall apply:
(A) Process for mandatory reporting of pregnancy-
related and pregnancy-associated deaths.--
(i) In general.--The State, through the
State maternal mortality review committee
established under subsection (a)(1), shall
develop a process that provides for mandatory
and confidential case reporting to the State
department of health by individuals and
entities described in clause (ii) with respect
to pregnancy-related and pregnancy-associated
deaths.
(ii) Individuals and entities described.--
Individuals and entities described in this
clause include each of the following:
(I) Health care professionals.
(II) Medical examiners.
(III) Medical coroners.
(IV) Hospitals.
(V) Birth centers.
(VI) Other health care facilities.
(VII) Other individuals responsible
for completing death records.
(VIII) Other appropriate
individuals or entities specified by
the Secretary.
(B) Process for voluntary reporting of pregnancy-
related and pregnancy-associated deaths.--The State,
through the State maternal mortality review committee
established under subsection (a)(1), shall develop a
process that provides for voluntary and confidential
case reporting to the State department of health by
family members of the deceased and other individuals on
possible pregnancy-related and pregnancy-associated
deaths. Such process shall include--
(i) making publicly available on the
website of the State department of health a
telephone number, Internet web link, and email
address for such reporting; and
(ii) publicizing to local professional
organizations, community organizations, and
social services agencies the availability of
the telephone number, Internet web link, and
email address made available under clause (i).
(C) Identification of pregnancy-related and
pregnancy-associated deaths by state vital statistics
unit.--The State, through the vital statistics unit of
the State, shall annually identify pregnancy-related
and pregnancy-associated deaths occurring in such State
in the year involved by--
(i) matching each death record of a person
in such year to a live birth certificate or an
infant death record for the purpose of
identifying deaths of persons that occurred
during pregnancy and within one year after the
end of a pregnancy;
(ii) identifying each death of a person
reported during such year as having an
underlying or contributing cause of death
related to pregnancy, regardless of the time
that has passed between the end of the
pregnancy and the death;
(iii) collecting data from medical examiner
and coroner reports; and
(iv) using any other method the State may
devise to identify maternal deaths such as
reviewing a random sample of reported deaths of
persons who could have been pregnant to
ascertain cases of pregnancy-related and
pregnancy-associated deaths that are not
discernable from a review of death records
alone.
For purposes of effectively collecting and obtaining
data on pregnancy-related and pregnancy-associated
deaths, the State shall adopt the most recent
standardized birth and death records, as issued by the
National Center for Vital Health Statistics, including
the recommended checkbox section for pregnancy on each
death record.
(D) Case investigation and development of case
summaries.--
(i) In general.--Following the receipt of
reports by the State department of health
pursuant to subparagraph (A) or (B) and the
collection of cases of pregnancy-related and
pregnancy-associated deaths by the vital
statistics unit of the State under subparagraph
(C), the State, through the State maternal
mortality review committee established under
subsection (a)(1), shall investigate each case,
using the case abstraction form described in
subsection (c), and prepare a de-identified
case summary for each case, which shall be
reviewed by the committee and included in
applicable reports. The State department of
health or vital statistics unit of the State,
as the case may be, shall provide the State
maternal mortality review committee with access
to the information collected pursuant to
subparagraph (A) or (B), or under subparagraph
(C), as necessary to carry out this
subparagraph.
(ii) Mandatory data and information.--Each
case investigation under this subparagraph
shall, subject to availability, include data
and information obtained through--
(I) medical examiner and autopsy
reports of the person involved;
(II) medical records of the person,
including such records related to
health care prior to pregnancy,
prenatal and postnatal care, labor and
delivery care, emergency room care,
hospital discharge records, and any
care delivered up until the time of
death of the person;
(III) oral and written interviews
of individuals directly involved in the
maternal care of the person during and
immediately following the pregnancy of
the person, including health care,
mental health, and social service
providers, as applicable;
(IV) socioeconomic and other
relevant background information about
the person;
(V) any information collected under
subparagraph (C)(i); and
(VI) any other information on the
cause of death of the person, such as
social services and child welfare
reports.
(iii) Discretionary data and information.--
Each case investigation under this subparagraph
may include data and information obtained
through oral or written interviews of the
family of the person.
(2) State maternal mortality review committees.--
(A) Mandatory activities.--A State maternal
mortality review committee established under subsection
(a)(1) shall carry out the following activities:
(i) Develop the processes described in
subparagraphs (A) and (B) of paragraph (1).
(ii) Review the data and information
collected by the vital statistics unit of the
State under paragraph (1)(C) regarding
pregnancy-related and pregnancy-associated
deaths to identify trends, patterns, and
disparities in adverse outcomes and address
medical, non-medical, and system-related
factors that may have contributed to such
pregnancy-related and pregnancy-associated
deaths and disparities.
(iii) Carry out the activities described in
paragraph (1)(D).
(iv) Develop recommendations, based on the
case summaries prepared under paragraph (1)(D)
and the data and information collected under
paragraph (1)(C), to improve maternal care,
social and health services, and public health
policy and institutions, including improving
access to maternal care and social and health
services and identifying disparities in
maternal care and outcomes.
(B) Discretionary activities.--
(i) In general.--A State maternal mortality
review committee established under subsection
(a)(1) may, while subject to confidentiality
requirements, present findings and
recommendations based on the case summaries
prepared under paragraph (1)(D) directly to a
health care facility or its local or State
professional organization for the purpose of--
(I) instituting policy changes,
educational activities, and
improvements in the quality of care
provided by the facility; and
(II) exploring and forming regional
collaborations.
(ii) Investigation of cases of severe
maternal morbidity.--A State maternal mortality
review committee may investigate cases of
severe maternal morbidity and any such
investigation may include data and information
obtained through--
(I) identified patient registries;
or
(II) oral or written interviews of
the person concerned and the family of
such person.
(C) Composition of state maternal mortality review
committees.--
(i) In general.--A State maternal mortality
review committee established under subsection
(a)(1) shall be multidisciplinary and diverse.
Membership on the State maternal mortality
review committee shall be reviewed annually by
the State department of health to ensure that
membership representation requirements are
being fulfilled in accordance with this
subparagraph.
(ii) Required membership.--Each State
maternal mortality review committee shall
include--
(I) representatives from medical
specialties providing care to pregnant
and postpartum patients, including
obstetricians (including generalists
and maternal fetal medicine
specialists) and family practice
physicians;
(II) certified nurse midwives,
certified midwives, and advanced
practice nurses;
(III) hospital-based registered
nurses;
(IV) representatives of the
maternal and child health department of
the State department of health;
(V) social service providers or
social workers, including those with
experience working with communities
diverse with respect to race,
ethnicity, and limited-English
proficiency;
(VI) chief medical examiners or
designees;
(VII) facility representatives,
such as from hospitals or birth
centers;
(VIII) patient advocates, community
maternal health organizations, and
minority advocacy groups that represent
those diverse racial and ethnic
communities within the State that are
the most affected by pregnancy-related
or pregnancy-associated deaths and by a
lack of access to maternal health care
services; and
(IX) representatives of the
departments of health or public health
of major cities in the State.
(iii) Discretionary membership.--Each State
maternal mortality review committee may also
include representatives from other relevant
academic, health, social service, or policy
professions or community organizations on an
ongoing basis, or as needed, as determined
beneficial by the committee, including--
(I) anesthesiologists;
(II) emergency physicians;
(III) pathologists;
(IV) epidemiologists;
(V) intensivists;
(VI) nutritionists;
(VII) mental health professionals;
(VIII) substance use disorder
treatment specialists;
(IX) representatives of relevant
patient and provider advocacy groups;
(X) academics;
(XI) paramedics; and
(XII) risk management specialists.
(iv) Staff.--Staff of each State maternal
mortality review committee shall include--
(I) vital health statisticians,
maternal child health statisticians, or
epidemiologists;
(II) a coordinator of the State
maternal mortality review committee, to
be designated by the State; and
(III) administrative staff.
(D) Option for states to establish regional
maternal mortality review committees.--States may
choose to partner with one or more neighboring States
to carry out the activities required of a State
maternal mortality review committee under this section.
In such a case, with respect to the States in such a
partnership, any requirement under this section
relating to the reporting of information related to
such activities shall be deemed to be fulfilled by each
such State if a single such report is submitted for the
partnership.
(E) Treatment as public health authority for
purposes of hipaa.--For purposes of applying HIPAA
privacy and security law (as defined in section
3009(a)(2) of the Public Health Service Act (42 U.S.C.
300jj-19)), each State maternal mortality review
committee and regional maternal mortality review
committee established under subsection (a)(1) or
subsection (b)(2)(D), as the case may be, shall be
deemed to be a public health authority described in
section 164.501 (and referenced in section
164.512(b)(1)(i)) of title 45, Code of Federal
Regulations (or any successor regulation), carrying out
public health activities and purposes described in such
section 164.512(b)(1)(i) (or any such successor
regulation).
(3) State department of health activities.--With respect to
a State that receives a grant under subsection (a)(1), the
State department of health shall--
(A) in consultation with the State maternal
mortality review committee and in conjunction with
relevant professional organizations and patient
advocacy organizations, develop a plan for ongoing
health care provider education, based on the findings
and recommendations of the committee, in order to
improve the quality of maternal care; and
(B) take steps to widely disseminate the findings
and recommendations of the State maternal mortality
review committee and implement the recommendations of
the committee.
(c) Case Abstraction Form.--
(1) Dissemination.--The Director of the Centers for Disease
Control and Prevention shall disseminate a uniform case
abstraction form to States and State maternal mortality review
committees for the purpose of--
(A) ensuring that the data and information
collected and reviewed by such committees can be pooled
for review by the Department of Health and Human
Services and its agencies; and
(B) preserving the uniformity of the information
collected for Federal public health purposes.
(2) Permissible state modification.--Each State may modify
the form developed under paragraph (1) for implementation and
use by such State or by the State maternal mortality review
committee of such State by including on such form additional
information to be collected, but may not alter the standard
questions on such form, in order to ensure that the information
can be collected and reviewed centrally at the Federal level.
(d) Public Disclosure of Information.--
(1) In general.--For fiscal year 2019, or a subsequent
fiscal year, each State receiving a grant under this section
for such year shall, subject to paragraph (3), provide for the
public disclosure, and submission to the information
clearinghouse established under paragraph (2), of the
information included in the report of the State under
subsection (f)(1) for such year.
(2) Information clearinghouse.--The Secretary shall
establish an information clearinghouse, to be administered by
the Director of the Centers for Disease Control and Prevention,
that will maintain findings and recommendations submitted
pursuant to paragraph (1) and provide such findings and
recommendations for public review and research purposes by
State departments of health, State maternal mortality review
committees, health providers and institutions, and national
patient and provider advocacy groups.
(3) Confidentiality of information.--In no case may any
individually identifiable health information be provided to the
public, or submitted to the information clearinghouse, under
this subsection.
(e) Confidentiality of Proceedings of State Maternal Mortality
Review Committees.--
(1) In general.--All proceedings and activities of a State
maternal mortality review committee established under
subsection (a)(1), opinions of members of such a committee
formed as a result of such proceedings and activities, and
records obtained, created, or maintained pursuant to this
section, including records of interviews, written reports, and
statements procured by the Department of Health and Human
Services or by any other person, agency, or organization acting
jointly with the Department, in connection with morbidity and
mortality reviews under this section, shall be confidential and
may not be subject to discovery, subpoena, or introduction into
evidence in any civil, criminal, legislative, or other
proceeding. Such records shall not be open to public
inspection.
(2) Testimony of members of committee.--
(A) In general.--Members of a State maternal
mortality review committee established under subsection
(a)(1) may not be questioned in any civil, criminal,
legislative, or other proceeding regarding information
presented in, or opinions formed as a result of, a
meeting or communication of the committee.
(B) Clarification.--Nothing in this subsection may
be construed to prevent a member of a State maternal
mortality review committee established under subsection
(a)(1) from testifying regarding information that was
obtained independent of such member's participation on
the committee, or public information.
(3) Availability of information for research purposes.--
Nothing in this subsection may prohibit a State maternal
mortality review committee established under subsection (a)(1)
or the Department of Health and Human Services from publishing
statistical compilations and research reports that--
(A) are based on confidential information, relating
to morbidity and mortality reviews under this section;
and
(B) do not contain identifying information or any
other information that could be used to ultimately
identify the individuals concerned.
(f) Reports.--
(1) State reports.--Not later than one year after the end
of fiscal year 2019, and each subsequent fiscal year, each
State maternal mortality review committee established under
subsection (a)(1) and receiving a grant under this section for
such year, shall submit to the Director of the Centers for
Disease Control and Prevention a report on the findings and
recommendations of such committee and information on the
implementation of such recommendations during such year.
(2) Annual reports to congress.--Not later than 60 days
after the deadline for State reports under paragraph (1) for
fiscal year 2019, and each subsequent fiscal year, the
Secretary of Health and Human Services shall submit to Congress
a report on--
(A) the findings, recommendations, and
implementation information submitted by any State
pursuant to paragraph (1); and
(B) the status of pregnancy-related and pregnancy-
associated deaths in the United States, including
recommendations on methods to prevent such deaths in
the United States.
(g) Definitions.--In this section:
(1) The term ``pregnancy-associated death'' means the death
of a person while pregnant or during the one-year period
following the date of the end of pregnancy, irrespective of the
cause of such death.
(2) The term ``pregnancy-related death'' means the death of
a person while pregnant or during the one-year period following
the date of the end of pregnancy, irrespective of the duration
of the pregnancy, from any cause related to, or aggravated by,
the pregnancy or its management, excluding any accidental or
incidental cause.
(3) The term ``severe maternal morbidity'' means the
physical and psychological conditions that result from, or are
aggravated by, pregnancy and have an adverse effect on the
health of a person.
(4) The term ``State'' means each of the 50 States, the
District of Columbia, and each of the territories.
(5) The term ``vital statistics unit'' means the entity
that is responsible for maintaining vital records for a State,
including official records of live births, deaths, fetal
deaths, marriages, divorces, and annulments.
(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $7,000,000 for each of fiscal
years 2019 through 2023.
SEC. 506. ELIMINATING DISPARITIES IN MATERNITY HEALTH OUTCOMES.
Part B of title III of the Public Health Service Act is amended by
inserting after section 317V of such Act, as added, the following new
section:
``SEC. 317W. ELIMINATING DISPARITIES IN MATERNAL HEALTH OUTCOMES.
``(a) In General.--The Secretary shall, in consultation with
relevant national stakeholder organizations, such as national medical
specialty organizations, national maternal child health organizations,
national patient advocacy organizations, and national health disparity
organizations, carry out the following activities to eliminate
disparities in maternal health outcomes:
``(1) Conduct research into the determinants and the
distribution of disparities in maternal care, health risks, and
health outcomes, and improve the capacity of the performance
measurement infrastructure to measure such disparities.
``(2) Expand access to health care services, resources, and
information that have been demonstrated to improve the quality
and outcomes of maternity care for vulnerable populations.
``(3) Establish a demonstration project to compare the
effectiveness of interventions to reduce disparities in
maternity services and outcomes and to implement and assess
effective interventions.
``(b) Scope and Selection of States for Demonstration Project.--The
demonstration project under subsection (a)(3) shall be conducted in no
more than 8 States, which shall be selected by the Secretary based on--
``(1) applications submitted by States, which specify which
regions and populations the State involved will serve under the
demonstration project;
``(2) criteria designed by the Secretary to ensure that, as
a whole, the demonstration project is, to the greatest extent
possible, representative of the demographic and geographic
composition of communities most affected by disparities;
``(3) criteria designed by the Secretary to ensure that a
variety of models are tested through the demonstration project
and that such models include interventions that have an
existing evidence base for effectiveness; and
``(4) criteria designed by the Secretary to ensure that the
demonstration projects and models will be carried out in
consultation with local and regional provider organizations,
such as community health centers, hospital systems, and medical
societies representing providers of maternity services.
``(c) Duration of Demonstration Project.--The demonstration project
under subsection (a)(3) shall begin on January 1, 2019, and end on
December 31, 2022.
``(d) Grants for Evaluation and Monitoring.--The Secretary may make
grants to States and health care providers participating in the
demonstration project under subsection (a)(3) for the purpose of
collecting data necessary for the evaluation and monitoring of such
project.
``(e) Reports.--
``(1) State reports.--Each State that participates in the
demonstration project under subsection (a)(3) shall report to
the Secretary, in a time, form, and manner specified by the
Secretary, the data necessary to--
``(A) monitor the--
``(i) outcomes of the project;
``(ii) costs of the project; and
``(iii) quality of maternity care provided
under the project; and
``(B) evaluate the rationale for the selection of
the items and services included in any bundled payment
made by the State under the project.
``(2) Final report.--Not later than December 31, 2022, the
Secretary shall submit to Congress a report on the results of
the demonstration project under subsection (a)(3).''.
SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN UNEXPECTED INFANT
DEATH AND SUDDEN UNEXPLAINED DEATH IN CHILDHOOD.
(a) Establishment.--The Secretary of Health and Human Services,
acting through the Administrator of the Health Resources and Services
Administration and in consultation with the Director of the Centers for
Disease Control and Prevention and the Director of the National
Institutes of Health (in this section referred to as the
``Secretary''), shall establish and implement a culturally and
linguistically competent public health awareness and education campaign
to provide information that is focused on decreasing the risk factors
for sudden unexpected infant death and sudden unexplained death in
childhood, including educating individuals about safe sleep
environments, sleep positions, and reducing exposure to smoking during
pregnancy and after birth.
(b) Targeted Populations.--The campaign under subsection (a) shall
be designed to reduce health disparities through the targeting of
populations with high rates of sudden unexpected infant death and
sudden unexplained death in childhood.
(c) Consultation.--In establishing and implementing the campaign
under subsection (a), the Secretary shall consult with national
organizations representing health care providers, including nurses and
physicians, parents, child care providers, children's advocacy and
safety organizations, maternal and child health programs, nutrition
professionals focusing on women, infants, and children, and other
individuals and groups determined necessary by the Secretary for such
establishment and implementation.
(d) Grants.--
(1) In general.--In carrying out the campaign under
subsection (a), the Secretary shall award grants to national
organizations, State and local health departments, and
community-based organizations for the conduct of education and
outreach programs for nurses, parents, child care providers,
public health agencies, and community organizations.
(2) Application.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
(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 2019 through 2023.
SEC. 508. REDUCING UNINTENDED TEENAGE PREGNANCIES.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following new part:
``PART W--YOUTH ACCESS TO SEXUAL HEALTH SERVICES
``SEC. 399OO. AUTHORIZATION OF GRANTS TO SUPPORT THE ACCESS OF
MARGINALIZED YOUTH TO SEXUAL HEALTH SERVICES.
``(a) Grants.--The Secretary of Health and Human Services may award
grants on a competitive basis to eligible entities to support the
access of marginalized youth to sexual health services.
``(b) Use of Funds.--An eligible entity that is awarded a grant
under subsection (a) may use the funds to--
``(1) provide medically accurate and complete and age-,
developmentally, and culturally appropriate sexual health
information to marginalized youth, including information on how
to access sexual health services;
``(2) promote effective communication regarding sexual
health among marginalized youth;
``(3) promote and support better health, education, and
economic opportunities for school-age parents; and
``(4) train individuals who work with marginalized youth to
promote--
``(A) the prevention of unintended pregnancy;
``(B) the prevention of sexually transmitted
infections, including the human immunodeficiency virus
(HIV);
``(C) healthy relationships; and
``(D) the development of safe and supportive
environments.
``(c) Application.--To be awarded a grant under subsection (a), an
eligible entity shall submit an application to the Secretary at such
time, in such manner, and containing such information as the Secretary
may require.
``(d) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to eligible entities--
``(1) with a history of supporting the access of
marginalized youth to sexuality education or sexual health
services; and
``(2) that plan to serve marginalized youth that are not
served by Federal adolescent programs for the prevention of
pregnancy, HIV, and other sexually transmitted infections.
``(e) Requirements.--The Secretary may not award a grant under
subsection (a) to an eligible entity unless--
``(1) such eligible entity has formed a partnership with a
community organization; and
``(2) such eligible entity agrees--
``(A) to employ a scientifically effective
strategy;
``(B) that all information provided to marginalized
youth will be--
``(i) age- and developmentally appropriate;
``(ii) medically accurate and complete;
``(iii) scientifically based; and
``(iv) provided in the language and
cultural context that is most appropriate for
the individuals served by the eligible entity;
and
``(C) that for each year the eligible entity
receives grant funds under subsection (a), the eligible
entity will submit to the Secretary an annual report
that includes--
``(i) the use of grant funds by the
eligible entity;
``(ii) how the use of grant funds has
increased the access of marginalized youth to
sexual health services; and
``(iii) such other information as the
Secretary may require.
``(f) Publication and Evaluations.--
``(1) Evaluations.--Not less than once every two years
after the date of the enactment of this Act, the Secretary
shall evaluate the effectiveness of whichever of the following
is greater:
``(A) Eight grants awarded under subsection (a).
``(B) Ten percent of the grants awarded under
subsection (a).
``(2) Publication.--The Secretary shall make available to
the public--
``(A) the evaluations required under paragraph (1);
and
``(B) the reports required under subsection
(e)(2)(C).
``(g) Limitations.--No funds made available to an eligible entity
under this section may be used by such entity to provide access to
sexual health services that--
``(1) withhold sexual health-promoting or life-saving
information;
``(2) are medically inaccurate or have been scientifically
shown to be ineffective;
``(3) promote gender stereotypes;
``(4) are insensitive or unresponsive to the needs of young
people, including--
``(A) youth with varying gender identities, gender
expressions, and sexual orientations;
``(B) sexually active youth;
``(C) pregnant or parenting youth;
``(D) survivors of sexual abuse or assault; and
``(E) youth of all physical, developmental, and
mental abilities; or
``(5) are inconsistent with the ethical imperatives of
medicine and public health.
``(h) Transfer of Funds.--Any unobligated balance of funds made
available under section 510(d) of the Social Security Act (42 U.S.C.
710(d)) (as in effect on the day before the date of the enactment of
this Act) are hereby transferred and made available to the Secretary to
carry out this Act. The amounts transferred and made available to carry
out this Act shall remain available until expended.
``(i) Definitions.--In this section:
``(1) Community organization.--The term `community
organization' includes a State or local health or education
agency, public school, youth-focused organization that is
faith-based and community-based, juvenile justice entity, or
other organization that provides confidential and appropriate
sexuality education or sexual health services to marginalized
youth.
``(2) Eligible entity.--The term `eligible entity' includes
a State or local health or education agency, public school,
nonprofit organization, hospital, or an Indian Tribe or Tribal
organization (as such terms are defined in section 4 of the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 5304)).
``(3) Marginalized youth.--The term `marginalized youth'
means a person under the age of 26 that is disadvantaged by
underlying structural barriers and social inequity.
``(4) Medically accurate and complete.--The term `medically
accurate and complete', when used with respect to information,
means information that--
``(A) is supported by research and recognized as
accurate, objective, and complete by leading medical,
psychological, psychiatric, or public health
organizations and agencies; and
``(B) does not withhold any information relating to
the effectiveness and benefits of correct and
consistent use of condoms or other contraceptives and
pregnancy prevention methods.
``(5) Scientifically effective strategy.--The term
`scientifically effective strategy' means a strategy that--
``(A) is widely recognized by leading medical and
public health agencies as effective in promoting sexual
health awareness and healthy behavior; and
``(B) either--
``(i) has been demonstrated to be effective
on the basis of rigorous scientific research;
or
``(ii) incorporates characteristics of
effective programs.
``(6) Secretary.--The term `Secretary' means the Secretary
of Health and Human Services.
``(7) Sexual health services.--The term `sexual health
services' includes--
``(A) sexual health information, education, and
counseling;
``(B) contraception;
``(C) emergency contraception;
``(D) condoms and other barrier methods to prevent
pregnancy or sexually transmitted infections;
``(E) routine gynecological care, including human
papillomavirus (HPV) vaccines and cancer screenings;
``(F) pre-exposure prophylaxis or post-exposure
prophylaxis;
``(G) mental health services;
``(H) sexual assault survivor services; and
``(I) other prevention, care, or treatment.''.
SEC. 509. GESTATIONAL DIABETES.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by adding after section 317H the following:
``SEC. 317H-1. GESTATIONAL DIABETES.
``(a) Understanding and Monitoring Gestational Diabetes.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, in
consultation with the Diabetes Mellitus Interagency
Coordinating Committee established under section 429 and
representatives of appropriate national health organizations,
shall develop a multisite gestational diabetes research project
within the diabetes program of the Centers for Disease Control
and Prevention to expand and enhance surveillance data and
public health research on gestational diabetes.
``(2) Areas to be addressed.--The research project
developed under paragraph (1) shall address--
``(A) procedures to establish accurate and
efficient systems for the collection of gestational
diabetes data within each State and commonwealth,
territory, or possession of the United States;
``(B) the progress of collaborative activities with
the National Vital Statistics System, the National
Center for Health Statistics, and State health
departments with respect to the standard birth
certificate, in order to improve surveillance of
gestational diabetes;
``(C) postpartum methods of tracking individuals
with gestational diabetes after delivery as well as
targeted interventions proven to lower the incidence of
type 2 diabetes in that population;
``(D) variations in the distribution of diagnosed
and undiagnosed gestational diabetes, and of impaired
fasting glucose tolerance and impaired fasting glucose,
within and among groups of pregnant individuals; and
``(E) factors and culturally sensitive
interventions that influence risks and reduce the
incidence of gestational diabetes and related
complications during childbirth, including cultural,
behavioral, racial, ethnic, geographic, demographic,
socioeconomic, and genetic factors.
``(3) Report.--Not later than 2 years after the date of the
enactment of this section, and annually thereafter, the
Secretary shall generate a report on the findings and
recommendations of the research project including prevalence of
gestational diabetes in the multisite area and disseminate the
report to the appropriate Federal and non-Federal agencies.
``(b) Expansion of Gestational Diabetes Research.--
``(1) In general.--The Secretary shall expand and intensify
public health research regarding gestational diabetes. Such
research may include--
``(A) developing and testing novel approaches for
improving postpartum diabetes testing or screening and
for preventing type 2 diabetes in individuals who can
become pregnant with a history of gestational diabetes;
and
``(B) conducting public health research to further
understanding of the epidemiologic, socioenvironmental,
behavioral, translation, and biomedical factors and
health systems that influence the risk of gestational
diabetes and the development of type 2 diabetes in
individuals who can become pregnant with a history of
gestational diabetes.
``(2) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $5,000,000 for
each of fiscal years 2019 through 2023.
``(c) Demonstration Grants To Lower the Rate of Gestational
Diabetes.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall award grants, on a competitive basis, to eligible
entities for demonstration projects that implement evidence-
based interventions to reduce the incidence of gestational
diabetes, the recurrence of gestational diabetes in subsequent
pregnancies, and the development of type 2 diabetes in
individuals who can become pregnant with a history of
gestational diabetes.
``(2) Priority.--In making grants under this subsection,
the Secretary shall give priority to projects focusing on--
``(A) helping individuals who can become pregnant
who have 1 or more risk factors for developing
gestational diabetes;
``(B) working with individuals who can become
pregnant with a history of gestational diabetes during
a previous pregnancy;
``(C) providing postpartum care for individuals who
can become pregnant with gestational diabetes;
``(D) tracking cases where individuals who can
become pregnant with a history of gestational diabetes
developed type 2 diabetes;
``(E) educating mothers with a history of
gestational diabetes about the increased risk of their
child developing diabetes;
``(F) working to prevent gestational diabetes and
prevent or delay the development of type 2 diabetes in
individuals who can become pregnant with a history of
gestational diabetes; and
``(G) achieving outcomes designed to assess the
efficacy and cost-effectiveness of interventions that
can inform decisions on long-term sustainability,
including third-party reimbursement.
``(3) Application.--An eligible entity desiring to receive
a grant under this subsection shall submit to the Secretary--
``(A) an application at such time, in such manner,
and containing such information as the Secretary may
require; and
``(B) a plan to--
``(i) lower the rate of gestational
diabetes during pregnancy; or
``(ii) develop methods of tracking
individuals who can become pregnant with a
history of gestational diabetes and develop
effective interventions to lower the incidence
of the recurrence of gestational diabetes in
subsequent pregnancies and the development of
type 2 diabetes.
``(4) Uses of funds.--An eligible entity receiving a grant
under this subsection shall use the grant funds to carry out
demonstration projects described in paragraph (1), including--
``(A) expanding community-based health promotion
education, activities, and incentives focused on the
prevention of gestational diabetes and development of
type 2 diabetes in individuals who can become pregnant
with a history of gestational diabetes;
``(B) aiding State- and Tribal-based diabetes
prevention and control programs to collect, analyze,
disseminate, and report surveillance data on
individuals who can become pregnant with, and at risk
for, gestational diabetes, the recurrence of
gestational diabetes in subsequent pregnancies, and,
for individuals who can become pregnant with a history
of gestational diabetes, the development of type 2
diabetes; and
``(C) training and encouraging health care
providers--
``(i) to promote risk assessment, high-
quality care, and self-management for
gestational diabetes and the recurrence of
gestational diabetes in subsequent pregnancies;
and
``(ii) to prevent the development of type 2
diabetes in individuals who can become pregnant
with a history of gestational diabetes, and its
complications in the practice settings of the
health care providers.
``(5) Report.--Not later than 4 years after the date of the
enactment of this section, the Secretary shall prepare and
submit to the Congress a report concerning the results of the
demonstration projects conducted through the grants awarded
under this subsection.
``(6) Definition of eligible entity.--In this subsection,
the term `eligible entity' means a nonprofit organization (such
as a nonprofit academic center or community health center) or a
State, Tribal, or local health agency.
``(7) Authorization of appropriations.--There is authorized
to be appropriated to carry out this subsection $5,000,000 for
each of fiscal years 2019 through 2023.
``(d) Postpartum Followup Regarding Gestational Diabetes.--The
Secretary, acting through the Director of the Centers for Disease
Control and Prevention, shall work with the State- and Tribal-based
diabetes prevention and control programs assisted by the Centers to
encourage postpartum followup after gestational diabetes, as medically
appropriate, for the purpose of reducing the incidence of gestational
diabetes, the recurrence of gestational diabetes in subsequent
pregnancies, the development of type 2 diabetes in individuals with a
history of gestational diabetes, and related complications.''.
SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND INFORMATION PROGRAMS.
(a) Emergency Contraception Public Education Program.--
(1) In general.--The Secretary, acting through the Director
of the Centers for Disease Control and Prevention, shall
develop and disseminate to the public medically accurate and
complete information on emergency contraception.
(2) Dissemination.--The Secretary may disseminate medically
accurate and complete information under paragraph (1) directly
or through arrangements with nonprofit organizations, community
health workers including promotoras, consumer groups,
institutions of higher education, clinics, the media, and
Federal, State, and local agencies.
(3) Information.--The information disseminated under
paragraph (1) shall--
(A) include, at a minimum, a description of
emergency contraception and an explanation of the use,
safety, efficacy, and availability of such
contraception and options for no-copay access through
insurance; and
(B) be pilot tested for consumer comprehension,
cultural and linguistic appropriateness, and acceptance
of the messages across geographically, racially,
ethnically, and linguistically diverse populations.
(b) Emergency Contraception Information Program for Health Care
Providers.--
(1) In general.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in consultation with major medical and
public health organizations, shall develop and disseminate to
health care providers information on emergency contraception.
(2) Information.--The information disseminated under
paragraph (1) shall include, at a minimum--
(A) information describing the use, safety,
efficacy, availability of emergency contraception, and
options for no-copay access through insurance;
(B) a recommendation regarding the use of such
contraception; and
(C) information explaining how to obtain copies of
the information developed under subsection (a) for
distribution to the patients of the providers.
(c) Definitions.--In this section:
(1) Emergency contraception.--The term ``emergency
contraception'' means a drug or device (as the terms are
defined in section 201 of the Federal Food, Drug, and Cosmetic
Act (21 U.S.C. 321)) or a drug regimen that--
(A) is used postcoitally;
(B) prevents pregnancy primarily by preventing or
delaying ovulation, and does not terminate an
established pregnancy; and
(C) is approved by the Food and Drug
Administration.
(2) Health care provider.--The term ``health care
provider'' means an individual who is licensed or certified
under State law to provide health care services and who is
operating within the scope of such license. Such term shall
include a pharmacist.
(3) Institution of higher education.--The term
``institution of higher education'' has the same meaning given
such term in section 101(a) of the Higher Education Act of 1965
(20 U.S.C. 1001(a)).
(4) Medically accurate and complete.--The term ``medically
accurate and complete'' means, with respect to information,
activities, or services verified or supported by the weight of
research conducted in compliance with accepted scientific
methods and--
(A) published in peer-reviewed journals, where
applicable; or
(B) comprising information that leading
professional organizations and agencies with relevant
expertise in the field recognize as accurate,
objective, and complete.
(5) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of the fiscal years 2019 through 2023.
SEC. 511. COMPREHENSIVE SEX EDUCATION PROGRAMS.
(a) Purposes; Finding; Sense of Congress.--
(1) Purposes.--The purposes of this Act are to provide
young people with comprehensive sex education programs that--
(A) promote and uphold the rights of young people
to information in order to make healthy decisions about
their sexual health;
(B) provide the information and skills all young
people need to make informed, responsible, and healthy
decisions in order to become sexually healthy adults
and have healthy relationships;
(C) provide information about the prevention of
unintended pregnancy, sexually transmitted infections,
including HIV, dating violence, sexual assault,
bullying, and harassment; and
(D) provide resources and information on topics
ranging from gender stereotyping and gender roles and
stigma and socio-cultural influences surrounding sex
and sexuality.
(2) Finding on required resources.--In order to provide the
comprehensive sex education described in paragraph (1),
Congress finds that increased resources are required for sex
education programs that--
(A) substantially incorporate elements of evidence-
based programs or characteristics of effective
programs;
(B) cover a broad range of topics, including
medically accurate and complete information that is age
and developmentally appropriate about all the aspects
of sex, sexual health, and sexuality;
(C) are gender and gender identity-sensitive,
emphasizing the importance of equality and the social
environment for achieving sexual and reproductive
health and overall well-being;
(D) promote educational achievement, critical
thinking, decisionmaking, self-esteem, and self-
efficacy;
(E) help develop healthy attitudes and insights
necessary for understanding relationships between
oneself and others and society;
(F) foster leadership skills and community
engagement by--
(i) promoting principles of fairness, human
dignity, and respect; and
(ii) engaging young people as partners in
their communities; and
(G) are culturally and linguistically appropriate,
reflecting the diverse circumstances and realities of
young people.
(3) Sense of congress.--It is the sense of Congress that--
(A) federally funded sex education programs should
aim to--
(i) provide information about a range of
human sexuality topics, including--
(I) human development, healthy
relationships, personal skills;
(II) sexual behavior including
abstinence;
(III) sexual health including
preventing unintended pregnancy;
(IV) sexually transmitted
infections including HIV; and
(V) society and culture;
(ii) promote safe and healthy
relationships;
(iii) promote gender equity;
(iv) use, and be informed by, the best
scientific information available;
(v) be culturally appropriate and inclusive
of youth with varying gender identities, gender
expressions, and sexual orientations;
(vi) be built on characteristics of
effective programs;
(vii) expand the existing body of research
on comprehensive sex education programs through
program evaluation;
(viii) expand training programs for
teachers of comprehensive sex education;
(ix) build on programs funded under section
513 of the Social Security Act (42 U.S.C. 713)
and the Office of Adolescent Health's Teen
Pregnancy Prevention Program, funded under
title II of the Consolidated Appropriations
Act, 2010 (Public Law 111-117; 123 Stat.), and
on programs supported through the Centers for
Disease Control and Prevention (CDC); and
(x) promote and uphold the rights of young
people to information in order to make healthy
and autonomous decisions about their sexual
health; and
(B) no Federal funds should be used for health
education programs that--
(i) withhold health-promoting or life-
saving information about sexuality-related
topics, including HIV;
(ii) are medically inaccurate or have been
scientifically shown to be ineffective;
(iii) promote gender or racial stereotypes;
(iv) are insensitive and unresponsive to
the needs of sexually active young people;
(v) are insensitive and unresponsive to the
needs of survivors of sexual violence;
(vi) are insensitive and unresponsive to
the needs of youth of all physical,
developmental, and mental abilities;
(vii) are insensitive and unresponsive to
the needs of youth with varying gender
identities, gender expressions, and sexual
orientations; or
(viii) are inconsistent with the ethical
imperatives of medicine and public health.
(b) Grants for Comprehensive Sex Education for Adolescents.--
(1) Program authorized.--The Secretary of Health and Human
Services, in coordination with the Associate Commissioner of
the Family and Youth Services Bureau of the Administration on
Children, Youth, and Families of the Department of Health and
Human Services, the Director of the Office of Adolescent
Health, the Director of the Division of Adolescent and School
Health within the Centers for Disease Control and Prevention
and the Secretary of Education, shall award grants, on a
competitive basis, to eligible entities to enable such eligible
entities to carry out programs that provide adolescents with
comprehensive sex education, as described in paragraph (6).
(2) Duration.--Grants awarded under this section shall be
for a period of 5 years.
(3) Eligible entity.--In this section, the term ``eligible
entity'' means a public or private entity that focuses on
adolescent health and education or has experience working with
adolescents.
(4) Applications.--An eligible entity desiring a grant
under this section shall submit an application to the Secretary
at such time, in such manner, and containing such information
as the Secretary may require, including an assurance to
participate in the evaluation described in subsection (e).
(5) Priority.--In awarding grants under this section, the
Secretary shall give priority to eligible entities that--
(A) are State or local public entities;
(B) are entities not currently receiving funds
under--
(i) section 513 of the Social Security Act
(42 U.S.C. 713);
(ii) the Office of Adolescent Health's Teen
Pregnancy Prevention Program, funded under
title II of the Consolidated Appropriations
Act, 2010 (Public Law-117; 123 Stat. 3253), or
any substantially similar successive program;
or
(iii) the Centers for Disease Control and
Prevention's Division of Adolescent and School
Health; and
(C) address health inequities among young people
that face systemic barriers resulting in
disproportionate rates of not less than one of the
following:
(i) Unintended pregnancies.
(ii) Sexually transmitted infections,
including HIV.
(iii) Dating violence and sexual violence.
(6) Use of funds.--
(A) In general.--Each eligible entity that receives
a grant under this section shall use the grant funds to
carry out an education program that provides
adolescents with comprehensive sex education that--
(i) is age and developmentally appropriate;
(ii) is medically accurate and complete;
(iii) substantially incorporates elements
of evidence-based sex education instruction; or
(iv) creates a demonstration project based
on characteristics of effective programs.
(B) Contents of comprehensive sex education
programs.--The comprehensive sex education programs
funded under this section shall include instruction and
materials that address--
(i) the physical, social, and emotional
changes of human development including, human
anatomy, reproduction, and sexual development;
(ii) healthy relationships, including
friendships, within families, and society, that
are based on mutual respect, and the ability to
distinguish between healthy and unhealthy
relationships, including--
(I) effective communication,
negotiation and refusal skills,
including the skills to recognize and
report inappropriate or abusive sexual
advances;
(II) bodily autonomy, setting and
respecting personal boundaries,
practicing personal safety, and
consent; and
(III) the limitations and harm of
gender-role stereotypes, violence,
coercion, bullying, harassment, and
intimidation in relationships;
(iii) healthy decisionmaking skills about
sexuality and relationships that include--
(I) critical thinking, problem
solving, self-efficacy, stress-
management, self-care, and
decisionmaking;
(II) individual values and
attitudes;
(III) the promotion of positive
body images;
(IV) developing an understanding
that there are a range of body types
and encouraging positive feeling about
students' own body types;
(V) information on how to respect
others and ensure safety on the
internet and when using other forms of
digital communication;
(VI) information on local services
and resources where students can obtain
additional information related to
bullying, harassment, dating violence
and sexual assault, suicide prevention,
and other related care;
(VII) encouragement for youth to
communicate with their parents or
guardians, health and social service
professionals, and other trusted adults
about sexuality and intimate
relationships;
(VIII) information on how to create
a safe environment for all students and
others in society;
(IX) examples of varying types of
relationships, couples, and family
structures; and
(X) affirmative representation of
varying gender identities, gender
expressions, and sexual orientations,
including individuals and relationships
between same sex couples and their
families;
(iv) abstinence, delaying age of first
sexual activity, the use of condoms, preventive
medication, vaccination, birth control, and
other sexually transmitted infection prevention
measures, and the options for pregnancy,
including parenting, adoption, and abortion,
including--
(I) the importance of effectively
using condoms, preventive medication,
and applicable vaccinations to protect
against sexually transmitted
infections, including HIV;
(II) the benefits of effective
contraceptive and condom use in
avoiding unintended pregnancy;
(III) the relationship between
substance use and sexual health and
behaviors; and
(IV) information about local health
services where students can obtain
additional information and services
related to sexual and reproductive
health and other related care;
(v) through affirmative recognition, the
roles that traditions, values, religion, norms,
gender roles, acculturation, family structure,
health beliefs, and political power play in how
students make decisions that affect their
sexual health, using examples of various types
of races, ethnicities, cultures, and families,
including single-parent households and young
families;
(vi) information about gender identity,
gender expression, and sexual orientation for
all students, including--
(I) affirmative recognition that
people have different gender
identities, gender expressions, and
sexual orientations; and
(II) community resources that can
provide additional support for
individuals with varying gender
identities, gender expressions, and
sexual orientations; and
(vii) opportunities to explore the roles
that race, ethnicity, immigration status,
disability status, economic status,
homelessness, foster care status, and language
within different communities affect sexual
attitudes in society and culture and how this
may impact student sexual health.
(c) Grants for Comprehensive Sex Education at Institutions of
Higher Education.--
(1) Program authorized.--The Secretary, in coordination
with the Secretary of Education, shall award grants, on a
competitive basis, to institutions of higher education or
consortia of such institutions to enable such institutions to
provide young people with comprehensive sex education,
described in paragraph (5)(B).
(2) Duration.--Grants awarded under this section shall be
for a period of 5 years.
(3) Applications.--An institution of higher education or
consortia of such institutions desiring a grant under this
section shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may require, including an assurance to participate in
the evaluation described in subsection (e).
(4) Priority.--In awarding grants under this section, the
Secretary shall give priority to an institution of higher
education that--
(A) has an enrollment of needy students as defined
in section 318(b) of the Higher Education Act of 1965
(20 U.S.C. 1059e(b));
(B) is a Hispanic-serving institution, as defined
in section 502(a) of such Act (20 U.S.C. 1101a(a));
(C) is a Tribal College or University, as defined
in section 316(b) of such Act (20 U.S.C. 1059c(b));
(D) is an Alaska Native-serving institution, as
defined in section 317(b) of such Act (20 U.S.C.
1059d(b));
(E) is a Native Hawaiian-serving institution, as
defined in section 317(b) of such Act (20 U.S.C.
1059d(b));
(F) is a Predominately Black Institution, as
defined in section 318(b) of such Act (20 U.S.C.
1059e(b));
(G) is a Native American-serving, nontribal
institution, as defined in section 319(b) of such Act
(20 U.S.C. 1059f(b));
(H) is an Asian American and Native American
Pacific Islander-serving institution, as defined in
section 320(b) of such Act (20 U.S.C. 1059g(b)); or
(I) is a minority institution, as defined in
section 365 of such Act (20 U.S.C. 1067k), with an
enrollment of needy students, as defined in section 312
of such Act (20 U.S.C. 1058).
(5) Uses of funds.--
(A) In general.--An institution of higher education
receiving a grant under this section shall use grant
funds to integrate issues relating to comprehensive sex
education into institution of higher education in order
to reach a large number of students, by carrying out
one or more of the following activities:
(i) Developing or adopting educational
content for issues relating to comprehensive
sex education that will be incorporated into
student orientation, general education, or core
courses.
(ii) Developing or adopting, and
implementing schoolwide educational programming
outside of class that delivers elements of
comprehensive sex education programs to
students, faculty, and staff.
(iii) Developing or adopting innovative
technology-based approaches to deliver sex
education to students, faculty, and staff.
(iv) Developing or adopting, and
implementing peer-outreach and education
programs to generate discussion, educate, and
raise awareness among students about issues
relating to comprehensive sex education.
(B) Contents of sex education programs.--Each
institution of higher education's program of
comprehensive sex education funded under this section
shall include instruction and materials that address
the requirements under paragraph 6.
(d) Grants for Pre-Service and In-Service Teacher Training.--
(1) Program authorized.--The Secretary, in coordination
with the Director of the Centers for Disease Control and
Prevention and the Secretary of Education, shall award grants,
on a competitive basis, to eligible entities to enable such
eligible entities to carry out the activities described in
paragraph (5).
(2) Duration.--Grants awarded under this section shall be
for a period of 5 years.
(3) Eligible entity.--In this section, the term ``eligible
entity'' means--
(A) a State educational agency, as defined in
section 8101 of the Elementary and Secondary Education
of 1965 (20 U.S.C. 7801);
(B) a local educational agency, as defined in
section 8101 of the Elementary and Secondary Education
of 1965 (20 U.S.C. 7801);
(C) a Tribe or Tribal organization, as defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304);
(D) a State or local department of health;
(E) a State or local department of education;
(F) an educational service agency, as defined in
section 8101 of the Elementary and Secondary Education
of 1965 (20 U.S.C. 7801);
(G) a nonprofit institution of higher education, as
defined in section 101 of the Higher Education Act of
1965 (20 U.S.C. 1001);
(H) a national or statewide nonprofit organization
that has as its primary purpose the improvement of
provision of comprehensive sex education through
training and effective teaching of comprehensive sex
education; or
(I) a consortium of nonprofit organizations that
has as its primary purpose the improvement of provision
of comprehensive sex education through training and
effective teaching of comprehensive sex education.
(4) Application.--An eligible entity desiring a grant under
this section shall submit an application to the Secretary at
such time, in such manner, and containing such information as
the Secretary may require, including an assurance to
participate in the evaluation described in subsection (e).
(5) Authorized activities.--
(A) Required activity.--Each eligible entity
receiving a grant under this section shall use grant
funds for professional development and training of
relevant faculty, school administrators, teachers, and
staff, in order to increase effective teaching of
comprehensive sex education students.
(B) Permissible activities.--Each eligible entity
receiving a grant under this section may use grant
funds to--
(i) provide research-based training of
teachers for comprehensive sex education for
adolescents as a means of broadening student
knowledge about issues related to human
development, healthy relationships, personal
skills, and sexual behavior, including
abstinence, sexual health, and society and
culture;
(ii) support the dissemination of
information on effective practices and research
findings concerning the teaching of
comprehensive sex education;
(iii) support research on--
(I) effective comprehensive sex
education teaching practices; and
(II) the development of assessment
instruments and strategies to
document--
(aa) student understanding
of comprehensive sex education;
and
(bb) the effects of
comprehensive sex education;
(iv) convene national conferences on
comprehensive sex education, in order to
effectively train teachers in the provision of
comprehensive sex education; and
(v) develop and disseminate appropriate
research-based materials to foster
comprehensive sex education.
(C) Subgrants.--Each eligible entity receiving a
grant under this section may award subgrants to
nonprofit organizations that possess a demonstrated
record of providing training to faculty, school
administrators, teachers, and staff on comprehensive
sex education to--
(i) train teachers in comprehensive sex
education;
(ii) support Internet or distance learning
related to comprehensive sex education;
(iii) promote rigorous academic standards
and assessment techniques to guide and measure
student performance in comprehensive sex
education;
(iv) encourage replication of best
practices and model programs to promote
comprehensive sex education;
(v) develop and disseminate effective,
research-based comprehensive sex education
learning materials;
(vi) develop academic courses on the
pedagogy of sex education at institutions of
higher education; or
(vii) convene State-based conferences to
train teachers in comprehensive sex education
and to identify strategies for improvement.
(e) Impact Evaluation and Reporting.--
(1) Multi-year evaluation.--
(A) In general.--Not later than 6 months after the
date of the enactment of this Act, the Secretary shall
enter into a contract with a nonprofit organization
with experience in conducting impact evaluations, to
conduct a multi-year evaluation on the impact of the
grants under subsections (b), (c), and (d), and to
report to Congress and the Secretary on the findings of
such evaluation.
(B) Evaluation.--The evaluation conducted under
this subsection shall--
(i) be conducted in a manner consistent
with relevant, nationally recognized
professional and technical evaluation
standards;
(ii) use sound statistical methods and
techniques relating to the behavioral sciences,
including quasi-experimental designs,
inferential statistics, and other methodologies
and techniques that allow for conclusions to be
reached;
(iii) be carried out by an independent
organization that has not received a grant
under subsection (b), (c), or (d); and
(iv) be designed to provide information
on--
(I) output measures, such as the
number of individuals served under the
grant and the number of hours of
instruction;
(II) outcome measures, including
measures relating to--
(aa) the knowledge that
individuals participating in
the grant program have gained
in each of the following age
and developmentally appropriate
areas--
(AA) growth and
development;
(BB) relationship
dynamics;
(CC) ways to
prevent unintended
pregnancy and sexually
transmitted infections,
including HIV; and
(DD) sexual health;
(bb) the age and
developmentally appropriate
skills that individuals
participating in the grant
program have gained regarding--
(AA) negotiation
and communication;
(BB) decisionmaking
and goal-setting;
(CC) interpersonal
skills and healthy
relationships; and
(DD) condom use;
and
(cc) the behaviors of
adolescents participating in
the grant program, including
data about--
(AA) age of first
intercourse;
(BB) condom and
contraceptive use at
first intercourse;
(CC) recent condom
and contraceptive use;
(DD) substance use;
(EE) dating abuse
and lifetime history of
sexual assault, dating
violence, bullying,
harassment, stalking;
and
(FF) academic
performance; and
(III) other measures necessary to
evaluate the impact of the grant
program.
(C) Report.--Not later than 6 years after the date
of enactment of this Act, the organization conducting
the evaluation under this subsection shall prepare and
submit to the appropriate committees of Congress and
the Secretary an evaluation report. Such report shall
be made publicly available, including on the website of
the Department of Health and Human Services.
(2) Secretary's report to congress.--Not later than 1 year
after the date of the enactment of this Act, and annually
thereafter for a period of 5 years, the Secretary shall prepare
and submit to the appropriate committees of Congress a report
on the activities to provide adolescents and young people with
comprehensive sex education and pre-service and in-service
teacher training funded under this Act. The Secretary's report
to Congress shall include--
(A) a statement of how grants awarded by the
Secretary meet the purposes described in subsection
(a)(1); and
(B) information about--
(i) the number of eligible entities and
institutions of higher education that are
receiving grant funds under subsections (b),
(c), and (d);
(ii) the specific activities supported by
grant funds awarded under subsections (b), (c),
and (d);
(iii) the number of adolescents served by
grant programs funded under subsection (b);
(iv) the number of young people served by
grant programs funded under subsection (c);
(v) the number of faculty, school
administrators, teachers, and staff trained
under subsection (d); and
(vi) the status of the evaluation required
under paragraph (1).
(f) Nondiscrimination.--Programs funded under this Act shall not
discriminate on the basis of actual or perceived sex, race, color,
ethnicity, national origin, disability, sexual orientation, gender
identity, or religion. Nothing in this Act shall be construed to
invalidate or limit rights, remedies, procedures, or legal standards
available under any other Federal law or any law of a State or a
political subdivision of a State, including the Civil Rights Act of
1964 (42 U.S.C. 2000a et seq.), title IX of the Education Amendments of
1972 (20 U.S.C. 1681 et seq.), section 504 of the Rehabilitation Act of
1973 (29 U.S.C. 794), the Americans with Disabilities Act of 1990 (42
U.S.C. 12101 et seq.), and section 1557 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18116).
(g) Limitation.--No Federal funds provided under this Act may be
used for health education programs that--
(1) withhold health-promoting or life-saving information
about sexuality-related topics, including HIV;
(2) are medically inaccurate or have been scientifically
shown to be ineffective;
(3) promote gender or racial stereotypes;
(4) are insensitive and unresponsive to the needs of
sexually active young people;
(5) are insensitive and unresponsive to the needs of
pregnant or parenting young people;
(6) are insensitive and unresponsive to the needs of
survivors of sexual abuse or assault;
(7) are insensitive and unresponsive to the needs of youth
of all physical, developmental, or mental abilities;
(8) are insensitive and unresponsive to individuals with
varying gender identities, gender expressions, and sexual
orientations; or
(9) are inconsistent with the ethical imperatives of
medicine and public health.
(h) Amendments to Other Laws.--
(1) Amendment to the public health service act.--Section
2500 of the Public Health Service Act (42 U.S.C. 300ee) is
amended by striking subsections (b) through (d) and inserting
the following:
``(b) Contents of Programs.--All programs of education and
information receiving funds under this subchapter shall include
information about the potential effects of intravenous substance
abuse.''.
(2) Amendments to the elementary and secondary education
act of 1965.--Section 8526 of the Elementary and Secondary
Education Act of (20 U.S.C. 7906) is amended--
(A) by striking paragraph (3);
(B) by redesignating paragraphs (4) and (5) as
paragraphs (3) and (4), respectively;
(C) in paragraph (4), by inserting ``or'' after the
semicolon;
(D) in paragraph (5), by striking ``; or'' and
inserting a period; and
(E) by striking paragraph (6).
(i) Definitions.--In this section:
(1) Adolescents.--The term ``adolescents'' means
individuals who are ages 10 through 19 at the time of
commencement of participation in a program supported under this
section.
(2) Age and developmentally appropriate.--The term ``age
and developmentally appropriate'' means topics, messages, and
teaching methods suitable to particular age, age group of
children and adolescents, or developmental levels, based on
cognitive, emotional, social, and behavioral capacity of most
students at that age level.
(3) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means the Committee on
Health, Education, Labor, and Pensions of the Senate, the
Committee on Appropriations of the Senate, the Committee on
Energy and Commerce of the House of Representatives, the
Committee on Education and the Workforce of the House of
Representatives, and the Committee on Appropriations of the
House of Representatives.
(4) Characteristics of effective programs.--The term
``characteristics of effective programs'' means the aspects of
evidence-based programs, including development, content, and
implementation of such programs, that--
(A) have been shown to be effective in terms of
increasing knowledge, clarifying values and attitudes,
increasing skills, and impacting upon behavior; and
(B) are widely recognized by leading medical and
public health agencies to be effective in changing
sexual behaviors that lead to sexually transmitted
infections, including HIV, unintended pregnancy, and
dating violence and sexual assault among young people.
(5) Comprehensive sex education.--The term ``comprehensive
sex education'' means instructional part of a comprehensive
school health education approach which addresses the physical,
mental, emotional, and social dimensions of human sexuality;
designed to motivate and assist students to maintain and
improve their sexual health, prevent disease and reduce sexual
health-related risk behaviors; and enable and empower students
to develop and demonstrate age and developmentally appropriate
sexuality and sexual health-related knowledge, attitudes,
skills, and practices.
(6) Consent.--The term ``consent'' means affirmative,
conscious, and voluntary agreement to engage in interpersonal,
physical, or sexual activity.
(7) Culturally appropriate.--The term ``culturally
appropriate'' means materials and instruction that respond to
culturally diverse individuals, families and communities in an
inclusive, respectful and effective manner; including materials
and instruction that are inclusive of race, ethnicity,
languages, cultural background, religion, sex, gender identity,
sexual orientation, and different abilities.
(8) Evidence-based.--The term ``evidence-based'', when used
with respect to sex education instruction means a sex education
program that has been proven through rigorous evaluation to be
effective in changing sexual behavior or incorporates elements
of other programs that have been proven to be effective in
changing sexual behavior.
(9) Gender expression.--The term ``gender expression'',
when used with respect to a sex education program, means the
expression of one's gender, such as through behavior, clothing,
haircut, or voice, and which may or may not conform to socially
defined behaviors and characteristics typically associated with
being either masculine or feminine.
(10) Gender identity.--Except with respect to section 7,
the term ``gender identity'', when used with respect to a sex
education program, means the gender-related identity,
appearance, mannerisms, or other gender-related characteristics
of an individual, regardless of the individual's designated sex
at birth including a person's deeply held sense or knowledge of
their own gender; such as male, female, both or neither.
(11) Inclusive.--The term ``inclusive'', when used with
respect to a sex education program, means curriculum that
ensures that students from historically marginalized
communities are reflected in classroom materials and lessons.
(12) Institution of higher education.--The term
``institution of higher education'' has the meaning given the
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
(13) Medically accurate and complete.--The term ``medically
accurate and complete'', when used with respect to a sex
education program, means that--
(A) the information provided through the program is
verified or supported by the weight of research
conducted in compliance with accepted scientific
methods and is published in peer-reviewed journals,
where applicable; or
(B)(i) the program contains information that
leading professional organizations and agencies with
relevant expertise in the field recognize as accurate,
objective, and complete; and
(ii) the program does not withhold information
about the effectiveness and benefits of correct and
consistent use of condoms and other contraceptives.
(14) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(15) Sexual development.--The term ``sexual development''
means the lifelong process of physical, behavioral, cognitive,
and emotional growth and change as it relates to an
individual's sexuality and sexual maturation, including
puberty, identity development, socio-cultural influences, and
sexual behaviors.
(16) Sexual orientation.--Except with respect to subsection
(g), the term ``sexual orientation'', when used with respect to
a sex education program, means an individual's attraction,
including physical or emotional, to the same or different
gender.
(17) Young people.--The term ``young people'' means
individuals who are ages 10 through 24 at the time of
commencement of participation in a program supported under this
Act.
(j) Funding.--
(1) Appropriation.--For the purpose of carrying out this
Act, there is appropriated $75,000,000 for each of fiscal years
2019 through 2024. Amounts appropriated under this subsection
shall remain available until expended.
(2) Reservations of funds.--
(A) The Secretary shall reserve 50 percent of the
amount appropriated under paragraph (1) for the
purposes of awarding grants for comprehensive sex
education for adolescents under subsection (c).
(B) The Secretary shall reserve 25 percent of the
amount appropriated under paragraph (1) for the
purposes of awarding grants for comprehensive sex
education at institutes of higher education under
subsection (d).
(C) The Secretary shall reserve 20 percent of the
amount appropriated under paragraph (1) for the
purposes of awarding grants for pre-service and in-
service teacher training under subsection (e).
(D) The Secretary shall reserve 2 percent of the
amount appropriated under paragraph (1) for the purpose
of carrying out the impact evaluation and reporting
required under subsection (a).
(3) Secretarial responsibilities.--The Secretary shall
reserve 3 percent of the amount appropriated under subsection
(a) for each fiscal year for expenditures by the Secretary to
provide, directly or through a competitive grant process,
research, training, and technical assistance, including
dissemination of research and information regarding effective
and promising practices, providing consultation and resources,
and developing resources and materials to support the
activities of recipients of grants. In carrying out such
functions, the Secretary shall collaborate with a variety of
entities that have expertise in adolescent sexual health
development, education, and promotion.
(4) Reprogramming of abstinence only until marriage program
funding.--The unobligated balance of funds made available to
carry out section 510 of the Social Security Act (42 U.S.C.
710) (as in effect on the day before the date of enactment of
this Act) are hereby transferred and shall be used by the
Secretary to carry out this Act. The amounts transferred and
made available to carry out this Act shall remain available
until expended.
(5) Repeal of abstinence only until marriage program.--
Section 510 of the Social Security Act (42 U.S.C. 710 et seq.)
is repealed.
SEC. 512. COMPASSIONATE ASSISTANCE FOR RAPE EMERGENCIES.
(a) Medicare.--
(1) Limitation on payment.--Section 1866(a)(1) of the
Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
(A) in the subparagraph (W) added by section
3005(1)(C) of Public Law 111-148--
(i) by striking the period at the end and
inserting a comma;
(ii) by moving the indentation 2 ems to the
left; and
(iii) by moving such subparagraph to
immediately follow subparagraph (V);
(B) in the subparagraph (W) added by section
6406(b)(3) of Public Law 111-148--
(i) by striking the period at the end and
inserting ``, and'';
(ii) by moving the indentation 2 ems to the
left;
(iii) by redesignating such subparagraph as
subparagraph (X); and
(iv) by moving such subparagraph to
immediately follow subparagraph (W), as moved
under paragraph (2)(C); and
(C) by inserting after the subparagraph (X), as
redesignated and moved under paragraph (3), the
following:
``(Y) in the case of a hospital or critical access
hospital, to adopt and enforce a policy to ensure
compliance with the requirements of subsection (l) and
to meet the requirements of such subsection.''.
(2) Assistance to victims.--Section 1866 of the Social
Security Act (42 U.S.C. 1395cc) is amended by adding at the end
the following new subsection:
``(l) Compassionate Assistance for Rape Emergencies.--
``(1) In general.--For purposes of section 1866(a)(1)(Y), a
hospital meets the requirements of this subsection if the
hospital provides each of the services described in paragraph
(2) to each individual, whether or not eligible for benefits
under this title or under any other form of health insurance.
who comes to the hospital on or after January 1, 2019, and--
``(A) who states to hospital personnel that they
are victims of sexual assault;
``(B) who is accompanied by an individual who
states to hospital personnel that the individual is a
victim of sexual assault; or
``(C) whom hospital personnel, during the course of
treatment and care for the individual, have reason to
believe is a victim of sexual assault.
``(2) Required services described.--For purposes of
paragraph (1), the services described in this subparagraph are
the following:
``(A) Provision of medically and factually accurate
and unbiased written and oral information about
emergency contraception that--
``(i) is written in clear and concise
language;
``(ii) is readily comprehensible;
``(iii) includes an explanation that--
``(I) emergency contraception has
been approved by the Food and Drug
Administration as an over-the-counter
or prescription medication for
individuals, and is a safe and
effective way to prevent pregnancy
after unprotected intercourse or
contraceptive failure if taken in a
timely manner;
``(II) emergency contraception is
more effective the sooner it is taken;
and
``(III) emergency contraception
does not cause an abortion and cannot
interrupt an established pregnancy;
``(iv) meets such conditions regarding the
provision of such information in languages
other than English as the Secretary may
establish; and
``(v) is provided without regard to the
ability of the individual or their family to
pay costs associated with the provision of such
information to the individual.
``(B) Immediate offer to provide emergency
contraception to the individual at the hospital and, in
the case that the individual accepts such offer,
immediate provision to the individual of such
contraception on the same day it is requested without
regard to the inability of the individual or their
family to pay costs associated with the offer and
provision of such contraception.
``(C) Development and implementation of a written
policy to ensure that an individual is present at the
hospital, or on-call, who--
``(i) has authority to dispense or
prescribe emergency contraception,
independently, or under a protocol prepared by
a physician for the administration of emergency
contraception at the hospital to a victim of
sexual assault; and
``(ii) is trained to comply with the
requirements of this section.
``(D) Provision of medically and factually accurate
and unbiased written and oral information and
counseling about post-exposure prophylaxis (PEP)
protocol for the prevention of HIV.
``(E) Immediately offer to begin PEP to the
individual at the hospital except in cases where the
medical professional's best judgement is that further
evaluation is required or that such a regimen will be
substantially detrimental to the individual's health.
Such provision shall be offered regardless of the
individual's ability to pay. Hospitals shall be
responsible for ensuring adequate supply of PEP
medications to provide to patients.
``(3) Definitions.--For purposes of this paragraph:
``(A) The term `emergency contraception' means a
drug or device (as such terms are defined in section
201 of the Federal Food, Drug, and Cosmetic Act (21
U.S.C. 321)) or a drug regimen that--
``(i) is used postcoitally;
``(ii) prevents pregnancy primarily by
preventing or delaying ovulation, and does not
terminate an established pregnancy; and
``(iii) is approved by the Food and Drug
Administration.
``(B) The term `hospital' includes a critical
access hospital, as defined in section 1861(mm)(1).
``(C) The term `sexual assault' means coitus in
which the individual involved does not consent or lacks
the legal capacity to consent.''.
(b) Limitation on Payment Under Medicaid.--Section 1903(i) of the
Social Security Act (42 U.S.C. 1396b(i)) is amended by inserting after
paragraph (11) the following new paragraph:
``(12) with respect to any amount expended for care or
services furnished under the plan by a hospital on or after
January 1, 2017, unless such hospital meets the requirements
specified in section 1866(l) for purposes of title XVIII.''.
SEC. 513. ACCESS TO BIRTH CONTROL DUTIES OF PHARMACIES TO ENSURE
PROVISION OF FDA-APPROVED CONTRACEPTION.
Part B of title II of the Public Health Service Act (42 U.S.C. 238
et seq.) is amended by adding at the end the following:
``SEC. 249. DUTIES OF PHARMACIES TO ENSURE PROVISION OF FDA-APPROVED
CONTRACEPTION.
``(a) In General.--Subject to subsection (c), a pharmacy that
receives Food and Drug Administration-approved drugs or devices in
interstate commerce shall maintain compliance with the following:
``(1) If a customer requests a contraceptive, including
emergency contraception, that is in stock, the pharmacy shall
ensure that the contraceptive is provided to the customer--
``(A) without delay;
``(B) without regard to the customer's age, gender,
gender identity, or sexual orientation;
``(C) without a requirement that identification be
presented; and
``(D) despite any conflicts of employees to filling
a prescription and dispensing a particular prescription
drug or device due to sincerely held moral,
philosophical, or religious beliefs.
``(2) If a customer requests a contraceptive that is not in
stock and the pharmacy in the normal course of business stocks
contraception, the pharmacy shall immediately inform the
customer that the contraceptive is not in stock and without
delay offer the customer the following options:
``(A) If the customer prefers to obtain the
contraceptive through a referral or transfer, the
pharmacy shall--
``(i) locate a pharmacy of the customer's
choice or the closest pharmacy confirmed to
have the contraceptive in stock; and
``(ii) refer the customer or transfer the
prescription to that pharmacy.
``(B) If the customer prefers for the pharmacy to
order the contraceptive, the pharmacy shall obtain the
contraceptive under the pharmacy's standard procedure
for expedited ordering of medication and notify the
customer when the contraceptive arrives.
``(3) The pharmacy shall ensure that its employees do not--
``(A) intimidate, threaten, or harass customers in
the delivery of services relating to a request for
contraception;
``(B) interfere with or obstruct the delivery of
services relating to a request for contraception;
``(C) intentionally misrepresent or deceive
customers about the availability of contraception or
its mechanism of action;
``(D) breach medical confidentiality with respect
to a request for contraception or threaten to breach
such confidentiality; or
``(E) refuse to return a valid, lawful prescription
for contraception upon customer request.
``(b) Contraceptives Not Ordinarily Stocked.--Nothing in subsection
(a)(2) shall be construed to require any pharmacy to comply with such
subsection if the pharmacy does not ordinarily stock contraceptives in
the normal course of business.
``(c) Refusals Pursuant to Standard Pharmacy Practice.--This
section does not prohibit a pharmacy from refusing to provide a
contraceptive to a customer in accordance with any of the following:
``(1) If it is unlawful to dispense the contraceptive to
the customer without a valid, lawful prescription and no such
prescription is presented.
``(2) If the customer is unable to pay for the
contraceptive.
``(3) If the employee of the pharmacy refuses to provide
the contraceptive on the basis of a professional clinical
judgment.
``(d) Rule of Construction.--Nothing in this section shall be
construed to invalidate or limit rights, remedies, procedures, or legal
standards under title VII of the Civil Rights Act of 1964.
``(e) Preemption.--This section does not preempt any provision of
State law or any professional obligation made applicable by a State
board or other entity responsible for licensing or discipline of
pharmacies or pharmacists, to the extent that such State law or
professional obligation provides protections for customers that are
greater than the protections provided by this section.
``(f) Enforcement.--
``(1) Civil penalty.--A pharmacy that violates a
requirement of subsection (a) is liable to the United States
for a civil penalty in an amount not exceeding $1,000 per day
of violation, not to exceed $100,000 for all violations
adjudicated in a single proceeding.
``(2) Private cause of action.--Any person aggrieved as a
result of a violation of a requirement of subsection (a) may,
in any court of competent jurisdiction, commence a civil action
against the pharmacy involved to obtain appropriate relief,
including actual and punitive damages, injunctive relief, and a
reasonable attorney's fee and cost.
``(3) Limitations.--A civil action under paragraph (1) or
(2) may not be commenced against a pharmacy after the
expiration of the 5-year period beginning on the date on which
the pharmacy allegedly engaged in the violation involved.
``(g) Definitions.--In this section:
``(1) The term `contraception' or `contraceptive' means any
drug or device approved by the Food and Drug Administration to
prevent pregnancy.
``(2) The term `employee' means a person hired, by contract
or any other form of an agreement, by a pharmacy.
``(3) The term `pharmacy' means an entity that--
``(A) is authorized by a State to engage in the
business of selling prescription drugs at retail; and
``(B) employs one or more employees.
``(4) The term `product' means a Food and Drug
Administration-approved drug or device.
``(5) The term `professional clinical judgment' means the
use of professional knowledge and skills to form a clinical
judgment, in accordance with prevailing medical standards.
``(6) The term `without delay', with respect to a pharmacy
providing, providing a referral for, or ordering contraception,
or transferring the prescription for contraception, means
within the usual and customary timeframe at the pharmacy for
providing, providing a referral for, or ordering other
products, or transferring the prescription for other products,
respectively.
``(h) Effective Date.--This section shall take effect on the 31st
day after the date of the enactment of this section, without regard to
whether the Secretary has issued any guidance or final rule regarding
this section.''.
SEC. 514. ADDITIONAL FOCUS AREA FOR THE OFFICE ON WOMEN'S HEALTH.
Section 229(b) of the Public Health Service Act (42 U.S.C. 237a(b))
is amended--
(1) in paragraph (6), at the end, by striking ``and'';
(2) in paragraph (7), at the end, by striking the period
and inserting a semicolon; and
(3) by adding at the end the following new paragraph:
``(8) facilitate policymakers, health system leaders and
providers, consumers, and other stakeholders in understanding
optimal maternity care and support for the provision of such
care, including the priorities of--
``(A) protecting, promoting, and supporting the
innate capacities of childbearing individuals and their
newborns for childbirth, breastfeeding, and attachment;
``(B) using obstetric interventions only when such
interventions are supported by strong, high-quality
evidence, and minimizing overuse of maternity practices
that have been shown to have benefit in limited
situations and that can expose women, infants, or both
to risk of harm if used routinely and indiscriminately,
including continuous electronic fetal monitoring, labor
induction, epidural analgesia, primary cesarean
section, and routine repeat cesarean birth;
``(C) reliably incorporating noninvasive, evidence-
based practices that have documented correlation with
considerable improvement in outcomes with no
detrimental side effects, such as smoking cessation
programs in pregnancy and proven models of group
prenatal care that integrate health assessment,
education, and support into a unified program and
supporting evidence-based breastfeeding promotion
efforts with respect for a breastfeeding individual's
personal decisionmaking;
``(D) a shared understanding of the qualifications
of licensed providers of maternity care and the best
evidence about the safety, satisfaction, outcomes, and
costs of their care, and appropriate deployment of such
caregivers within the maternity care workforce to
address the needs of childbearing individuals and
newborns and the growing shortage of maternity
caregivers;
``(E) a shared understanding of the results of the
best available research comparing hospital, birth
center, and planned home births, including information
about each setting's safety, satisfaction, outcomes,
and costs; and
``(F) high-quality, evidence-based childbirth
education that promotes a natural, healthy, and safe
approach to pregnancy, childbirth, and early parenting;
is taught by certified educators, peer counselors, and
health professionals; and promotes informed
decisionmaking by childbearing individual;''.
SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF
OPTIMAL MATERNITY OUTCOMES.
(a) In General.--Part A of title II of the Public Health Service
Act (42 U.S.C. 202 et seq.) is amended by adding at the end the
following new section:
``SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF
OPTIMAL MATERNITY OUTCOMES.
``(a) In General.--The Secretary of Health and Human Services,
acting through the Deputy Assistant Secretary for Women's Health under
section 229 and in collaboration with the Federal officials specified
in subsection (b), shall establish the Interagency Coordinating
Committee on the Promotion of Optimal Maternity Outcomes (referred to
in this subsection as the `ICCPOM').
``(b) Other Agencies.--The officials specified in this subsection
are the Secretary of Labor, the Secretary of Defense, the Secretary of
Veterans Affairs, the Surgeon General, the Director of the Centers for
Disease Control and Prevention, the Administrator of the Health
Resources and Services Agency, the Administrator of the Centers for
Medicare & Medicaid Services, the Director of the Indian Health
Service, the Administrator of the Substance Abuse and Mental Health
Services Administration, the Director of the National Institute on
Child Health and Development, the Director of the Agency for Healthcare
Research and Quality, the Assistant Secretary for Children and
Families, the Deputy Assistant Secretary for Minority Health, the
Director of the Office of Personnel Management, and such other Federal
officials as the Secretary of Health and Human Services determines to
be appropriate.
``(c) Chair.--The Deputy Assistant Secretary for Women's Health
shall serve as the chair of the ICCPOM.
``(d) Duties.--The ICCPOM shall guide policy and program
development across the Federal Government with respect to promotion of
optimal maternity care, provided, however, that nothing in this section
shall be construed as transferring regulatory or program authority from
an agency to the ICCPOM.
``(e) Consultations.--The ICCPOM shall actively seek the input of,
and shall consult with, all appropriate and interested stakeholders,
including State health departments, public health research and interest
groups, foundations, childbearing individuals and their advocates, and
maternity care professional associations and organizations, reflecting
racially, ethnically, demographically, and geographically diverse
communities.
``(f) Annual Report.--
``(1) In general.--The Secretary, on behalf of the ICCPOM,
shall annually submit to Congress a report that summarizes--
``(A) all programs and policies of Federal agencies
(including the Medicare Program under title XVIII of
the Social Security Act and the Medicaid program under
title XIX of such Act) designed to promote optimal
maternity care, focusing particularly on programs and
policies that support the adoption of evidence based
maternity care, as defined by timely, scientifically
sound systematic reviews;
``(B) all programs and policies of Federal agencies
(including the Medicare Program under title XVIII of
the Social Security Act and the Medicaid program under
title XIX of such Act) designed to address the problems
of maternal mortality and morbidity, infant mortality,
prematurity, and low birth weight, including such
programs and policies designed to address racial and
ethnic disparities with respect to each of such
problems;
``(C) the extent of progress in reducing maternal
mortality and infant mortality, low birth weight, and
prematurity at State and national levels; and
``(D) such other information regarding optimal
maternity care as the Secretary determines to be
appropriate.
The information specified in subparagraph (C) shall be included
in each such report in a manner that disaggregates such
information by race, ethnicity, and indigenous status in order
to determine the extent of progress in reducing racial and
ethnic disparities and disparities related to indigenous
status.
``(2) Certain information.--Each report under paragraph (1)
shall include information (disaggregated by race, ethnicity,
and indigenous status, as applicable) on the following rates
and costs by State:
``(A) The rate of primary cesarean deliveries and
repeat cesarean deliveries.
``(B) The rate of vaginal births after cesarean.
``(C) The rate of vaginal breech births.
``(D) The rate of induction of labor.
``(E) The rate of freestanding birth center births.
``(F) The rate of planned and unplanned home birth.
``(G) The rate of attended births by provider,
including by an obstetrician-gynecologist, family
practice physician, obstetrician-gynecologist physician
assistant, certified nurse-midwife, certified midwife,
and certified professional midwife.
``(H) The cost of maternity care disaggregated by
place of birth and provider of care, including--
``(i) uncomplicated vaginal birth;
``(ii) complicated vaginal birth;
``(iii) uncomplicated cesarean birth; and
``(iv) complicated cesarean birth.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated, in addition to amounts authorized to be appropriated
under section 229(e), to carry out this section $1,000,000 for each of
the fiscal years 2019 through 2023.''.
(b) Conforming Amendments.--
(1) Inclusion as duty of hhs office on women's health.--
Section 229(b) of such Act (42 U.S.C. 237a(b)), as amended by
section 514, is further amended by adding at the end the
following new paragraph:
``(9) establish the Interagency Coordinating Committee on
the Promotion of Optimal Maternity Outcomes in accordance with
section 229A; and''.
(2) Treatment of biennial reports.--Section 229(d) of such
Act (42 U.S.C. 237a(d)) is amended by inserting ``(other than
under subsection (b)(9))'' after ``under this section''.
SEC. 516. CONSUMER EDUCATION CAMPAIGN.
Section 229(b) of the Public Health Service Act (42 U.S.C.
237a(b)), as amended, is further amended by adding at the end the
following new paragraph:
``(10) not later than one year after the date of the
enactment of the Health Equity and Accountability Act of 2018,
develop and implement a 4-year culturally and linguistically
appropriate multimedia consumer education campaign that is
designed to promote understanding and acceptance of evidence-
based maternity practices and models of care for optimal
maternity outcomes among individuals of childbearing ages and
families of such individuals and that--
``(A) highlights the importance of protecting,
promoting, and supporting the innate capacities of
childbearing individuals and their newborns for
childbirth, breastfeeding, and attachment;
``(B) promotes understanding of the importance of
using obstetric interventions when medically necessary
and when supported by strong, high-quality evidence;
``(C) highlights the widespread overuse of
maternity practices that have been shown to have
benefit when used appropriately in situations of
medical necessity, but which can expose pregnant
individuals, infants, or both to risk of harm if used
routinely and indiscriminately, including continuous
fetal monitoring, labor induction, epidural anesthesia,
elective primary cesarean section, and repeat cesarean
delivery;
``(D) emphasizes the noninvasive maternity
practices that have strong proven correlation or may be
associated with considerable improvement in outcomes
with no detrimental side effects, and are significantly
underused in the United States, including smoking
cessation programs in pregnancy, group model prenatal
care, continuous labor support, nonsupine positions for
birth, and external version to turn breech babies at
term;
``(E) educates consumers about the qualifications
of licensed providers of maternity care and the best
evidence about their safety, satisfaction, outcomes,
and costs;
``(F) informs consumers about the best available
research comparing birth center births, planned home
births, and hospital births, including information
about each setting's safety, satisfaction, outcomes,
and costs;
``(G) fosters participation in high-quality,
evidence-based childbirth education that promotes a
natural, healthy, and safe approach to pregnancy,
childbirth, and early parenting; is taught by certified
educators, peer counselors, and health professionals;
and promotes informed decisionmaking by childbearing
individuals; and
``(H) is pilot tested for consumer comprehension,
cultural sensitivity, and acceptance of the messages
across geographically, racially, ethnically, and
linguistically diverse populations.''.
SEC. 517. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC REVIEWS FOR CARE OF
CHILDBEARING INDIVIDUALS AND NEWBORNS.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Health and Human Services,
through the Agency for Healthcare Research and Quality, shall--
(1) make publicly available an online bibliographic
database identifying systematic reviews, including an
explanation of the level and quality of evidence, for care of
childbearing individuals and newborns; and
(2) initiate regular updates that incorporate newly issued
and updated systematic reviews.
(b) Sources.--To aim for a comprehensive inventory of systematic
reviews relevant to maternal and newborn care, the database shall
identify reviews from diverse sources, including--
(1) scientific peer-reviewed journals;
(2) databases, including Cochrane Database of Systematic
Reviews, Clinical Evidence, and Database of Abstracts of
Reviews of Effects; and
(3) Internet Web sites of agencies and organizations
throughout the world that produce such systematic reviews.
(c) Features.--The database shall--
(1) provide bibliographic citations for each record within
the database, and for each such citation include an explanation
of the level and quality of evidence;
(2) include abstracts, as available;
(3) provide reference to companion documents as may exist
for each review, such as evidence tables and guidelines or
consumer educational materials developed from the review;
(4) provide links to the source of the full review and to
any companion documents;
(5) provide links to the source of a previous version or
update of the review;
(6) be searchable by intervention or other topic of the
review, reported outcomes, author, title, and source; and
(7) offer to users periodic electronic notification of
database updates relating to users' topics of interest.
(d) Outreach.--Not later than the first date the database is made
publicly available and periodically thereafter, the Secretary of Health
and Human Services shall publicize the availability, features, and uses
of the database under this section to the stakeholders described in
subsection (e).
(e) Consultation.--For purposes of developing the database under
this section and maintaining and updating such database, the Secretary
of Health and Human Services shall convene and consult with an advisory
committee composed of relevant stakeholders, including--
(1) Federal Medicaid administrators and State agencies
administrating State plans under title XIX of the Social
Security Act pursuant to section 1902(a)(5) of such Act (42
U.S.C. 1396a(a)(5));
(2) providers of maternity and newborn care from both
academic and community-based settings, including obstetrician-
gynecologists, family physicians, certified nurse midwives,
certified midwives, certified professional midwives, physician
assistants, perinatal nurses, pediatricians, and nurse
practitioners;
(3) maternal-fetal medicine specialists;
(4) neonatologists;
(5) childbearing individuals and advocates for such
individuals, including childbirth educators certified by a
nationally accredited program, representing communities that
are diverse in terms of race, ethnicity, indigenous status, and
geographic area;
(6) employers and purchasers;
(7) health facility and system leaders, including both
hospital and birth center facilities;
(8) journalists; and
(9) bibliographic informatics specialists.
(f) Authorization of Appropriations.--There is authorized to be
appropriated $2,500,000 for each of the fiscal years 2019 through 2021
for the purpose of developing the database and such sums as may be
necessary for each subsequent fiscal year for updating the database and
providing outreach and notification to users, as described in this
section.
SEC. 518. MATERNITY CARE HEALTH PROFESSIONAL SHORTAGE AREAS.
Section 332 of the Public Health Service Act (42 U.S.C. 254e) is
amended by adding at the end the following new subsection:
``(k)(1) The Secretary, acting through the Administrator of the
Health Resources and Services Administration, shall designate maternity
care health professional shortage areas in the States, publish a
descriptive list of the area's population groups, medical facilities,
and other public facilities so designated, and at least annually review
and, as necessary, revise such designations.
``(2) For purposes of paragraph (1), a complete descriptive list
shall be published in the Federal Register not later than one year
after the date of the enactment of the Health Equity and Accountability
Act of 2018 and annually thereafter.
``(3) The provisions of subsections (b), (c), (e), (f), (g), (h),
(i), and (j) (other than (j)(1)(B)) of this section shall apply to the
designation of a maternity care health professional shortage area in a
similar manner and extent as such provisions apply to the designation
of health professional shortage areas, except in applying subsection
(b)(3), the reference in such subsection to `physicians' shall be
deemed to be a reference to nationally certified and State licensed
obstetricians, family practice physicians who practice full-scope
maternity care, certified nurse midwives, certified midwives, certified
professional midwives, and physician's assistants who practice full
scope maternity care.
``(4) For purposes of this subsection, the term `maternity care
health professional shortage area' means--
``(A) an area in an urban or rural area (which need not
conform to the geographic boundaries of a political subdivision
and which is a rational area for the delivery of health
services) which the Secretary determines has a shortage of
providers of maternity care health services including those
referenced in paragraph (3) or an urban or rural area that the
Secretary determines has lost a significant number of such
providers during the 10-year period beginning with 2004 or has
no obstetrical providers licensed to provide operative
obstetrical services;
``(B) an area in an urban or rural area (which need not
conform to the geographic boundaries of a political subdivision
and which is a rational area for the delivery of health
services) which the Secretary determines has a shortage of
hospital or labor and delivery units, hospital birth center
units, or freestanding birth centers or an area that lost a
significant number of these units during the 10-year period
beginning with 2004; or
``(C) a population group which the Secretary determines has
such a shortage of providers or facilities.''.
SEC. 519. EXPANSION OF CDC PREVENTION RESEARCH CENTERS PROGRAM TO
INCLUDE CENTERS ON OPTIMAL MATERNITY OUTCOMES.
(a) In General.--Not later than one year after the date of the
enactment of this Act, the Secretary of Health and Human Services,
shall support the establishment of additional Prevention Research
Centers under the Prevention Research Center Program administered by
the Centers for Disease Control and Prevention. Such additional centers
shall each be known as a Center for Excellence on Optimal Maternity
Outcomes.
(b) Research.--Each Center for Excellence on Optimal Maternity
Outcomes shall--
(1) conduct at least one focused program of research to
improve maternity outcomes, including the reduction of cesarean
birth rates, elective inductions, prematurity rates, and low
birth weight rates within an underserved population that has a
disproportionately large burden of suboptimal maternity
outcomes, including maternal mortality and morbidity, infant
mortality, prematurity, or low birth weight;
(2) work with partners on special interest projects, as
specified by the Centers for Disease Control and Prevention and
other relevant agencies within the Department of Health and
Human Services, and on projects funded by other sources; and
(3) involve a minimum of two distinct birth setting models,
such as a hospital labor and delivery model and freestanding
birth center model; or a hospital labor and delivery model and
planned home birth model.
(c) Interdisciplinary Providers.--Each Center for Excellence on
Optimal Maternity Outcomes shall include the following
interdisciplinary providers of maternity care:
(1) Obstetrician-gynecologists.
(2) At least two of the following providers:
(A) Family practice physicians.
(B) Nurse practitioners.
(C) Physician assistants.
(D) Certified professional midwives.
(d) Services.--Research conducted by each Center for Excellence on
Optimal Maternity Outcomes shall include at least 2 (and preferably
more) of the following supportive provider services:
(1) Mental health.
(2) Doula labor support.
(3) Nutrition education.
(4) Childbirth education.
(5) Social work.
(6) Physical therapy or occupation therapy.
(7) Substance abuse services.
(8) Home visiting.
(e) Coordination.--The programs of research at each of the two
Centers of Excellence on Optimal Maternity Outcomes shall compliment
and not replicate the work of the other.
(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of the
fiscal years 2019 through 2023.
SEC. 520. EXPANDING MODELS ALLOWED TO BE TESTED BY CENTER FOR MEDICARE
& MEDICAID INNOVATION TO INCLUDE MATERNITY CARE MODELS.
Section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C.
1315a(b)(2)(B)) is amended by adding at the end the following new
clause:
``(xxv) Promoting evidence-based models of
care that have been associated with reductions
in maternal and infant health disparities,
including incorporating the use of doula and
promotoras support for pregnant and
childbearing individuals into evidence-based
models of prenatal care, labor and delivery,
and postpartum care, and supporting the
appropriate use of out-of-hospital birth
models, including births at home and in
freestanding birth centers.''.
SEC. 521. DEVELOPMENT OF INTERPROFESSIONAL MATERNITY CARE EDUCATIONAL
MODELS AND TOOLS.
(a) In General.--Not later than 6 months after the date of the
enactment of this Act, the Secretary of Health and Human Services,
acting in conjunction with the Administrator of Health Resources and
Services Administration, shall convene, for a 1-year period, an
Interprofessional Maternity Provider Education Commission to discuss
and make recommendations for--
(1) a consensus standard physiologic maternity care
curriculum that takes into account the core competencies for
basic midwifery practice such as those developed by the
American College of Nurse Midwives and the North American
Registry of Midwives, and the educational objectives for
physicians practicing in obstetrics and gynecology as
determined by the Council on Resident Education in Obstetrics
and Gynecology;
(2) suggestions for multidisciplinary use of the consensus
physiologic curriculum;
(3) strategies to integrate and coordinate education across
maternity care disciplines, including recommendations to
increase medical and midwifery student exposure to out-of-
hospital birth; and
(4) pilot demonstrations of interprofessional educational
models.
(b) Participants.--The Commission shall include maternity care
educators, curriculum developers, service leaders, certification
leaders, and accreditation leaders from the various professions that
provide maternity care in this country. Such professions shall include
obstetrician gynecologists, certified nurse midwives or certified
midwives, family practice physicians, nurse practitioners, physician
assistants, certified professional midwives, and perinatal nurses.
Additionally, the Commission shall include representation from
maternity care consumer advocates.
(c) Curriculum.--The consensus standard physiologic maternity care
curriculum described in subsection (a)(1) shall--
(1) have a public health focus with a foundation in health
promotion and disease prevention;
(2) foster physiologic childbearing and woman and family
centered care;
(3) integrate strategies to reduce maternal and infant
morbidity and mortality;
(4) incorporate recommendations to ensure respectful, safe,
and seamless consultation, referral, transport, and transfer of
care when necessary; and
(5) include cultural sensitivity and strategies to decrease
disparities in maternity outcomes.
(d) Report.--Not later than 6 months after the final meeting of the
Commission, the Secretary of Health and Human Services shall--
(1) submit to Congress a report containing the
recommendations made by the Commission under this section; and
(2) make such report publicly available.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $1,000,000 for each of the
fiscal years 2019 and 2020, and such sums as are necessary for each of
the fiscal years 2021 through 2023.
SEC. 522. INCLUDING WITHIN INPATIENT HOSPITAL SERVICES UNDER MEDICARE
SERVICES FURNISHED BY CERTAIN STUDENTS, INTERNS, AND
RESIDENTS SUPERVISED BY CERTIFIED NURSE MIDWIVES.
(a) In General.--Section 1861(b) of the Social Security Act (42
U.S.C. 1395x(b)) is amended--
(1) in paragraph (6), by striking ``; or'' and inserting
``, or in the case of services in a hospital or osteopathic
hospital by a student midwife or an intern or resident-in-
training under a teaching program previously described in this
paragraph who is in the field of obstetrics and gynecology, if
such student midwife, intern, or resident-in-training is
supervised by a certified nurse-midwife to the extent permitted
under applicable State law and as may be authorized by the
hospital;'';
(2) in paragraph (7), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(8) a certified nurse-midwife where the hospital has a
teaching program approved as specified in paragraph (6), if--
``(A) the hospital elects to receive any payment
due under this title for reasonable costs of such
services; and
``(B) all certified nurse-midwives in such hospital
agree not to bill charges for professional services
rendered in such hospital to individuals covered under
the insurance program established by this title.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services furnished on or after the date of the enactment of
this Act.
SEC. 523. GRANTS TO PROFESSIONAL ORGANIZATIONS TO INCREASE DIVERSITY IN
MATERNAL, REPRODUCTIVE, AND SEXUAL HEALTH PROFESSIONALS.
(a) In General.--The Secretary of Health and Human Services,
through the Administrator of the Health Resources and Services
Administration, shall carry out a grant program under which the
Secretary may make to eligible health professional organizations--
(1) for fiscal year 2019, planning grants described in
subsection (b); and
(2) for the subsequent 4-year period, implementation grants
described in subsection (c).
(b) Planning Grants.--
(1) In general.--Planning grants described in this
subsection are grants for the following purposes:
(A) To collect data and identify any workforce
disparities, with respect to a health profession, at
each of the following areas along the health
professional continuum:
(i) Pipeline availability with respect to
students at the high school and college or
university levels considering and working
toward entrance in the profession.
(ii) Entrance into the training program for
the profession.
(iii) Graduation from such training
program.
(iv) Entrance into practice.
(v) Retention in practice for more than a
5-year period.
(B) To develop one or more strategies to address
the workforce disparities within the health profession,
as identified under (and in response to the findings
pursuant to) subparagraph (A).
(2) Application.--To be eligible to receive a grant under
this subsection, an eligible health professional organization
shall submit to the Secretary of Health and Human Services an
application in such form and manner and containing such
information as specified by the Secretary.
(3) Amount.--Each grant awarded under this subsection shall
be for an amount not to exceed $300,000.
(4) Report.--Each recipient of a grant under this
subsection shall submit to the Secretary of Health and Human
Services a report containing--
(A) information on the extent and distribution of
workforce disparities identified through the grant; and
(B) reasonable objectives and strategies developed
to address such disparities within a 5-, 10-, and 25-
year period.
(c) Implementation Grants.--
(1) In general.--Implementation grants described in this
subsection are grants to implement one or more of the
strategies developed pursuant to a planning grant awarded under
subsection (b).
(2) Application.--To be eligible to receive a grant under
this subsection, an eligible health professional organization
shall submit to the Secretary of Health and Human Services an
application in such form and manner as specified by the
Secretary. Each such application shall contain information on
the capability of the organization to carry out a strategy
described in paragraph (1), involvement of partners or
coalitions, plans for developing sustainability of the efforts
after the culmination of the grant cycle, and any other
information specified by the Secretary.
(3) Amount.--Each grant awarded under this subsection shall
be for an amount not to exceed $500,000 each year during the 4-
year period of the grant.
(4) Reports.--For each of the first 3 years for which an
eligible health professional organization is awarded a grant
under this subsection, the organization shall submit to the
Secretary of Health and Human Services a report on the
activities carried out by such organization through the grant
during such year and objectives for the subsequent year. For
the fourth year for which an eligible health professional
organization is awarded a grant under this subsection, the
organization shall submit to the Secretary a report that
includes an analysis of all the activities carried out by the
organization through the grant and a detailed plan for
continuation of out-reach efforts.
(d) Eligible Health Professional Organization Defined.--For
purposes of this section, the term ``eligible health professional
organization'' means a professional organization representing
obstetrician-gynecologists, certified nurse midwives, certified
midwives, family practice physicians, nurse practitioners whose scope
of practice includes maternity or sexual and reproductive health care,
physician assistants whose scope of practice includes obstetrical or
sexual and reproductive health care, or certified professional midwives
adolescent medicine specialists, and pediatricians who provide sexual
and reproductive health care.
(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for fiscal year 2019
and $3,000,000 for each of the fiscal years 2020 through 2023.
SEC. 524. INTERAGENCY UPDATE TO THE QUALITY FAMILY PLANNING GUIDELINES.
(a) In General.--Not later than six months after the date of
enactment of this Act, the Director of the Centers for Disease Control
and Prevention and the Office of Population Affairs shall review and
expand the 2014 Quality Family Planning Guidelines to address--
(1) health disparities; and
(2) the importance of patient-directed contraceptive
decisionmaking.
(b) Consultation.--In carrying out subsection (a), the Director of
the Centers for Disease Control and Prevention and the Office of
Population Affairs shall convene a meeting, and solicit the views of,
stakeholders including experts on health disparities, experts on
reproductive coercion, representatives of provider organizations,
patient advocates, reproductive justice organizations, organizations
that represent racial and ethnic minority communities, organizations
that represent people with disabilities, organizations that represent
LGBTQ persons, and organizations that represent people with limited-
English proficiency.
SEC. 525. DISSEMINATION OF THE QUALITY FAMILY PLANNING GUIDELINES.
(a) In General.--Not later than six months after the date of
enactment of this Act, the Secretary of Health and Human Services and
the Director of the Centers for Disease Control and Prevention shall--
(1) develop a plan for outreach to publicly funded health
care providers, including federally qualified health centers
and branches of the Indian Health Service, about the quality
family planning guidelines referred to in section 524; and
(2) award grants to eligible entities to implement these
guidelines for all patients seeking family planning services.
(b) Definition.--In this section, the term ``eligible entity''
means a publicly funded health care provider that serves persons of
reproductive age.
Subtitle B--Pregnancy Screening
SEC. 531. PREGNANCY INTENTION SCREENING INITIATIVE DEMONSTRATION
PROGRAM.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following new
sections:
``SEC. 399V-7. PREGNANCY INTENTION SCREENING INITIATIVE DEMONSTRATION
PROGRAM.
``(a) Program Establishment.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall
establish a demonstration program to facilitate the clinical adoption
of pregnancy intention screening initiatives by health care providers.
``(b) Grants.--The Secretary may carry out the demonstration
program through awarding grants to eligible entities to implement
pregnancy intention screening initiatives, collect data, and evaluate
such initiatives.
``(c) Eligible Entities.--
``(1) In general.--An eligible entity under this section is
an entity described in paragraph (2) that provides non-
directive, comprehensive, medically accurate information.
``(2) Entities described.--For purposes of paragraph (1),
an entity described in this paragraph is a community-based
organization, voluntary health organization, public health
department, community health center, or other interested public
or private health care provider or organization.
``(d) Pregnancy Intention Screening Initiative.--For purposes of
this section, the term `pregnancy intention screening initiative' means
any initiative by a health care provider to routinely screen women with
respect to their pregnancy intentions and goals to either prevent
unintended pregnancies or improve the likelihood of healthy
pregnancies, in order to better provide health care that meets the
contraceptive or pre-pregnancy needs of such women.
``(e) Evaluation.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall, by grant or contract, and after consultation as
described in paragraph (2), conduct an evaluation of the
demonstration program, with respect to pregnancy intention
screening initiatives, conducted under this section. The
evaluation shall include:
``(A) Assessment of the implementation of pregnancy
intention screening protocols among a diverse group of
patients and providers, including collecting data on
the experiences and outcomes for diverse patient
populations in a variety of clinical settings.
``(B) Analysis of outcome measures that will
facilitate effective and widespread adoption of such
protocols by health care providers for inquiring about
and responding to pregnancy intentions of women with
both contraceptive and pre-pregnancy care.
``(C) Consideration of health disparities among the
population served.
``(D) Assessment of the equitable and voluntary
application of such initiatives to minority and
medically underserved communities.
``(E) Assessment of the training, capacity, and
ongoing technical assistance needed for providers to
effectively implement such pregnancy intention
screening protocols.
``(F) Assessment of whether referral systems for
selected protocols follow evidence-based standards that
ensure access to comprehensive health services and
appropriate follow-up care.
``(2) Independent, expert advisory panel.--In conducting
the evaluation under paragraph (1), the Director of the Centers
for Disease Control and Prevention shall consult with
physicians, physician assistants, and nurses who specialize in
women's health, and other experts in clinical practice, program
evaluation, and research.
``(3) Report.--Not later than one year after the last day
of the demonstration program under this section, the Director
of the Centers for Disease Control and Prevention shall submit
to Congress a report on the results of the evaluation conducted
under paragraph (1) and shall make the report publicly
available.
``(f) Funding.--
``(1) Authorization of appropriations.--To carry out this
section, there is authorized to be appropriated $5,000,000 for
each of fiscal years 2019 through 2021.
``(2) Limitation.--Not more than 25 percent of funds
appropriated to carry out this section pursuant to paragraph
(1) for a fiscal year may be used for purposes of the
evaluation under subsection (e).''.
TITLE VI--MENTAL HEALTH
SEC. 601. MENTAL HEALTH FINDINGS.
Congress finds the following:
(1) Despite the existence of effective treatments,
disparities lie in the availability, accessibility, and quality
of mental health services for racial and ethnic minorities.
(2) These disparities have powerful significance for
minority groups and for society as a whole.
(3) Racial and ethnic minorities bear a greater burden from
unmet mental health needs and thus suffer a greater loss to
their overall health and productivity.
(4) The foremost barriers include the cost of care,
societal stigma, and the fragmented organization of services.
(5) African American attitudes toward mental illness are
another barrier to seeking mental health care.
(6) Mental illness retains considerable stigma, and seeking
treatment is not always encouraged.
(7) Mental illness is highly stigmatizing in many Asian
cultures.
(8) Addressing mental health stigma in communities will
help increase utilization of mental health services and reduce
the burden of mental illness
SEC. 602. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES, MENTAL
HEALTH COUNSELOR SERVICES, AND SUBSTANCE ABUSE 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)), as amended by section 450, is
amended--
(A) in subparagraph (FF), by striking ``and'' at
the end;
(B) in subparagraph (GG), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(HH) marriage and family therapist services (as defined
in subsection (lll)(1)) and mental health counselor services
(as defined in subsection (lll)(3)) and substance abuse
counselor services (as defined in subsection (lll)(5));''.
(2) Definitions.--Section 1861 of such Act (42 U.S.C.
1395x), as amended by sections 413(a) and 470(a), 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
``(lll)(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.
``(5) The term `substance abuse counselor services' means services
performed by a substance abuse counselor (as defined in paragraph (6))
for the diagnosis and treatment of substance abuse and addiction which
the substance abuse 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.
``(6) The term `substance abuse counselor' means an individual
who--
``(A) has performed at least 2 years of supervised
substance abuse counselor practice;
``(B) in the case of an individual performing services in a
State that provides for licensure or certification of substance
abuse counselors or professional counselors, is licensed or
certified as a substance abuse counselor or professional
counselor in such State; or
``(C) is a drug and alcohol counselor as defined in section
40.281 of title 49, Code of Federal Regulations.''.
(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--
(A) by striking ``and'' at the end of clause (iv);
and
(B) by adding at the end the following new clause:
``(v) marriage and family therapist
services, mental health counselor services, and
substance abuse counselor services; and''.
(4) Amount of payment.--Section 1833(a)(1) of such Act (42
U.S.C. 1395l(a)(1)), as amended by section 431(c)(3), is
amended--
(A) by striking ``and (AA)'' and inserting
``(AA)''; and
(B) by inserting before the semicolon at the end
the following: ``, and (BB) with respect to marriage
and family therapist services, mental health counselor
services, and substance abuse counselor services under
section 1861(s)(2)(HH), 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(lll)(1)), mental health counselor services (as defined in
section 1861(lll)(3)),'' after ``qualified psychologist
services,''.
(6) Inclusion of marriage and family therapists, mental
health counselors, and substance abuse 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(lll)(2)).
``(viii) A mental health counselor (as defined in section
1861(lll)(4)).
``(ix) A substance abuse counselor (as defined in section
1861 (lll)(6)).''.
(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 (lll)(2)), or by a mental health
counselor (as defined in subsection (lll)(4)), or by a
substance abuse counselor (as defined in section 1861
(lll)(6)).''.
(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 (lll)(2))'' after ``social worker''.
(c) Authorization of Marriage and Family Therapists To Develop
Discharge Plans for Posthospital 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
(lll)(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, 2019.
SEC. 603. INTEGRATED HEALTH CARE DEMONSTRATION PROGRAM.
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
et seq.) is amended by adding at the end the following:
``SEC. 550. INTERPROFESSIONAL HEALTH CARE TEAMS FOR PROVISION OF
BEHAVIORAL HEALTH CARE IN PRIMARY CARE SETTINGS.
``(a) Grants.--The Secretary, acting through the Assistant
Secretary for Mental Health and Substance Abuse, shall award grants to
eligible entities for the purpose of establishing interprofessional
health care teams that provide behavioral health care.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be a federally qualified health center
(as defined in section 1861(aa) of the Social Security Act), rural
health clinic, or behavioral health program, serving a high proportion
of individuals from racial and ethnic minority groups (as defined in
section 1707(g)).
``(c) Scientifically Based.--Integrated health care funded through
this section shall be scientifically based, taking into consideration
the results of the most recent peer-reviewed research available.
``(d) Authorization of Appropriations.--To carry out this section,
there is authorized to be appropriated $20,000,000 for each of fiscal
years 2019 through 2024.''.
SEC. 604. ADDRESSING RACIAL AND ETHNIC MINORITY MENTAL HEALTH
DISPARITIES RESEARCH GAPS.
Not later than 6 months after the date of the enactment of this
Act, the Director of the National Institute on Minority Health and
Health Disparities shall enter into an arrangement with the National
Academy of Sciences (or, if the National Academy of Sciences declines
to enter into such an arrangement, an arrangement with the Institute of
Medicine, the Patient Centered Outcomes Research Institute, the Agency
for Healthcare Quality, or another appropriate entity)--
(1) to conduct a study with respect to mental health
disparities in racial and ethnic minority groups (as defined in
section 1707(g) of the Public Health Service Act (42 U.S.C.
300u-6(g)); and
(2) to submit to the Congress a report on the results of
such study, including--
(A) a compilation of information on the dynamics of
mental disorders in such racial and ethnic minority
groups; and
(B) a compilation of information on the impact of
exposure to community violence, adverse childhood
experiences, and other psychological traumas on mental
disorders in such racial and minority groups.
SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC
MINORITY MENTAL HEALTH DISPARITIES.
(a) In General.--The Secretary of Health and Human Services, acting
through the Assistant Secretary for Mental Health and Substance Use,
shall award grants to qualified national organizations for the purposes
of--
(1) developing, and disseminating to health professional
educational programs curricula or core competencies addressing
mental health disparities among racial and ethnic minority
groups for use in the training of students in the professions
of social work, psychology, psychiatry, marriage and family
therapy, mental health counseling, and substance abuse
counseling; and
(2) certifying community health workers and peer wellness
specialists with respect to such curricula and core
competencies and integrating and expanding the use of such
workers and specialists into health care to address mental
health disparities among racial and ethnic minority groups.
(b) Curricula; Core Competencies.--Organizations receiving funds
under subsection (a) may use the funds to engage in the following
activities related to the development and dissemination of curricula or
core competencies described in subsection (a)(1):
(1) Formation of committees or working groups comprised of
experts from accredited health professions schools to identify
core competencies relating to mental health disparities among
racial and ethnic minority groups.
(2) Planning of workshops in national fora to allow for
public input into the educational needs associated with mental
health disparities among racial and ethnic minority groups.
(3) Dissemination and promotion of the use of curricula or
core competencies in undergraduate and graduate health
professions training programs nationwide.
(4) Establishing external stakeholder advisory boards to
provide meaningful input into policy and program development
and best practices to reduce mental health disparities among
racial and ethnic minority groups.
(c) Definitions.--In this section:
(1) Qualified national organization.--The term ``qualified
national organization'' means a national organization that
focuses on the education of students in programs of social
work, psychology, psychiatry, and marriage and family therapy.
(2) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given to such term
in section 1707(g) of the Public Health Service Act (42 U.S.C.
300u-6(g)).
(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 2019 through 2024.
SEC. 606. ASIAN AMERICAN, NATIVE HAWAIIAN, AND PACIFIC ISLANDER
BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION
STRATEGIES.
Part D of title V of the Public Health Service Act (42 U.S.C. 290dd
et seq.) is amended by adding at the end the following new section:
``SEC. 544. BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION
STRATEGIES.
``(a) In General.--The Secretary, acting through the Administrator
of the Substance Abuse and Mental Health Services Administration,
shall, in coordination with advocacy and behavioral and mental health
organizations serving populations of Asian American, Native Hawaiian,
and Pacific Islander individuals or communities, develop and implement
an outreach and education strategy to promote behavioral and mental
health and reduce stigma associated with mental health conditions and
substance abuse among the Asian American, Native Hawaiian, and Pacific
Islander populations. Such strategy shall--
``(1) be designed to--
``(A) meet the diverse cultural and language needs
of the various Asian American, Native Hawaiian, and
Pacific Islander populations; and
``(B) ensure such strategies are developmentally
and age appropriate;
``(2) increase awareness of symptoms of mental illnesses
common among such populations, taking into account differences
within subgroups, such as gender, gender identity, age, sexual
orientation, or ethnicity, of such populations;
``(3) provide information on evidence-based, culturally and
linguistically appropriate and adapted interventions and
treatments;
``(4) ensure full participation of, and engage, both
consumers and community members in the development and
implementation of materials; and
``(5) seek to broaden the perspective among both
individuals in these communities and stakeholders serving these
communities to use a comprehensive public health approach to
promoting behavioral health that addresses a holistic view of
health by focusing on the intersection between behavioral and
physical health.
``(b) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $300,000 for fiscal year
2019.''.
SEC. 607. MENTAL HEALTH IN SCHOOLS.
(a) Purpose.--It is the purpose of this section to--
(1) revise, increase funding for, and expand the scope of
the Project AWARE State Educational Agency Grant Program
carried out by the Secretary of Health and Human Services, in
order to provide access to more comprehensive school-based
mental health services and supports;
(2) provide for comprehensive staff development for school
and community service personnel working in the school; and
(3) provide for comprehensive training for children with
mental health disorders, for parents, siblings, and other
family members of such children, and for concerned members of
the community.
(b) Technical Amendments.--The second part G (relating to services
provided through religious organizations) of title V of the Public
Health Service Act (42 U.S.C. 290kk et seq.) is amended--
(1) by redesignating such part as part J; and
(2) by redesignating sections 581 through 584 as sections
596 through 596C, respectively.
(c) School-Based Mental Health and Children and Violence.--Section
581 of the Public Health Service Act (42 U.S.C. 290hh) is amended to
read as follows:
``SEC. 581. SCHOOL-BASED MENTAL HEALTH AND CHILDREN AND VIOLENCE.
``(a) In General.--The Secretary, in collaboration with the
Secretary of Education and in consultation with the Attorney General,
shall, directly or through grants, contracts, or cooperative agreements
awarded to eligible entities described in subsection (c), assist local
communities and schools (including schools funded by the Bureau of
Indian Education) in applying a public health approach to mental health
services both in schools and in the community. Such approach should
provide comprehensive age appropriate services and supports, be
linguistically and culturally appropriate, be trauma-informed, and
incorporate age appropriate strategies of positive behavioral
interventions and supports. A comprehensive school mental health
program funded under this section shall assist children in dealing with
trauma and violence.
``(b) Activities.--Under the program under subsection (a), the
Secretary may--
``(1) provide financial support to enable local communities
to implement a comprehensive culturally and linguistically
appropriate, trauma-informed, and age-appropriate, school-based
mental health program that--
``(A) builds awareness of trauma;
``(B) trains appropriate staff to identify signs of
trauma or mental health disorders; and
``(C) incorporates positive behavioral
interventions, family engagement, student treatment,
and multi-generational supports to foster the health
and development of children;
``(2) provide technical assistance to local communities
with respect to the development of programs described in
paragraph (1);
``(3) provide assistance to local communities in the
development of policies to address child and adolescent trauma
and mental health issues and violence when and if it occurs;
``(4) facilitate community partnerships among families,
students, law enforcement agencies, education systems, mental
health and substance use disorder service systems, family-based
mental health service systems, child welfare agencies, health
care service systems (including primary care physicians),
faith-based programs, trauma networks, and other community-
based systems; and
``(5) establish mechanisms for children and adolescents to
report incidents of violence or plans by other children,
adolescents, or adults to commit violence.
``(c) Requirements.--
``(1) In general.--To be eligible for a grant, contract, or
cooperative agreement under subsection (a), an entity shall--
``(A) be a partnership that--
``(i) shall include a State educational
agency and one or more local educational
agencies, with a local educational agency
serving as the lead partner; and
``(ii) may include, in accordance with
paragraph (2)(A)(i), appropriate public or
private entities that use evidence-based
interventions, as defined in section 8101 of
the Elementary and Secondary Education Act of
1965 (20 U.S.C. 7801); and
``(B) submit an application, that is endorsed by
all members of the partnership, that contains the
assurances described in paragraph (2).
``(2) Required assurances.--An application under paragraph
(1) shall contain assurances as follows:
``(A) That the eligible entity will ensure that, in
carrying out activities under this section, the
eligible entity will enter into a memorandum of
understanding--
``(i) with at least 1 public or private
mental health entity, health care entity, law
enforcement or juvenile justice entity, child
welfare agency, family-based mental health
entity, trauma network, or other community-
based entity; and
``(ii) that clearly states--
``(I) the responsibilities of each
partner with respect to the activities
to be carried out, including how family
engagement will be incorporated in the
activities;
``(II) how school-employed and
school-based mental health
professionals will be utilized for
carrying out such responsibilities;
``(III) how each such partner will
be accountable for carrying out such
responsibilities; and
``(IV) the amount of non-Federal
funding or in-kind contributions that
each such partner will contribute in
order to sustain the program.
``(B) That the comprehensive school-based mental
health program carried out under this section supports
the flexible use of funds to address--
``(i) the promotion of the social,
emotional, and behavioral health of all
students in an environment that is conducive to
learning;
``(ii) the reduction in the likelihood of
at risk students developing social, emotional,
behavioral health problems, or substance use
disorders;
``(iii) the early identification of social,
emotional, behavioral problems, or substance
use disorders and the provision of early
intervention services;
``(iv) the treatment or referral for
treatment of students with existing social,
emotional, behavioral health problems, or
substance use disorders; and
``(v) the development and implementation of
programs to assist children in dealing with
trauma and violence, including program
curricula, school supports, and after-school
programs.
``(C) That the comprehensive school-based mental
health program carried out under this section will
provide for in-service training of all school
personnel, including ancillary staff and volunteers,
in--
``(i) the techniques and supports needed to
identify early children with trauma histories
and children with, or at risk of, mental
illness;
``(ii) the use of referral mechanisms that
effectively link such children to appropriate
treatment and intervention services in the
school and in the community and to follow-up
when services are not available;
``(iii) strategies that promote a school-
wide positive environment;
``(iv) strategies for promoting the social,
emotional, mental, and behavioral health of all
students; and
``(v) strategies to increase the knowledge
and skills of school and community leaders
about the impact of trauma and violence and on
the application of a public health approach to
comprehensive school-based mental health
programs.
``(D) That the comprehensive school-based mental
health program carried out under this section will
include comprehensive training for parents, siblings,
and other family members of children with mental health
disorders, and for concerned members of the community
in--
``(i) the techniques and supports needed to
identify early children with trauma histories,
and children with, or at risk of, mental
illness;
``(ii) the use of referral mechanisms that
effectively link such children to appropriate
treatment and intervention services in the
school and in the community and follow-up when
such services are not available; and
``(iii) strategies that promote a school-
wide positive environment.
``(E) That the comprehensive school-based mental
health program carried out under this section will
demonstrate the measures to be taken to sustain the
program after funding under this section terminates
(which may include seeking funding for the program
under a State Medicaid plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) or a
waiver of such a plan).
``(F) That the eligible entity is supported by the
State agency with primary responsibility for behavioral
health to ensure that the sustainability of the
programs is established after funding under this
section terminates.
``(G) That the comprehensive school-based mental
health program carried out under this section will be
based on trauma-informed and evidence-based practices.
``(H) That the comprehensive school-based mental
health program carried out under this section will be
coordinated with early intervening activities carried
out under the Individuals with Disabilities Education
Act.
``(I) That the comprehensive school-based mental
health program carried out under this section will be
trauma-informed and culturally and linguistically
appropriate.
``(J) That the comprehensive school-based mental
health program carried out under this section will
include a broad needs assessment of youth who drop out
of school due to policies of `zero tolerance' with
respect to drugs, alcohol, or weapons and an inability
to obtain appropriate services.
``(K) That the mental health services provided
through the comprehensive school-based mental health
program carried out under this section will be provided
by qualified mental and behavioral health professionals
who are certified or licensed by the State involved and
practicing within their area of expertise.
``(3) Coordinator.--Any entity that is a member of a
partnership described in paragraph (1)(A) may serve as the
coordinator of funding and activities under the grant if all
members of the partnership agree.
``(4) Compliance with hipaa.--A grantee under this section
shall be deemed to be a covered entity for purposes of
compliance with the regulations promulgated under section
264(c) of the Health Insurance Portability and Accountability
Act of 1996 with respect to any patient records developed
through activities under the grant.
``(d) Geographical Distribution.--The Secretary shall ensure that
grants, contracts, or cooperative agreements under subsection (a) will
be distributed equitably among the regions of the country and among
urban and rural areas.
``(e) Duration of Awards.--With respect to a grant, contract, or
cooperative agreement under subsection (a), the period during which
payments under such an award will be made to the recipient shall be 5
years. An eligible entity described in subsection (c) may receive only
one award under this section, except that an eligible entity that is
providing services and supports on a regional basis may receive
additional funding after the expiration of the preceding grant period.
``(f) Evaluation and Measures of Outcomes.--
``(1) Development of process.--The Administrator shall
develop a fiscally appropriate process for evaluating
activities carried out under this section. Such process shall
include--
``(A) the development of guidelines for the
submission of program data by grant, contract, or
cooperative agreement recipients;
``(B) the development of measures of outcomes (in
accordance with paragraph (2)) to be applied by such
recipients in evaluating programs carried out under
this section; and
``(C) the submission of annual reports by such
recipients concerning the effectiveness of programs
carried out under this section.
``(2) Measures of outcomes.--
``(A) In general.--The Administrator shall develop
measures of outcomes to be applied by recipients of
assistance under this section, and the Administrator,
in evaluating the effectiveness of programs carried out
under this section. Such measures shall include student
and family measures as provided for in subparagraph (B)
and local educational measures as provided for under
subparagraph (C).
``(B) Student and family measures of outcomes.--The
measures of outcomes developed under paragraph (1)(B)
relating to students and families shall, with respect
to activities carried out under a program under this
section, at a minimum include provisions to evaluate
whether the program is effective in--
``(i) increasing social and emotional
competency;
``(ii) increasing academic competency (as
defined by the Secretary);
``(iii) reducing disruptive and aggressive
behaviors;
``(iv) improving child functioning;
``(v) reducing substance use disorders;
``(vi) reducing suspensions, truancy,
expulsions, and violence;
``(vii) increasing high school graduation
rates, calculated using the four-year adjusted
cohort graduation rate or the extended-year
adjusted cohort graduation rate (as such terms
are defined in section 8101 of the Elementary
and Secondary Education Act of 1965 (20 U.S.C.
7801)); and
``(viii) improving access to care for
mental health disorders.
``(C) Local educational outcomes.--The outcome
measures developed under paragraph (1)(B) relating to
local educational systems shall, with respect to
activities carried out under a program under this
section, at a minimum include provisions to evaluate--
``(i) the effectiveness of comprehensive
school mental health programs established under
this section;
``(ii) the effectiveness of formal
partnership linkages among child and family
serving institutions, community support
systems, and the educational system;
``(iii) the progress made in sustaining the
program once funding under the grant has
expired;
``(iv) the effectiveness of training and
professional development programs for all
school personnel that incorporate indicators
that measure cultural and linguistic
competencies under the program in a manner that
incorporates appropriate cultural and
linguistic training;
``(v) the improvement in perception of a
safe and supportive learning environment among
school staff, students, and parents;
``(vi) the improvement in case-finding of
students in need of more intensive services and
referral of identified students to early
intervention and clinical services;
``(vii) the improvement in the immediate
availability of clinical assessment and
treatment services within the context of the
local community to students posing a danger to
themselves or others;
``(viii) the increased successful
matriculation to postsecondary school; and
``(ix) reduced referrals to juvenile
justice.
``(3) Submission of annual data.--An eligible entity
described in subsection (c) that receives a grant, contract, or
cooperative agreement under this section shall annually submit
to the Administrator a report that includes data to evaluate
the success of the program carried out by the entity based on
whether such program is achieving the purposes of the program.
Such reports shall utilize the measures of outcomes under
paragraph (2) in a reasonable manner to demonstrate the
progress of the program in achieving such purposes.
``(4) Evaluation by administrator.--Based on the data
submitted under paragraph (3), the Administrator shall annually
submit to Congress a report concerning the results and
effectiveness of the programs carried out with assistance
received under this section.
``(5) Limitation.--An eligible entity shall use not more
than 10 percent of amounts received under a grant under this
section to carry out evaluation activities under this
subsection.
``(g) Information and Education.--The Secretary shall establish
comprehensive information and education programs to disseminate the
findings of the knowledge development and application under this
section to the general public and to health care professionals.
``(h) Amount of Grants and Authorization of Appropriations.--
``(1) Amount of grants.--A grant under this section shall
be in an amount that is not more than $2,000,000 for each of
fiscal years 2019 through 2023. The Secretary shall determine
the amount of each such grant based on the population of
children up to age 21 of the area to be served under the grant.
``(2) Authorization of appropriations.--There is authorized
to be appropriated to carry out this section, $200,000,000 for
each of fiscal years 2019 through 2023.''.
(d) Conforming Amendment.--Part G of title V of the Public Health
Service Act (42 U.S.C. 290hh et seq.), as amended by this section, is
further amended by striking the part heading and inserting the
following:
``PART G--SCHOOL-BASED MENTAL HEALTH''.
SEC. 608. 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, affordable, and accessible
services; and
(2) submit a report to the Congress on the results of such
study.
TITLE VII--ADDRESSING HIGH IMPACT MINORITY DISEASES
Subtitle A--Cancer
SEC. 701. LUNG CANCER MORTALITY REDUCTION.
(a) Short Title.--This section may be cited as the ``Lung Cancer
Mortality Reduction Act of 2018''.
(b) 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) 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) Recent research has shown that screening with low-dose
computed tomography (CT) scan improved lung cancer death
mortality by 20 percent for those with a high risk of lung
cancer through early detection. The Centers for Medicare &
Medicaid Services supports annual lung cancer screening for
high-risk patients with low-dose computed tomography.
(12) Additional strategies are necessary to further enhance
the existing tests and therapies available to diagnose and
treat lung cancer in the future.
(13) 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''.
(14) 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.
(15) 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 2020 and targeted funding to
support this coordinated effort.
(c) 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.
(d) Lung Cancer Mortality Reduction Program.--
(1) 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. 417H. 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 Institute on Minority Health and Health
Disparities, and other members of the Lung Cancer Advisory Board
established under section 701 of the Health Equity and Accountability
Act of 2018, 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 2020.
``(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 530 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 promotion (including education) of lung cancer
screening within minority and rural populations and the study
of the effectiveness of efforts to increase such screening.
``(6) 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.
``(7) 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.''.
(2) 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. 530. (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 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 the Health Equity and
Accountability Act of 2018 shall monitor the program implemented under
this section.''.
(3) 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 530, 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''.
(4) 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.''.
(e) 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 417H;
(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.
(f) Lung Cancer Advisory Board.--
(1) In general.--The Secretary of Health and Human Services
shall convene a Lung Cancer Advisory Board (referred to in this
section as the ``Board'')--
(A) to monitor the programs established under this
section (and the amendments made by this section); and
(B) to provide annual reports to the Congress
concerning benchmarks, expenditures, lung cancer
statistics, and the public health impact of such
programs.
(2) Composition.--The Board shall be composed of--
(A) the Secretary of Health and Human Services;
(B) the Secretary of Defense;
(C) the Secretary of Veterans Affairs; and
(D) 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.
(g) Authorization of Appropriations.--
(1) In general.--To carry out this section (and the
amendments made by this section), there are authorized to be
appropriated such sums as may be necessary for each of fiscal
years 2019 through 2023.
(2) Lung cancer mortality reduction program.--Of the
amounts authorized to be appropriated by subsection (a), there
are authorized to be appropriated--
(A) $25,000,000 for fiscal year 2019, and such sums
as may be necessary for each of fiscal years 2020
through 2023, for the activities described in section
417H(b)(1)(B) of the Public Health Service Act, as
added by subsection (d)(1);
(B) $25,000,000 for fiscal year 2019, and such sums
as may be necessary for each of fiscal years 2020
through 2023, for the activities described in section
417H(b)(1)(C) of such Act;
(C) $10,000,000 for fiscal year 2019, and such sums
as may be necessary for each of fiscal years 2020
through 2023, for the activities described in section
417H(b)(1)(D) of such Act; and
(D) $15,000,000 for fiscal year 2019, and such sums
as may be necessary for each of fiscal years 2020
through 2023, for the activities described in section
417H(b)(3) of such Act.
SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUTREACH, SCREENING,
TESTING, ACCESS, AND TREATMENT EFFECTIVENESS.
(a) Short Title.--This section may be cited as the ``Prostate
Research, Outreach, Screening, Testing, Access, and Treatment
Effectiveness Act of 2018'' or the ``PROSTATE Act''.
(b) Findings.--Congress makes the following findings:
(1) Prostate cancer is the second leading cause of cancer
death among men.
(2) In 2010, more than 217,730 new patients were diagnosed
with prostate cancer and more than 32,000 men died from this
disease.
(3) Roughly 2,000,000 Americans are living with a diagnosis
of prostate cancer and its consequences.
(4) While prostate cancer generally affects older
individuals, younger men are also at risk for the disease, and
when prostate cancer appears in early middle age, it frequently
takes on a more aggressive form.
(5) There are significant racial and ethnic disparities
that demand attention, namely African Americans have prostate
cancer mortality rates that are more than double those in the
White population.
(6) Underserved rural populations have higher rates of
mortality compared to their urban counterparts, and innovative
and cost-efficient methods to improve rural access to high-
quality care should take advantage of advances in telehealth to
diagnose and treat prostate cancer when appropriate.
(7) Certain veterans populations may have nearly twice the
incidence of prostate cancer as the general population of the
United States.
(8) Urologists may constitute the specialists who diagnose
and treat the vast majority of prostate cancer patients.
(9) Although much basic and translational research has been
completed and much is currently known, there are still many
unanswered questions. For example, it is not fully understood
how much of known disparities are attributable to disease
etiology, access to care, or education and awareness in the
community.
(10) Causes of prostate cancer are not known. There is not
good information regarding how to differentiate accurately,
early on, between aggressive and indolent forms of the disease.
As a result, there is significant overtreatment in prostate
cancer. There are no treatments that can durably arrest growth
or cure prostate cancer once it has metastasized.
(11) A significant proportion (roughly 23 to 54 percent) of
cases may be clinically indolent and ``overdiagnosed'',
resulting in significant overtreatment. More accurate tests
will allow men and their families to face less physical,
psychological, financial, and emotional trauma, and billions of
dollars could be saved in private and public health care
systems in an area that has been identified by the Medicare
Program as one of eight high-volume, high-cost areas in the
Resource Utilization Report Program authorized by Congress
under the Medicare Improvements for Patients and Providers Act
of 2008.
(12) Prostate cancer research and health care programs
across Federal agencies should be coordinated to improve
accountability and actively encourage the translation of
research into practice, to identify and implement best
practices, in order to foster an integrated and consistent
focus on effective prevention, diagnosis, and treatment of this
disease.
(c) Prostate Cancer Coordination and Education.--
(1) Interagency prostate cancer coordination and education
task force.--Not later than 180 days after the date of the
enactment of this section, the Secretary of Veterans Affairs,
in cooperation with the Secretary of Defense and the Secretary
of Health and Human Services, shall establish an Interagency
Prostate Cancer Coordination and Education Task Force (in this
section referred to as the ``Prostate Cancer Task Force'').
(2) Duties.--The Prostate Cancer Task Force shall--
(A) develop a summary of advances in prostate
cancer research supported or conducted by Federal
agencies relevant to the diagnosis, prevention, and
treatment of prostate cancer, including psychosocial
impairments related to prostate cancer treatment, and
compile a list of best practices that warrant broader
adoption in health care programs;
(B) consider establishing, and advocating for, a
guidance to enable physicians to allow screening of men
who are over age 74, on a case-by-case basis, taking
into account quality of life and family history of
prostate cancer;
(C) share and coordinate information on Federal
research and health care program activities, including
activities related to--
(i) determining how to improve research and
health care programs, including psychosocial
impairments related to prostate cancer
treatment;
(ii) identifying any gaps in the overall
research inventory and in health care programs;
(iii) identifying opportunities to promote
translation of research into practice; and
(iv) maximizing the effects of Federal
efforts by identifying opportunities for
collaboration and leveraging of resources in
research and health care programs that serve
those susceptible to or diagnosed with prostate
cancer;
(D) develop a comprehensive interagency strategy
and advise relevant Federal agencies in the
solicitation of proposals for collaborative,
multidisciplinary research and health care programs,
including proposals to evaluate factors that may be
related to the etiology of prostate cancer, that
would--
(i) result in innovative approaches to
study emerging scientific opportunities or
eliminate knowledge gaps in research to improve
the prostate cancer research portfolio of the
Federal Government;
(ii) outline key research questions,
methodologies, and knowledge gaps; and
(iii) ensure consistent action, as outlined
by section 402(b) of the Public Health Service
Act;
(E) develop a coordinated message related to
screening and treatment for prostate cancer to be
reflected in educational and beneficiary materials for
Federal health programs as such documents are updated;
and
(F) not later than 2 years after the date of the
establishment of the Prostate Cancer Task Force, submit
to the Expert Advisory Panel to be reviewed and
returned within 30 days, and then within 90 days
submitted to Congress recommendations--
(i) regarding any appropriate changes to
research and health care programs, including
recommendations to improve the research
portfolio of the Department of Veterans
Affairs, the Department of Defense, National
Institutes of Health, and other Federal
agencies to ensure that scientifically based
strategic planning is implemented in support of
research and health care program priorities;
(ii) designed to ensure that the research
and health care programs and activities of the
Department of Veterans Affairs, the Department
of Defense, the Department of Health and Human
Services, and other Federal agencies are free
of unnecessary duplication;
(iii) regarding public participation in
decisions relating to prostate cancer research
and health care programs to increase the
involvement of patient advocates, community
organizations, and medical associations
representing a broad geographical area;
(iv) on how to best disseminate information
on prostate cancer research and progress
achieved by health care programs;
(v) about how to expand partnerships
between public entities, including Federal
agencies, and private entities to encourage
collaborative, cross-cutting research and
health care delivery;
(vi) assessing any cost savings and
efficiencies realized through the efforts
identified and supported in this section and
recommending expansion of those efforts that
have proved most promising while also ensuring
against any conflicts in directives from other
congressional or statutory mandates or enabling
statutes;
(vii) identifying key priority action items
from among the recommendations; and
(viii) with respect to the level of funding
needed by each agency to implement the
recommendations contained in the report.
(3) Members of the prostate cancer task force.--The
Prostate Cancer Task Force described in this subsection shall
be composed of representatives from such Federal agencies, as
each Secretary determines necessary, to coordinate a uniform
message relating to prostate cancer screening and treatment
where appropriate, including representatives of the following:
(A) The Department of Veterans Affairs, including
representatives of each relevant program area of the
Department of Veterans Affairs.
(B) The Prostate Cancer Research Program of the
Congressionally Directed Medical Research Program of
the Department of Defense.
(C) The Department of Health and Human Services,
including at a minimum representatives of the
following:
(i) The National Institutes of Health.
(ii) National research institutes and
centers, including the National Cancer
Institute, the National Institute of Allergy
and Infectious Diseases, and the Office of
Minority Health.
(iii) The Centers for Medicare & Medicaid
Services.
(iv) The Food and Drug Administration.
(v) The Centers for Disease Control and
Prevention.
(vi) The Agency for Healthcare Research and
Quality.
(vii) The Health Resources and Services
Administration.
(4) Appointing expert advisory panels.--The Prostate Cancer
Task Force shall appoint expert advisory panels, as determined
appropriate, to provide input and concurrence from individuals
and organizations from the medical, prostate cancer patient and
advocate, research, and delivery communities with expertise in
prostate cancer diagnosis, treatment, and research, including
practicing urologists, primary care providers, and others and
individuals with expertise in education and outreach to
underserved populations affected by prostate cancer.
(5) Meetings.--The Prostate Cancer Task Force shall convene
not less than twice a year, or more frequently as the Secretary
determines to be appropriate.
(6) Federal advisory committee act.--
(A) In general.--Except as provided in subparagraph
(B), the Federal Advisory Committee Act (5 U.S.C. App.)
shall apply to the Prostate Cancer Task Force.
(B) Exception.--Section 14(a)(2)(B) of such Act
(relating to the termination of advisory committees)
shall not apply to the Prostate Cancer Task Force.
(7) Sunset date.--The Prostate Cancer Task Force shall
terminate at the end of fiscal year 2021.
(d) Prostate Cancer Research.--
(1) Research coordination.--The Secretary of Veterans
Affairs, in coordination with the Secretaries of Defense and of
Health and Human Services, shall establish and carry out a
program to coordinate and intensify prostate cancer research as
needed. Specifically, such research program shall--
(A) develop advances in diagnostic and prognostic
methods and tests, including biomarkers and an improved
prostate cancer screening blood test, including
improvements or alternatives to the prostate specific
antigen test and additional tests to distinguish
indolent from aggressive disease;
(B) better understand the etiology of the disease
(including an analysis of lifestyle factors proven to
be involved in higher rates of prostate cancer, such as
obesity and diet, and in different ethnic, racial, and
socioeconomic groups, such as the African-American,
Latino or Hispanic, and American Indian populations and
men with a family history of prostate cancer) to
improve prevention efforts;
(C) expand basic research into prostate cancer,
including studies of fundamental molecular and cellular
mechanisms;
(D) identify and provide clinical testing of novel
agents for the prevention and treatment of prostate
cancer;
(E) establish clinical registries for prostate
cancer;
(F) use the National Institute of Biomedical
Imaging and Bioengineering and the National Cancer
Institute for assessment of appropriate imaging
modalities; and
(G) address such other matters relating to prostate
cancer research as may be identified by the Federal
agencies participating in the program under this
section.
(2) Prostate cancer advisory board.--There is established
in the Office of the Chief Scientist of the Food and Drug
Administration a Prostate Cancer Scientific Advisory Board.
Such board shall be responsible for accelerating real-time
sharing of the latest research data and accelerating movement
of new medicines to patients.
(3) Underserved minority grant program.--In carrying out
such program, the Secretary shall--
(A) award grants to eligible entities to carry out
components of the research outlined in paragraph (1);
(B) integrate and build upon existing knowledge
gained from comparative effectiveness research; and
(C) recognize and address--
(i) the racial and ethnic disparities in
the incidence and mortality rates of prostate
cancer and men with a family history of
prostate cancer;
(ii) any barriers in access to care and
participation in clinical trials that are
specific to racial, ethnic, and other
underserved minorities and men with a family
history of prostate cancer;
(iii) needed outreach and educational
efforts to raise awareness in these
communities; and
(iv) appropriate access and utilization of
imaging modalities.
(e) Telehealth and Rural Access Pilot Projects.--
(1) In general.--The Secretary of Veterans Affairs, the
Secretary of Defense, and the Secretary of Health and Human
Services (in this section referred to as the ``Secretaries'')
shall establish 4-year telehealth pilot projects for the
purpose of analyzing the clinical outcomes and cost-
effectiveness associated with telehealth services in a variety
of geographic areas that contain high proportions of medically
underserved populations, including African Americans, Latinos
or Hispanics, American Indians or Alaska Natives, and those in
rural areas. Such projects shall promote efficient use of
specialist care through better coordination of primary care and
physician extender teams in underserved areas and more
effectively employ tumor boards to better counsel patients.
(2) Eligible entities.--
(A) In general.--The Secretaries shall select
eligible entities to participate in the pilot projects
under this section.
(B) Priority.--In selecting eligible entities to
participate in the pilot projects under this section,
the Secretaries shall give priority to such entities
located in medically underserved areas, particularly
those that include African Americans, Latinos and
Hispanics, and facilities of the Indian Health Service,
including Indian Health Service-operated facilities,
tribally operated facilities, and Urban Indian Clinics,
and those in rural areas.
(3) Evaluation.--The Secretaries shall, through the pilot
projects, evaluate--
(A) the effective and economic delivery of care in
diagnosing and treating prostate cancer with the use of
telehealth services in medically underserved and Tribal
areas including collaborative uses of health
professionals and integration of the range of
telehealth and other technologies;
(B) the effectiveness of improving the capacity of
nonmedical providers and nonspecialized medical
providers to provide health services for prostate
cancer in medically underserved and Tribal areas,
including the exploration of innovative medical home
models with collaboration between urologists, other
relevant medical specialists, including oncologists,
radiologists, and primary care teams and coordination
of care through the efficient use of primary care teams
and physician extenders; and
(C) the effectiveness of using telehealth services
to provide prostate cancer treatment in medically
underserved areas, including the use of tumor boards to
facilitate better patient counseling.
(4) Report.--Not later than 12 months after the completion
of the pilot projects under this subsection, the Secretaries
shall submit to Congress a report describing the outcomes of
such pilot projects, including any cost savings and
efficiencies realized, and providing recommendations, if any,
for expanding the use of telehealth services.
(f) Education and Awareness.--
(1) In general.--The Secretary of Veterans Affairs shall
develop a national education campaign for prostate cancer. Such
campaign shall involve the use of written educational materials
and public service announcements consistent with the findings
of the Prostate Cancer Task Force under subsection (c), that
are intended to encourage men to seek prostate cancer screening
when appropriate.
(2) Racial disparities and the population of men with a
family history of prostate cancer.--In developing the national
campaign under paragraph (1), the Secretary shall ensure that
such educational materials and public service announcements are
more readily available in communities experiencing racial
disparities in the incidence and mortality rates of prostate
cancer and by men of any race classification with a family
history of prostate cancer.
(3) Grants.--In carrying out the national campaign under
this section, the Secretary shall award grants to nonprofit
private entities to enable such entities to test alternative
outreach and education strategies.
(g) Authorization of Appropriations.--
(1) In general.--There is authorized to be appropriated to
carry out this section for the period of fiscal years 2019
through 2023 an amount equal to the savings described in
paragraph (2).
(2) Corresponding reduction.--The amount authorized to be
appropriated by provisions of law other than this section for
the period of fiscal years 2019 through 2023 for Federal
research and health care program activities related to prostate
cancer is reduced by the amount of Federal savings projected to
be achieved over such period by implementation of this section.
SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN BREAST AND CERVICAL
CANCER PATIENTS IN THE TERRITORIES.
(a) Elimination of Funding Limitations.--
(1) In general.--Section 1108(g)(4) of the Social Security
Act (42 U.S.C. 1308(g)(4)) is amended by adding at the end the
following: ``With respect to fiscal years beginning with fiscal
year 2019, payment for medical assistance for individuals who
are eligible for such assistance only on the basis of section
1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in
applying subsection (f) (as increased in accordance with
paragraphs (1), (2), (3), and (5) of this subsection) to such
commonwealth or territory for such fiscal year.''.
(2) Technical amendment.--Such section is further amended
by striking ``(3), and (4)'' and inserting ``(3), and (5)''.
(b) Application of Enhanced FMAP for Highest State.--Section
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the
end the following: ``Notwithstanding the first sentence of this
subsection, with respect to medical assistance described in clause (4)
of such sentence that is furnished in Puerto Rico, the United States
Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands,
or American Samoa in a fiscal year, the Federal medical assistance
percentage is equal to the highest such percentage applied under such
clause for such fiscal year for any of the 50 States or the District of
Columbia that provides such medical assistance for any portion of such
fiscal year.''
(c) Effective Date.--The amendments made by this section shall
apply to payment for medical assistance for items and services
furnished on or after October 1, 2016.
SEC. 704. 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, appropriate use of items and services
covered under the Medicare Program under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.), and
referral patterns with respect to target individuals
with cancer;
(C) eliminate disparities in the rate of preventive
cancer screening measures, such as Pap smears, prostate
cancer screenings, colon cancer screenings, breast
cancer screenings, and computed tomography (CT) scans,
for lung cancer among target individuals;
(D) promote collaboration with community-based
organizations to ensure cultural competency of health
care professionals and linguistic access for target
individuals who are persons with limited-English
proficiency; and
(E) encourage the incorporation of community health
workers to increase the efficiency and appropriateness
of cancer screening programs.
(2) Community health worker defined.--In this section, the
term ``community health worker'' includes a community health
advocate, a lay health worker, a community health
representative, a peer health promoter, a community health
outreach worker, and a promotore de salud, who promotes health
or nutrition within the community in which the individual
resides.
(3) Target individual defined.--In this section, the term
``target individual'' means an individual of a racial and
ethnic minority group, as defined in section 1707(g)(1) of the
Public Health Service Act (42 U.S.C. 300u-6(g)(1)), 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, each of which shall target
different ethnic subpopulations, 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) Latinos or Hispanics.
(v) Native Hawaiians and other Pacific
Islanders.
(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 (42 U.S.C.
1395 et seq.); 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
Medicare 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 (42 U.S.C.
1395 et seq.) to such extent and for such period as the Secretary
determines is necessary to conduct demonstration projects.
SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDICARE.
(a) Development of Measures of Disparities in Quality of Cancer
Care.--
(1) Development of measures.--The Secretary of Health and
Human Services (in this section referred to as the
``Secretary'') shall enter into an agreement with an entity
that specializes in developing quality measures for cancer care
under which the entity shall develop a uniform set of measures
to evaluate disparities in the quality of cancer care and
annually update such set of measures.
(2) Measures to be included.--Such set of measures shall
include, with respect to the treatment of cancer, measures of
patient outcomes, the process for delivering medical care
related to such treatment, patient counseling and engagement in
decisionmaking, patient experience of care, resource use, and
practice capabilities, such as care coordination.
(b) Establishment of Reporting Process.--
(1) In general.--The Secretary shall establish a reporting
process that requires and provides for a method for health care
providers specified under paragraph (2) to submit to the
Secretary and make public data on the performance of such
providers during each reporting period through use of the
measures developed pursuant to subsection (a). Such data shall
be submitted in a form and manner and at a time specified by
the Secretary.
(2) Specification of providers to report on measures.--The
Secretary shall specify the classes of Medicare providers of
services and suppliers, including hospitals, cancer centers,
physicians, primary care providers, and specialty providers,
that will be required under such process to publicly report on
the measures specified under subsection (a).
(3) Assessment of changes.--Under such reporting process,
the Secretary shall establish a format that assesses changes in
both the absolute and relative disparities in cancer care over
time. These measures shall be presented in an easily
comprehensible format, such as those presented in the final
publications relating to Healthy People 2010 or the National
Healthcare Disparities Report.
(4) Initial implementation.--The Secretary shall implement
the reporting process under this subsection for reporting
periods beginning not later than 6 months after the date that
measures are first established under subsection (a).
Subtitle B--Viral Hepatitis and Liver Cancer Control and Prevention
SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL AND PREVENTION.
(a) Short Title.--This subtitle may be cited as the ``Viral
Hepatitis and Liver Cancer Control and Prevention Act of 2018''.
(b) Findings.--Congress finds the following:
(1) In the United States, as many as 4,400,000 persons are
living with the hepatitis B virus (referred to in this section
as ``HBV'') or the hepatitis C virus (referred to in this
section as ``HCV'').
(2) In the United States, chronic HBV and HCV are the most
common cause of liver cancer, one of the most lethal and
fastest growing cancers in this country. It is the most common
cause of chronic liver disease, liver cirrhosis, and the most
common indication for liver transplantation. At least 21,000
deaths per year in the United States can be attributed to
chronic HBV and HCV. Chronic HCV is also a leading cause of
death in Americans living with HIV/AIDS; many of those living
with HIV/AIDS are coinfected with chronic HBV, chronic HCV, or
both.
(3) According to the Centers for Disease Control and
Prevention (referred to in this section as the ``CDC''),
approximately 2 percent of the population of the United States
is living with chronic HBV, chronic HCV, or both. The CDC has
recognized HCV as the Nation's most common chronic bloodborne
virus infection and HBV as the deadliest vaccine-preventable
disease.
(4) HBV is easily transmitted and is 100 times more
infectious than HIV. According to the CDC, HBV is transmitted
through contact with infectious blood, semen, or other body
fluids. HCV is transmitted by contact with infectious blood,
particularly through percutaneous exposures (i.e. puncture
through the skin).
(5) The CDC estimates that in 2015, approximately 33,900
Americans were newly infected with HCV and approximately 21,900
Americans were newly infected with HBV. These estimates could
be much higher due to many reasons, including lack of screening
education and awareness, and perceived marginalization of the
populations at risk.
(6) In 2012, CDC released new guidelines recommending every
person born between 1945 and 1965 receive a one-time test.
Among the estimated 102 million (1.6 million chronically HCV-
infected) eligible for screening, birth-cohort screening leads
to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer
cases of hepatocellular carcinoma, 10,000 fewer liver
transplants, and 78,000 fewer HCV-related deaths gained versus
risk-based screening.
(7) In 2013, the United States Preventive Services Task
Force (USPSTF) issued a Grade B rating for screening for the
hepatitis C virus (HCV) infection in persons at high risk for
infection and adults born between 1945 and 1965. In 2014, the
USPSTF issued a Grade B for screening for the hepatitis B virus
(HBV) in persons at high-risk of hepatitis B infection. In
2009, the USPSTF issued a Grade A for screening pregnant women
for the hepatitis B virus (HBV) during their first prenatal
visit.
(8) There were 59 outbreaks (24 of HBV and 36 of HCV,
including one of both HBV and HCV) reported to CDC for
investigation from 2008 through 2016 related to healthcare-
associated infection of HBV and HCV, 56 of which occurred in
nonhospital settings. There were more than 115,983 patients
potentially exposed to one of the viruses.
(9) Chronic HBV and chronic HCV usually do not cause
symptoms early in the course of the disease, but after many
years of a clinically ``silent'' phase, CDC estimates show more
than 33 percent of infected individuals will develop cirrhosis,
end-stage liver disease, or liver cancer. Since most
individuals with chronic HBV, HCV, or both are unaware of their
infection, they do not know to take precautions to prevent the
spread of their infection and can unknowingly exacerbate their
own disease progression.
(10) HBV and HCV disproportionately affect certain
populations in the United States. Although representing only
about 5 percent of the population, Asian Americans and Pacific
Islanders account for over half of all chronic HBV cases in the
United States. Baby boomers (those born between 1945 and 1965)
account for approximately 75 percent of domestic chronic
hepatitis C cases. In addition, African Americans, Latinos
(Latinas), and American Indian/Native Alaskans are among the
groups which have disproportionately high rates of HBV and/or
HCV infections in the United States.
(11) For both chronic HBV and chronic HCV, behavioral
changes can slow disease progression if diagnosis is made
early. Early diagnosis, which is determined through simple
blood tests, can reduce the risk of transmission and disease
progression through education and vaccination of household
members and other susceptible persons at risk.
(12) Advancements have led to the development of improved
diagnostic tests for viral hepatitis. These tests, including
rapid, point of care testing and others in development, can
facilitate testing, notification of results and post-test
counseling, and referral to care at the time of the testing
visit. In particular, these tests are also advantageous because
they can be used simultaneously with HIV rapid testing for
persons at risk for both HCV and HIV infections.
(13) For those chronically infected with HBV or HCV,
regular monitoring can lead to the early detection of liver
cancer at a stage where a cure is still possible. Liver cancer
is the second deadliest cancer in the United States; however,
liver cancer has received little funding for research,
prevention, or treatment.
(14) Treatment for chronic HCV can eradicate the disease in
approximately 90 percent of those currently treated. The
treatment of chronic HBV can effectively suppress viral
replication in the overwhelming majority (over 80 percent) of
those treated, thereby reducing the risk of transmission and
progression to liver scarring or liver cancer, even though a
complete cure is much less common than for HCV.
(15) To combat the viral hepatitis epidemic in the United
States, in February 2017, the Department of Health and Human
Services released its ``National Viral Hepatitis Action Plan
2017-2020'' (hereafter referred to as the ``HHS Action Plan'').
In March 2017, the National Academies of Sciences, Engineering,
and Medicine (NASEM) released ``A National Strategy for the
Elimination of Hepatitis B and C: Phase Two Report'',
recommending specific actions to eliminate viral hepatitis as
public health problems in the United States by 2030.
(16) The annual health care costs attributable to HBV and
HCV in the United States are significant. For HBV, it is
estimated to be approximately $2,500,000,000 ($2,000 per
infected person). In 2000, the lifetime cost of HBV--before the
availability of most current therapies--was approximately
$80,000 per chronically infected person, totaling more than
$100,000,000,000. For HCV, medical costs for patients are
expected to increase from $30,000,000,000 in 2009 to over
$85,000,000,000 in 2024. Avoiding these costs by screening and
diagnosing individuals earlier--and connecting them to
appropriate treatment and care, will save lives and critical
health care dollars. Currently, without a comprehensive
screening, testing, and diagnosis program, most patients are
diagnosed too late when they need a liver transplant costing at
least $314,000 for uncomplicated cases or when they have liver
cancer or end-stage liver disease which costs $30,980 to
$110,576 per hospital admission. As health care costs continue
to grow, it is critical that the Federal Government invests in
effective mechanisms to avoid documented cost drivers.
(17) According to the IOM report in 2010, chronic HBV and
HCV infections cause substantial morbidity and mortality
despite being preventable and treatable. Deficiencies in the
implementation of established guidelines for the prevention,
diagnosis, and medical management of chronic HBV and HCV
infections perpetuate personal and economic burdens. Existing
grants are not sufficient for the scale of the health burden
presented by HBV and HCV.
(18) Screening and testing for HBV and HCV is aligned with
the Healthy People 2020 goal to increase immunization rates and
reduce preventable infectious diseases. Awareness of disease
and access to prevention and treatment remain essential
components for reducing infectious disease transmission.
(19) Federal support is necessary to increase knowledge and
awareness of HBV and HCV and to assist State and local
prevention and control efforts in reducing the morbidity and
mortality of these epidemics.
(20) The Secretary of Health and Human Services has the
discretion to carry out this Act directly and through whichever
of the agencies of the Public Health Service the Secretary
determines to be appropriate, which may (in the Secretary's
discretion) include the Centers for Disease Control and
Prevention, the Health Resources and Services Administration,
the Substance Abuse and Mental Health Services Administration,
the National Institutes of Health (including the National
Institute on Minority Health and Health Disparities), and other
agencies of such Service.
(21) The Centers for Disease Control and Prevention
reported a 151 percent increase in hepatitis C cases from 2010-
2013, stemming from the opioid, heroin, and overdose epidemics
affecting communities nationwide. For the first time since
2006, the number of reported cases of acute hepatitis B
infection in the United States is rising; it increased by 20.7
percent in 2015 alone, which is also largely due to the opioid
epidemic.
(c) Biennial Assessment of HHS Hepatitis B and Hepatitis C
Prevention, Education, Research, and Medical Management Plan.--Title
III of the Public Health Service Act (42 U.S.C. 241 et seq.) is
amended--
(1) by striking section 317N (42 U.S.C. 247b-15); and
(2) by adding at the end the following:
``PART X--BIENNIAL ASSESSMENT OF HHS HEPATITIS B AND HEPATITIS C
PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PLAN
``SEC. 399PP. BIENNIAL UPDATE OF THE PLAN.
``(a) In General.--The Secretary shall conduct a biennial
assessment of the Secretary's plan for the prevention, control, and
medical management of, and education and research relating to,
hepatitis B and hepatitis C, for the purposes of--
``(1) incorporating into such plan new knowledge or
observations relating to hepatitis B and hepatitis C (such as
knowledge and observations that may be derived from clinical,
laboratory, and epidemiological research and disease detection,
prevention, and surveillance outcomes);
``(2) addressing gaps in the coverage or effectiveness of
the plan; and
``(3) evaluating and, if appropriate, updating
recommendations, guidelines, or educational materials of the
Centers for Disease Control and Prevention or the National
Institutes of Health for health care providers or the public on
viral hepatitis in order to be consistent with the plan.
``(b) Publication of Notice of Assessments.--Not later than October
1 of the first even-numbered year beginning after the date of the
enactment of this part, and October 1 of each even-numbered year
thereafter, the Secretary shall publish in the Federal Register a
notice of the results of the assessments conducted under paragraph (1).
Such notice shall include--
``(1) a description of any revisions to the plan referred
to in subsection (a) as a result of the assessment;
``(2) an explanation of the basis for any such revisions,
including the ways in which such revisions can reasonably be
expected to further promote the original goals and objectives
of the plan; and
``(3) in the case of a determination by the Secretary that
the plan does not need revision, an explanation of the basis
for such determination.
``SEC. 399PP-1. ELEMENTS OF PROGRAM.
``(a) Education and Awareness Programs.--The Secretary, acting
through 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, and in accordance with the plan referred to in section
399PP(a), shall implement programs to increase awareness and enhance
knowledge and understanding of hepatitis B and hepatitis C. Such
programs shall include--
``(1) the conduct of culturally and language appropriate
health education in primary and secondary schools, college
campuses, public awareness campaigns, and community outreach
activities (especially to the ethnic communities with high
rates of chronic hepatitis B and chronic hepatitis C and other
high-risk groups) to promote public awareness and knowledge
about the value of hepatitis A and hepatitis B immunization,
risk factors, the transmission and prevention of hepatitis B
and hepatitis C, the value of screening for the early detection
of hepatitis B and hepatitis C, and options available for the
treatment of chronic hepatitis B and chronic hepatitis C;
``(2) the promotion of immunization programs that increase
awareness and access to hepatitis A and hepatitis B vaccines
for susceptible adults and children;
``(3) the training of health care professionals regarding
the importance of vaccinating individuals infected with
hepatitis C and individuals who are at risk for hepatitis C
infection against hepatitis A and hepatitis B;
``(4) the training of health care professionals regarding
the importance of vaccinating individuals chronically infected
with hepatitis B and individuals who are at risk for chronic
hepatitis B infection against the hepatitis A virus;
``(5) the training of health care professionals and health
educators to make them aware of the high rates of chronic
hepatitis B and chronic hepatitis C in certain adult ethnic
populations, and the importance of prevention, detection, and
medical management of hepatitis B and hepatitis C and of liver
cancer screening;
``(6) the development and distribution of health education
curricula (including information relating to the special needs
of individuals infected with hepatitis B and hepatitis C, such
as the importance of prevention and early intervention, regular
monitoring, the recognition of psychosocial needs, appropriate
treatment, and liver cancer screening) for individuals
providing hepatitis B and hepatitis C counseling; and
``(7) support for the implementation curricula described in
paragraph (6) by State and local public health agencies.
``(b) Immunization, Prevention, and Control Programs.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support the integration of activities described in
paragraph (3) into existing clinical and public health programs
at State, local, territorial, and Tribal levels (including
community health clinics, programs for the prevention and
treatment of HIV/AIDS, sexually transmitted infections, and
substance abuse, and programs for individuals in correctional
settings).
``(2) Coordination of development of federal screening
guidelines.--
``(A) References.--For purposes of this subsection,
the term `CDC Director' means the Director of the
Centers for Disease Control and Prevention, and the
term `AHRQ Director' means the Director of the Agency
for Healthcare Research and Quality.
``(B) Agency for healthcare research and quality.--
Due to the rapidly evolving standard of care associated
with diagnosing and treating viral hepatitis infection,
the AHRQ Director shall convene the Preventive Services
Task Force under section 915(a) of the Public Health
Service Act to review its recommendation for screening
for HBV and HCV infection every 3 years.
``(3) Activities.--
``(A) Voluntary testing programs.--
``(i) In general.--The Secretary shall
establish a mechanism by which to support and
promote the development of State, local,
territorial, and Tribal voluntary hepatitis B
and hepatitis C testing programs to screen the
high-prevalence populations to aid in the early
identification of chronically infected
individuals.
``(ii) Confidentiality of the test
results.--The Secretary shall prohibit the use
of the results of a hepatitis B or hepatitis C
test conducted by a testing program developed
or supported under this subparagraph for any of
the following:
``(I) Issues relating to health
insurance.
``(II) To screen or determine
suitability for employment.
``(III) To discharge a person from
employment.
``(B) Counseling regarding viral hepatitis.--The
Secretary shall support State, local, territorial, and
Tribal programs in a wide variety of settings,
including those providing primary and specialty health
care services in nonprofit private and public sectors,
to--
``(i) provide individuals with ongoing risk
factors for hepatitis B and hepatitis C
infection with client-centered education and
counseling which concentrates on--
``(I) promoting testing of
individuals that have been exposed to
their blood, family members, and their
sexual partners; and
``(II) changing behaviors that
place individuals at risk for
infection;
``(ii) provide individuals chronically
infected with hepatitis B or hepatitis C with
education, health information, and counseling
to reduce their risk of--
``(I) dying from end-stage liver
disease and liver cancer; and
``(II) transmitting viral hepatitis
to others; and
``(iii) provide women chronically infected
with hepatitis B or hepatitis C who are
pregnant or of childbearing age with culturally
and linguistically appropriate health
information, such as how to prevent hepatitis B
perinatal infection, and to alleviate fears
associated with pregnancy or raising a family.
``(C) Immunization.--The Secretary shall support
State, local, territorial, and Tribal efforts to expand
the current vaccination programs to protect every child
in the country and all susceptible adults, particularly
those infected with hepatitis C and high-prevalence
ethnic populations and other high-risk groups, from the
risks of acute and chronic hepatitis B infection by--
``(i) ensuring continued funding for
hepatitis B vaccination for all children 19
years of age or younger through the Vaccines
for Children Program;
``(ii) ensuring that the recommendations of
the Advisory Committee on Immunization
Practices are followed regarding the birth dose
of hepatitis B vaccinations for newborns;
``(iii) requiring proof of hepatitis B
vaccination for entry into public or private
daycare, preschool, elementary school,
secondary school, and institutions of higher
education;
``(iv) expanding the availability of
hepatitis B vaccination for all susceptible
adults to protect them from becoming acutely or
chronically infected, including ethnic and
other populations with high prevalence rates of
chronic hepatitis B infection;
``(v) expanding the availability of
hepatitis B vaccination for all susceptible
adults, particularly those in their
reproductive age (women and men less than 45
years of age), to protect them from the risk of
hepatitis B infection;
``(vi) ensuring the vaccination of
individuals infected, or at risk for infection,
with hepatitis C against hepatitis A, hepatitis
B, and other infectious diseases, as
appropriate, for which such individuals may be
at increased risk; and
``(vii) ensuring the vaccination of
individuals infected, or at risk for infection,
with hepatitis B against hepatitis A virus and
other infectious diseases, as appropriate, for
which such individuals may be at increased
risk.
``(D) Medical referral.--The Secretary shall
support State, local, territorial, and Tribal programs
that support--
``(i) referral of persons chronically
infected with hepatitis B or hepatitis C--
``(I) for medical evaluation to
determine the appropriateness for
antiviral treatment to reduce the risk
of progression to cirrhosis and liver
cancer; and
``(II) for ongoing medical
management including regular monitoring
of liver function and screening for
liver cancer; and
``(ii) referral of persons infected with
acute or chronic hepatitis B infection or acute
or chronic hepatitis C infection for drug and
alcohol abuse treatment where appropriate.
``(4) Increased support for adult viral hepatitis
prevention coordinators.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall provide increased support to adult viral hepatitis
prevention coordinators in State, local, territorial, and
Tribal health departments in order to enhance the additional
management, networking, and technical expertise needed to
ensure successful integration of hepatitis B and hepatitis C
prevention and control activities into existing public health
programs.
``(c) Epidemiological Surveillance.--
``(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention,
shall support the establishment and maintenance of a national
chronic and acute hepatitis B and hepatitis C surveillance
program, in order to identify--
``(A) trends in the incidence of acute and chronic
hepatitis B and acute and chronic hepatitis C;
``(B) trends in the prevalence of acute and chronic
hepatitis B and acute and chronic hepatitis C infection
among groups that may be disproportionately affected;
and
``(C) trends in liver cancer and end-stage liver
disease incidence and deaths, caused by chronic
hepatitis B and chronic hepatitis C in the high-risk
ethnic populations.
``(2) Seroprevalence and liver cancer studies.--The
Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall prepare a report
outlining the population-based seroprevalence studies currently
underway, future planned studies, the criteria involved in
determining which seroprevalence studies to conduct, defer, or
suspend, and the scope of those studies, the economic and
clinical impact of hepatitis B and hepatitis C, and the impact
of chronic hepatitis B and chronic hepatitis C infections on
the quality of life. Not later than one year after the date of
the enactment of this part, the Secretary shall submit the
report to the Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate.
``(3) Confidentiality.--The Secretary shall not disclose
any individually identifiable information identified under
paragraph (1) or derived through studies under paragraph (2).
``(d) Research.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, the Director of the
National Cancer Institute, and the Director of the National Institutes
of Health, shall--
``(1) conduct epidemiologic and community-based research to
develop, implement, and evaluate best practices for hepatitis B
and hepatitis C prevention especially in the ethnic populations
with high rates of chronic hepatitis B and chronic hepatitis C
and other high-risk groups;
``(2) conduct research on hepatitis B and hepatitis C
natural history, pathophysiology, improved treatments and
prevention (such as the hepatitis C vaccine), and noninvasive
tests that help to predict the risk of progression to liver
cirrhosis and liver cancer;
``(3) conduct research that will lead to better noninvasive
or blood tests to screen for liver cancer, and more effective
treatments of liver cancer caused by chronic hepatitis B and
chronic hepatitis C; and
``(4) conduct research comparing the effectiveness of
screening, diagnostic, management, and treatment approaches for
chronic hepatitis B, chronic hepatitis C, and liver cancer in
the affected communities.
``(e) Underserved and Disproportionately Affected Populations.--In
carrying out this section, the Secretary shall provide expanded support
for individuals with limited access to health education, testing, and
health care services and groups that may be disproportionately affected
by hepatitis B and hepatitis C.
``(f) Evaluation of Program.--The Secretary shall develop
benchmarks for evaluating the effectiveness of the programs and
activities conducted under this section and make determinations as to
whether such benchmarks have been achieved.
``SEC. 399PP-2. GRANTS.
``(a) In General.--The Secretary may award grants to, or enter into
contracts or cooperative agreements with, States, political
subdivisions of States, territories, Indian Tribes, or nonprofit
entities that have special expertise relating to hepatitis B, hepatitis
C, or both, to carry out activities under this part.
``(b) Application.--To be eligible for a grant, contract, or
cooperative agreement under subsection (a), an entity shall prepare and
submit to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.
``SEC. 399PP-3. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated to carry out this part
$90,000,000 for fiscal year 2019, $90,000,000 for fiscal year 2020,
$110,000,000 for fiscal year 2021, $130,000,000 for fiscal year 2022,
and $150,000,000 for fiscal year 2023.''.
Subtitle C--Acquired Bone Marrow Failure Diseases
SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES.
(a) Short Title.--This subtitle may be cited as the ``Bone Marrow
Failure Disease Research and Treatment Act of 2018''.
(b) Findings.--The Congress finds the following:
(1) Between 20,000 and 30,000 Americans are diagnosed each
year with myelodysplastic syndromes, aplastic anemia,
paroxysmal nocturnal hemoglobinuria, and other acquired bone
marrow failure diseases.
(2) Acquired bone marrow failure diseases have a
debilitating and often fatal impact on those diagnosed with
these diseases.
(3) While some treatments for acquired bone marrow failure
diseases can prolong and improve the quality of patients'
lives, there is no single cure for these diseases.
(4) The prevalence of acquired bone marrow failure diseases
in the United States will continue to grow as the general
public ages.
(5) Evidence exists suggesting that acquired bone marrow
failure diseases occur more often in minority populations,
particularly in Asian-American and Latino or Hispanic
populations.
(6) The National Heart, Lung, and Blood Institute and the
National Cancer Institute have conducted important research
into the causes of and treatments for acquired bone marrow
failure diseases.
(7) The National Marrow Donor Program Registry has made
significant contributions to the fight against bone marrow
failure diseases by connecting millions of potential marrow
donors with individuals and families suffering from these
conditions.
(8) Despite these advances, a more comprehensive Federal
strategic effort among numerous Federal agencies is needed to
discover a cure for acquired bone marrow failure disorders.
(9) Greater Federal surveillance of acquired bone marrow
failure diseases is needed to gain a better understanding of
the causes of acquired bone marrow failure diseases.
(10) The Federal Government should increase its research
support for and engage with public and private organizations in
developing a comprehensive approach to combat and cure acquired
bone marrow failure diseases.
(c) National Acquired Bone Marrow Failure Disease Registry.--Part B
of the Public Health Service Act (42 U.S.C. 311 et seq.) is amended by
inserting after section 317W, as added, the following:
``SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE DISEASE REGISTRY.
``(a) Establishment of Registry.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Director of the Centers for Disease Control and Prevention,
shall--
``(A) develop a system to collect data on acquired
bone marrow failure diseases; and
``(B) establish and maintain a national and
publicly available registry, to be known as the
National Acquired Bone Marrow Failure Disease Registry,
in accordance with paragraph (3).
``(2) Recommendations of advisory committee.--In carrying
out this subsection, the Secretary shall take into
consideration the recommendations of the Advisory Committee on
Acquired Bone Marrow Failure Diseases established under
subsection (b).
``(3) Purposes of registry.--The National Acquired Bone
Marrow Failure Disease Registry--
``(A) shall identify the incidence and prevalence
of acquired bone marrow failure diseases in the United
States;
``(B) shall be used to collect and store data on
acquired bone marrow failure diseases, including data
concerning--
``(i) the age, race or ethnicity, general
geographic location, sex, and family history of
individuals who are diagnosed with acquired
bone marrow failure diseases, and any other
characteristics of such individuals determined
appropriate by the Secretary;
``(ii) the genetic and environmental
factors that may be associated with developing
acquired bone marrow failure diseases;
``(iii) treatment approaches for dealing
with acquired bone marrow failure diseases;
``(iv) outcomes for individuals treated for
acquired bone marrow failure diseases,
including outcomes for recipients of stem cell
therapeutic products as contained in the
database established pursuant to section 379A;
and
``(v) any other factors pertaining to
acquired bone marrow failure diseases
determined appropriate by the Secretary; and
``(C) shall be made available--
``(i) to the general public; and
``(ii) to researchers to facilitate further
research into the causes of, and treatments
for, acquired bone marrow failure diseases in
accordance with standard practices of the
Centers for Disease Control and Preventions.
``(b) Advisory Committee.--
``(1) Establishment.--Not later than 6 months after the
date of the enactment of this section, the Secretary, acting
through the Director of the Centers for Disease Control and
Prevention, shall establish an advisory committee, to be known
as the Advisory Committee on Acquired Bone Marrow Failure
Diseases.
``(2) Members.--The members of the Advisory Committee on
Acquired Bone Marrow Failure Diseases shall be appointed by the
Secretary, acting through the Director of the Centers for
Disease Control and Prevention, and shall include at least one
representative from each of the following:
``(A) A national patient advocacy organization with
experience advocating on behalf of patients suffering
from acquired bone marrow failure diseases.
``(B) The National Institutes of Health, including
at least one representative from each of--
``(i) the National Cancer Institute;
``(ii) the National Heart, Lung, and Blood
Institute; and
``(iii) the Office of Rare Diseases.
``(C) The Centers for Disease Control and
Prevention.
``(D) Clinicians with experience in--
``(i) diagnosing or treating acquired bone
marrow failure diseases; and
``(ii) medical data registries.
``(E) Epidemiologists who have experience with data
registries.
``(F) Publicly or privately funded researchers who
have experience researching acquired bone marrow
failure diseases.
``(G) The entity operating the C.W. Bill Young Cell
Transplantation Program established pursuant to section
379 and the entity operating the C.W. Bill Young Cell
Transplantation Program Outcomes Database.
``(3) Responsibilities.--The Advisory Committee on Acquired
Bone Marrow Failure Diseases shall provide recommendations to
the Secretary on the establishment and maintenance of the
National Acquired Bone Marrow Failure Disease Registry,
including recommendations on the collection, maintenance, and
dissemination of data.
``(4) Public availability.--The Secretary shall make the
recommendations of the Advisory Committee on Acquired Bone
Marrow Failure Disease publicly available.
``(c) Grants.--The Secretary, acting through the Director of the
Centers for Disease Control and Prevention, may award grants to, and
enter into contracts and cooperative agreements with, public or private
nonprofit entities for the management of, as well as the collection,
analysis, and reporting of data to be included in, the National
Acquired Bone Marrow Failure Disease Registry.
``(d) Definition.--In this section, the term `acquired bone marrow
failure disease' means--
``(1) myelodysplastic syndromes (MDS);
``(2) aplastic anemia;
``(3) paroxysmal nocturnal hemoglobinuria (PNH);
``(4) pure red cell aplasia;
``(5) acute myeloid leukemia that has progressed from
myelodysplastic syndromes; or
``(6) large granular lymphocytic leukemia.
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $3,000,000 for each of fiscal
years 2019 through 2023.''.
(d) Pilot Studies Through the Agency for Toxic Substances and
Disease Registry.--
(1) Pilot studies.--The Secretary of Health and Human
Services, acting through the Administrator of the Agency for
Toxic Substances and Disease Registry, shall conduct pilot
studies to determine which environmental factors, including
exposure to toxins, may cause acquired bone marrow failure
diseases.
(2) Collaboration with the radiation injury treatment
network.--In carrying out the directives of this section, the
Secretary may collaborate with the Radiation Injury Treatment
Network of the C.W. Bill Young Cell Transplantation Program
established pursuant to section 379 of the Public Health
Service Act (42 U.S.C. 274j) to--
(A) augment data for the pilot studies authorized
by this section;
(B) access technical assistance that may be
provided by the Radiation Injury Treatment Network; or
(C) perform joint research projects.
(3) Authorization of appropriations.--There is authorized
to be appropriated to carry out this section $1,000,000 for
each of fiscal years 2019 through 2023.
(e) Minority-Focused Programs on Acquired Bone Marrow Failure
Diseases.--Title XVII of the Public Health Service Act (42 U.S.C. 300u
et seq.) is amended by inserting after section 1707A the following:
``minority-focused programs on acquired bone marrow failure diseases
``Sec. 1707B. (a) Information and Referral Services.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall
establish and coordinate outreach and informational programs
targeted to minority populations affected by acquired bone
marrow failure diseases.
``(2) Program requirements.--Minority-focused outreach and
informational programs authorized by this section--
``(A) shall make information about treatment
options and clinical trials for acquired bone marrow
failure diseases publicly available; and
``(B) shall provide referral services for treatment
options and clinical trials;
at the National Minority Health Resource Center supported under
section 1707(b)(8) (including by means of the Center's website,
through appropriate locations such as the Center's knowledge
center, and through appropriate programs such as the Center's
resource persons network) and through minority health
consultants located at each Department of Health and Human
Services regional office.
``(b) Hispanic and Asian-American and Pacific Islander Outreach.--
``(1) In general.--The Secretary, acting through the Deputy
Assistant Secretary for Minority Health, shall undertake a
coordinated outreach effort to connect Hispanic, Asian-
American, and Pacific Islander communities with comprehensive
services focused on treatment of, and information about,
acquired bone marrow failure diseases.
``(2) Collaboration.--In carrying out this subsection, the
Secretary may collaborate with public health agencies,
nonprofit organizations, community groups, and online entities
to disseminate information about treatment options and clinical
trials for acquired bone marrow failure diseases.
``(c) Grants and Cooperative Agreements.--
``(1) In general.--Not later than 6 months after the date
of the enactment of this section, the Secretary, acting through
the Deputy Assistant Secretary for Minority Health, shall award
grants to, or enter into cooperative agreements with, entities
to perform research on acquired bone marrow failure diseases.
``(2) Requirement.--Grants and cooperative agreements
authorized by this subsection shall be awarded or entered into
on a competitive, peer-reviewed basis.
``(3) Scope of research.--Research funded under this
section shall examine factors affecting the incidence of
acquired bone marrow failure diseases in minority populations.
``(d) Definition.--In this section, the term `acquired bone marrow
failure disease' has the meaning given to such term in section 317X(d).
``(e) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,000,000 for each of fiscal
years 2019 through 2023.''.
(f) Diagnosis and Quality of Care for Acquired Bone Marrow Failure
Diseases.--
(1) Grants.--The Secretary of Health and Human Services,
acting through the Director of the Agency for Healthcare
Research and Quality, shall award grants to entities to improve
diagnostic practices and quality of care with respect to
patients with acquired bone marrow failure diseases.
(2) Authorization of appropriations.--There is authorized
to be appropriated to carry out this section $2,000,000 for
each of fiscal years 2019 through 2023.
(g) Definition.--In this section, the term ``acquired bone marrow
failure disease'' means--
(1) myelodysplastic syndromes (MDS);
(2) aplastic anemia;
(3) paroxysmal nocturnal hemoglobinuria (PNH);
(4) pure red cell aplasia;
(5) acute myeloid leukemia that progressed from
myelodysplastic syndromes; or
(6) large granular lymphocytic leukemia.
Subtitle D--Cardiovascular Disease, Chronic Disease, and Other Disease
Issues
SEC. 731. 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 Institute 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 as appropriate under subsection (a) for--
(1) hypertension;
(2) hypercholesterolemia;
(3) diabetes;
(4) cardiovascular disease;
(5) cancers, including breast, prostate, colon, cervical,
and lung cancer;
(6) other pulmonary problems including sleep apnea;
(7) asthma;
(8) diabetes;
(9) kidney diseases;
(10) eye diseases and disorders, including glaucoma;
(11) HIV/AIDS and sexually transmitted infections;
(12) uterine fibroids;
(13) autoimmune disease;
(14) mental health conditions;
(15) dental health conditions and oral diseases, including
oral cancer;
(16) environmental and related health illnesses and
conditions;
(17) sickle cell disease and sickle cell trait;
(18) violence and injury prevention and control;
(19) genetic and related conditions;
(20) heart disease and stroke;
(21) tuberculosis;
(22) chronic obstructive pulmonary disease;
(23) musculoskeletal diseases, arthritis, and obesity; and
(24) 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 such sums as may be necessary
for each of fiscal years 2019 through 2023.
SEC. 732. CDC WISEWOMAN SCREENING PROGRAM.
Section 1509 of the Public Health Service Act (42 U.S.C. 300n-4a)
is amended--
(1) in subsection (a)--
(A) by striking the heading and inserting ``In
General.--''; and
(B) in the matter preceding paragraph (1), by
striking ``may make grants'' and all that follows
through ``purpose'' and inserting the following: ``may
make grants to such States for the purpose''; and
(2) in subsection (d)(1), by striking ``there are
authorized'' and all that follows through the period and
inserting ``there are authorized to be appropriated $23,000,000
for fiscal year 2019, $25,300,000 for fiscal year 2020,
$27,800,000 for fiscal year 2021, $30,800,000 for fiscal year
2022, and $34,000,000 for fiscal year 2023.''.
SEC. 733. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.
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:
``SEC. 399V-8. REPORT ON CARDIOVASCULAR CARE FOR WOMEN AND MINORITIES.
``Not later than September 30, 2019, and annually thereafter, the
Secretary shall prepare and submit to the Congress a report on the
quality of and access to care for women and minorities with heart
disease, stroke, and other cardiovascular diseases. The report shall
contain recommendations for eliminating disparities in, and improving
the treatment of, heart disease, stroke, and other cardiovascular
diseases in women, racial and ethnic minorities, those for whom English
is not their primary language, and individuals with disabilities.''.
SEC. 734. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES IN
MEDICAID AND PRIVATE HEALTH INSURANCE.
(a) Requiring Medicaid Coverage of Counseling and Pharmacotherapy
for Cessation of Tobacco Use.--Section 1905 of the Social Security Act
(42 U.S.C. 1396d) is amended--
(1) in subsection (a)(4)(D), by striking ``by pregnant
women''; and
(2) in subsection (bb)--
(A) by striking ``by pregnant women'' each place it
appears;
(B) in paragraph (1), in the matter before
subparagraph (A), by inserting ``by individuals''
before ``who use tobacco''; and
(C) in paragraph (2)(A), by striking ``with respect
to pregnant women''.
(b) Exception From Optional Restriction Under Medicaid Prescription
Drug Coverage.--Section 1927(d)(2)(F) of the Social Security Act (42
U.S.C. 1396r-8(d)(2)(F)) is amended--
(1) by striking ``in the case of pregnant women''; and
(2) by striking ``under the over-the-counter monograph
process''.
(c) State Monitoring and Promoting of Comprehensive Tobacco
Cessation Services Under Medicaid.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)), as amended by section 450(c), is
amended--
(1) by striking ``and'' at the end of paragraph (82);
(2) by striking the period at the end of paragraph (83) and
inserting ``; and''; and
(3) by inserting after paragraph (83) the following new
paragraph:
``(84) provide for the State to monitor and promote the use
of comprehensive tobacco cessation services under the State
plan, including conducting an outreach campaign to increase
awareness of, and the benefits of using, such services among--
``(A) individuals entitled to medical assistance
under the State plan who use tobacco products; and
``(B) clinicians and others who provide services to
individuals entitled to medical assistance under the
State plan.''.
(d) Federal Reimbursement for Medicaid Outreach Campaign To
Increase Awareness.--Section 1903(a) of the Social Security Act (42
U.S.C. 1396b(a)) is amended--
(1) by striking the period at the end of paragraph (7) and
inserting ``; plus''; and
(2) by inserting after paragraph (7) the following new
paragraph:
``(8) an amount equal to 90 percent of the sums expended
during each quarter which are attributable to the development,
implementation, and evaluation of an outreach campaign to--
``(A) increase awareness of comprehensive tobacco
cessation services covered in the State plan among--
``(i) individuals who are likely to be
eligible for medical assistance under the State
plan; and
``(ii) clinicians and others who provide
services to individuals who are likely to be
eligible for medical assistance under the State
plan; and
``(B) increase awareness of the benefits of using
comprehensive tobacco cessation services covered in the
State plan among--
``(i) individuals who are likely to be
eligible for medical assistance under the State
plan; and
``(ii) clinicians and others who provide
services to individuals who are likely to be
eligible for medical assistance under the State
plan about the benefits of using comprehensive
tobacco cessation services.''.
(e) Removal of Cost Sharing for Counseling and Pharmacotherapy for
Cessation of Tobacco Use Under Medicaid.--
(1) General cost sharing limitations.--Section 1916 of the
Social Security Act (42 U.S.C. 1396o) is amended--
(A) in subsections (a)(2)(B) and (b)(2)(B), by
striking ``and counseling and pharmacotherapy for
cessation of tobacco use by pregnant women (as defined
in section 1396d(bb) of this title) and covered
outpatient drugs (as defined in subsection (k)(2) of
section 1396r-8 of this title and including
nonprescription drugs described in subsection (d)(2) of
such section) that are prescribed for purposes of
promoting, and when used to promote, tobacco cessation
by pregnant women in accordance with the Guideline
referred to in section 1396d(bb)(2)(A) of this title''
each place it appears; and
(B) in each of subsections (a)(2)(D) and (b)(2)(D)
by inserting ``and counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1396d(bb) of this title) and covered outpatient drugs
(as defined in subsection (k)(2) of section 1396r-8 of
this title and including nonprescription drugs
described in subsection (d)(2) of such section) that
are prescribed for purposes of promoting, and when used
to promote, tobacco cessation in accordance with the
Guideline referred to in section 1396d(bb)(2)(A) of
this title,'' after ``(or at the option of the State,
any services furnished to pregnant women''.
(2) Application to alternative cost sharing.--Section
1916A(b)(3)(B) of such Act (42 U.S.C. 1396o-1(b)(3)(B)) is
amended--
(A) in clause (iii), by striking ``, and counseling
and pharmacotherapy for cessation of tobacco use by
pregnant women (as defined in section 1396d of this
title)''; and
(B) by adding at the end the following:
``(xi) Counseling and pharmacotherapy for
cessation of tobacco use (as defined in section
1905(bb)) and covered outpatient drugs (as
defined in subsection (k)(2) of section 1396r-8
of this title and including nonprescription
drugs described in subsection (d)(2) of such
section) that are prescribed for purposes of
promoting, and when used to promote, tobacco
cessation in accordance with the Guideline
referred to in section 1396d (bb)(2)(A) of this
title.''.
(f) No Prior Authorization for Tobacco Cessation Drugs Under
Medicaid.--Section 1927(d) of the Social Security Act (42 U.S.C. 1396r-
8) is amended--
(1) by striking in paragraph (1)(A) ``A State'' and
inserting ``Except as otherwise provided in paragraph (6), a
State'';
(2) by inserting after paragraph (5) the following new
paragraph:
``(6) No prior authorization programs for tobacco cessation
drugs.--A State plan under this subchapter shall not require,
as a condition of coverage or payment for a covered outpatient
drug for which Federal financial participation is available in
accordance with this section, the approval of an agent when
used to promote smoking cessation, including agents approved by
the Food and Drug Administration for the purposes of promoting,
and when used to promote, tobacco cessation.''.
(3) by redesignating paragraphs (6) and (7) as paragraphs
(7) and (8).
(g) Comprehensive Coverage of Tobacco Cessation Coverage in Private
Health Insurance.--
(1) No prior authorization for tobacco cessation
coverage.--Section 2713 of the Public Health Service Act (42
U.S.C. 300gg-3) is amended by inserting after subsection (c) a
new subsection:
``(d) No Prior Authorization.--A group health plan and a health
insurance issuer offering group or individual health insurance coverage
shall not impose any prior authorization requirement for tobacco
cessation counseling and pharmacotherapy that has in effect a rating of
`A' or `B' in the current recommendations of the United States
Preventive Services Task Force.''.
(2) No cost sharing.--Section 1302(c) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(c)) is
amended by inserting after paragraph (1) the following new
paragraph:
``(2) No cost sharing or prior authorization for
comprehensive tobacco cessation coverage.--There shall be no
cost sharing or prior authorization requirement imposed with
respect to services described in subsection (b)(1)(K).''.
(h) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2019.
SEC. 735. CLINICAL RESEARCH FUNDING FOR ORAL HEALTH.
(a) In General.--The Secretary of Health and Human Services shall
expand and intensify the conduct and support of the research activities
of the National Institutes of Health and the National Institute of
Dental and Craniofacial Research to improve the oral health of the
population through the prevention and management of oral diseases and
conditions.
(b) Included Research Activities.--Research activities under
subsection (a) shall include--
(1) comparative effectiveness research and clinical disease
management research addressing early childhood caries and oral
cancer; and
(2) awarding of grants and contracts to support the
training and development of health services researchers,
comparative effectiveness researchers, and clinical researchers
whose research improves the oral health of the population.
SEC. 736. PARTICIPATION BY MEDICAID BENEFICIARIES IN APPROVED CLINICAL
TRIALS.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by inserting after section 1943 the following
new section:
``SEC. 1944. PARTICIPATION IN AN APPROVED CLINICAL TRIAL.
``(a) Coverage of Routine Patient Costs Associated With Approved
Clinical Trials.--
``(1) Inclusion.--Subject to paragraph (2), routine patient
costs shall include all items and services consistent with the
medical assistance provided under the State plan that would
otherwise be provided to the individual under such State plan
if such individual was not enrolled in an approved clinical
trial, including any items or services related to the
prevention, detection, and treatment of any medical
complications that arise as a result of participation in the
approved clinical trial.
``(2) Exclusion.--For purposes of paragraph (1), routine
patient costs does not include--
``(A) the investigational item, device, or service
itself;
``(B) items and services that are provided solely
to satisfy data collection and analysis needs and that
are not used in the direct clinical management of the
patient; or
``(C) a service that is clearly inconsistent with
widely accepted and established standards of care for a
particular diagnosis.
``(3) Information concerning clinical trials.--
``(A) In general.--Subject to subparagraph (B), the
Secretary, in consultation with relevant stakeholders,
shall develop a single standardized electronic form for
use by the individual or the referring health care
provider to submit to the State agency administering
the State plan in order to verify that the clinical
trial meets the conditions established for an approved
clinical trial (as defined in subsection (c)).
``(B) Excluded information.--For purposes of
subparagraph (A) or any such request by the State
agency for information regarding a clinical trial, an
individual or referring health care provider shall not
be required to submit--
``(i) the clinical protocol document for
the clinical trial; or
``(ii) subject to subparagraph (C), any
additional information other than such
information as is required pursuant to the form
described in subparagraph (A).
``(C) Optional information.--For purposes of
subparagraphs (A) and (B)(ii), the form may include a
requirement that the referring health care provider
attest that the individual is eligible to participate
in the clinical trial pursuant to the trial protocol
and that individual participation in such trial would
be appropriate.
``(D) Review of information.--
``(i) In general.--A State plan under this
title shall establish a process for timely
review by the State agency of the form and
information submitted pursuant to subparagraph
(A) and, not later than 48 hours after receipt
of such form, confirmation that the information
provided in such form satisfies the
requirements established under such
subparagraph, with such process to include
establishment and operation of a 24-hour, toll-
free telephone number and email address to
provide for expedited communication.
``(ii) Failure to respond.--If an
individual or the referring health care
provider does not receive a response or request
for additional information from the State
agency following the 48-hour period described
in clause (i), the information provided in the
form may be presumed to satisfy the
requirements established under this paragraph.
``(b) Encouragement of Participation in Approved Clinical Trials.--
``(1) Reasonably accessible provider.--For purposes of
participation in an approved clinical trial by an individual
eligible for medical assistance under this title, the State
agency administering the State plan shall make reasonable
efforts to ensure that the individual is provided with access
to a provider who is--
``(A) participating in the approved clinical trial;
``(B) located not more than 25 miles from the
residence of the individual (or, if no such provider is
available, as close as possible to the residence of the
individual); and
``(C) a participating provider under the State plan
or has been deemed to be a participating provider under
the State plan for purposes of providing medical
assistance to the individual during their participation
in the approved clinical trial.
``(2) Informational materials.--The State agency
administering the plan approved under this title shall develop
informational materials and programs to encourage participating
providers to make appropriate referrals to physicians and other
appropriate health care professionals who can provide
individuals with access to approved clinical trials.
``(c) Definition of Approved Clinical Trial.--The term `approved
clinical trial' has the same meaning as provided under section 2709(d)
of the Public Health Service Act.''.
(b) Conforming Amendment.--Section 1902(a) of the Social Security
Act (42 U.S.C. 1396a(a)) is amended by inserting after paragraph (77)
the following new paragraph:
``(78) provide that participation in an approved clinical
trial and coverage of routine patient costs associated with
such trial for an individual eligible for medical assistance
under this title is conducted in accordance with the
requirements under section 1944;''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall apply to calendar
quarters beginning on or after October 1, 2018.
(2) Delay permitted for state plan amendment.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirements imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State
legislature that begins after the date of enactment of this
Act. For purposes of the previous sentence, in the case of a
State that has a 2-year legislative session, each year of such
session shall be deemed to be a separate regular session of the
State legislature.
Subtitle E--HIV/AIDS
SEC. 741. STATEMENT OF POLICY.
It is the policy of the United States to achieve an AIDS-free
generation, and to--
(1) expand access to lifesaving antiretroviral therapy for
people living with HIV/AIDS and immediately link people to
continuous and coordinated high-quality care when they learn
they are infected with HIV;
(2) expand targeted efforts to prevent HIV infection using
a combination of effective, evidence-based approaches,
including routine HIV screening, and universal access to HIV
prevention tools in the communities where HIV/AIDS is most
heavily concentrated, particularly communities of color;
(3) ensure laws, policies, and regulations do not impede
access to prevention, treatment, and care for people living
with HIV/AIDS or at risk for acquiring HIV;
(4) accelerate research for more efficacious HIV prevention
and treatments tools, a cure, and a vaccine; and
(5) respect the human rights and dignity of persons living
with HIV/AIDS.
SEC. 742. FINDINGS.
The Congress finds the following:
(1) Over one million people are estimated to be living with
HIV in the United States according to the Centers for Disease
Control and Prevention, 15 percent of whom are unaware of their
HIV-positive status.
(2) Annually there are about 37,600 new HIV infections and
20,000 deaths in people with an HIV diagnoses in 50 States and
6 dependent areas of the United States.
(3) The Centers for Disease Control and Prevention
estimates that, in 2015, there were approximately 37,600 people
newly diagnosed with HIV. The estimated number of annual new
HIV infections declined 10 percent from 2010 to 2014. However,
the number of new infections is increasing among certain
populations, such as Latino gay and bisexual men, where annual
infections increase 14 percent. New infections among Black gay
or bisexual men are remaining stable.
(4) HIV disproportionately affects certain populations in
the United States. Though African Americans represent
approximately 12 percent of the population, African Americans
account for almost half (45 percent) of all people living with
HIV in the United States. Men who have sex with men (MSM)
account for 67 percent of all new HIV infections and are the
only risk group in which HIV infections continue to increase.
(5) Disparities exist among Latinos/Hispanics; they make up
18 percent of the United States population and 24 percent of
new infections (2015).
(6) Though the rate of new infections among American
Indians/Alaska Native (AI/AN) is proportional to their
population size, from 2005 to 2014, the annual number of HIV
diagnoses increased 19 percent among AIs/ANs overall and 63
percent among AI/AN gay and bisexual men.
(7) Asian Americans account for about 2 percent of new HIV
infections, but in 2013, 22 percent were undiagnosed, the
highest rate of undiagnosed HIV among any race/ethnicity.
(8) The latest data from the CDC (2015) indicate that new
infections among women declined 20 percent.
(9) The history of HIV shows that culturally relevant and
gender-responsive supportive services, including psychosocial
support, treatment literacy, case management, and
transportation are necessary strategies to reach and engage
women and girls in medical care.
(10) The limited data available on transgender individuals
point to a disproportionate burden of HIV infection.
(11) Stigma and discrimination contribute to these
disparities.
(12) The Centers for Disease Control and Prevention has
determined that increasing the proportion of people who know
their HIV status is an essential component of comprehensive
HIV/AIDS treatment and prevention efforts and that early
diagnosis is critical in order for people with HIV/AIDS to
receive life-extending therapy. Additionally, the Centers for
Disease Control and Prevention recommend routine HIV screening
in health care settings for all patients aged 13 to 64,
regardless of risk.
(13) In 1998, Congress created the National Minority AIDS
Initiative to provide technical assistance, build capacity, and
strengthen outreach efforts among local institutions and
community-based organizations that serve racial and ethnic
minorities living with or vulnerable to HIV/AIDS.
(14) To combat the HIV epidemic in the United States, the
National HIV/AIDS Strategy (NHAS) provides a framework of
increasing access to care, reducing new infections, and
eliminating HIV-related health disparities. The vision of NHAS
is ``The United States will become a place where new HIV
infections are rare and when they do occur, every person,
regardless of age, gender, race/ethnicity, gender identity, or
socioeconomic circumstance, will have unfettered access to high
quality, life-extending care, free from stigma and
discrimination.''.
(15) At present, many States and United States territories
have criminal statutes based on ``exposure'' to HIV. Most of
these laws were adopted before the availability of effective
antiretroviral treatment for HIV/AIDS.
(16) Research shows that stable housing leads to better
health outcomes for those living with HIV. Inadequate or
unstable housing is not only a barrier to effective treatment,
but also increases the likelihood of engaging in risky
behaviors leading to HIV infection. Insecure housing puts
people with HIV/AIDS at risk of premature death from exposure
to other diseases, poor nutrition, and lack of medical care.
(17) Due to advances in treatment, many people living with
HIV/AIDS (PLWHA) today are living healthy lives and have the
ability and desire to fully participate in all aspects of
community life, including employment. Research associates being
employed with tremendous economic, social, and health benefits
for many people living with HIV/AIDS.
(18) The common benefits associated with employment include
income, autonomy, productivity, and status within society,
daily structure, making a contribution to one's community, and
increased skills and self-esteem. Research also indicates that
many people with disabilities, including PLWHA, report
perceiving themselves as being less disabled or not disabled at
all, when working. Furthermore, some studies link working with
better physical and mental health outcomes for PLWHA when
compared to those who are not working. Preliminary data also
suggest that transitioning to employment is associated with
reduced HIV-related health risk behavior for many people.
(19) On July 16, 2012, the Food and Drug Administration
approved the first drug to reduce the risk of HIV infection in
uninfected individuals who are at high risk of HIV infection
and who may engage in sexual activity with HIV-infected
partners.
(20) Syringe service programs (SSPs) have been associated
with lowered HIV infections, lower hepatitis C infections, and
increased linkage to substance use treatment.
(21) There is now conclusive scientific evidence that a
person living with HIV who is on antiretroviral therapy (ART)
and is durably virally suppressed (defined as having a
consistent viral load of less than 200 copies/ml) does not
sexually transmit HIV. The conclusive evidence about the highly
effective preventative benefits of ART provides an
unprecedented opportunity to improve the lives of people living
with HIV, improve treatment uptake and adherence, and advocate
for expanded access to treatment and care.
SEC. 743. ADDITIONAL FUNDING FOR AIDS DRUG ASSISTANCE PROGRAM
TREATMENTS.
Section 2623 of the Public Health Service Act (42 U.S.C. 300ff-31b)
is amended by adding at the end the following:
``(c) Additional Funding for AIDS Drug Assistance Program
Treatments.--In addition to amounts otherwise authorized to be
appropriated for carrying out this subpart, there are authorized to be
appropriated such sums as may be necessary to carry out sections
2612(b)(3)(B) and 2616 for each of fiscal years 2019 through 2022.''.
SEC. 744. ENHANCING THE NATIONAL HIV SURVEILLANCE SYSTEM.
(a) Grants.--The Secretary of Health and Human Services, acting
through the Director of the Centers for Disease Control and Prevention,
shall make grants to States to support integration of public health
surveillance systems into all electronic health records in order to
allow rapid communications between the clinical setting and health
departments, by means that include--
(1) providing technical assistance and policy guidance to
State and local health departments, clinical providers, and
other agencies serving individuals with HIV to improve the
interoperability of data systems relevant to monitoring HIV
care and supportive services;
(2) capturing longitudinal data pertaining to the
initiation and ongoing prescription or dispensing of
antiretroviral therapy for individuals diagnosed with HIV (such
as through pharmacy-based reporting);
(3) obtaining information--
(A) on a voluntary basis, on sexual orientation and
gender identity; and
(B) on sources of coverage (or the lack thereof)
for medical treatment (including coverage through
Medicaid, Medicare, the program under title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-11 et seq.;
commonly referred to as the ``Ryan White HIV/AIDS
Program''), other public funding, private insurance,
and health maintenance organizations); and
(4) obtaining and using current geographic markers of
residence (such as current address, zip code, partial zip code,
and census block).
(b) Privacy and Security Safeguards.--In carrying out this section,
the Secretary of Health and Human Services shall ensure that
appropriate privacy and security safeguards are met to prevent
unauthorized disclosure of protected health information and compliance
with the HIPAA privacy and security law (as defined in section 3009 of
the Public Health Service Act (42 U.S.C. 300jj-19)) and other relevant
laws and regulations.
(c) Prohibition Against Improper Use of Data.--No grant under this
section may be used to allow or facilitate the collection or use of
surveillance or clinical data or records--
(1) for punitive measures of any kind, civil or criminal,
against the subject of such data or records; or
(2) for imposing any requirement or restriction with
respect to an individual without the individual's written
consent.
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2019 through 2023.
SEC. 745. EVIDENCE-BASED STRATEGIES FOR IMPROVING LINKAGE TO AND
RETENTION IN APPROPRIATE CARE.
(a) Strategies.--The Secretary of Health and Human Services, in
collaboration with the Director of the Centers for Disease Control and
Prevention, the Administrator of the Substance Abuse and Mental Health
Services Administration, the Director of the Office of AIDS Research,
the Administrator of the Health Resources and Services Administration,
and the Administrator of the Centers for Medicare & Medicaid Services,
shall--
(1) identify evidence-based strategies most effective at
addressing the multifaceted issues that impede disease status
awareness and linkage to and retention in appropriate care,
taking into consideration health care systems issues, clinic
and provider issues, and individual psychosocial,
environmental, and other contextual factors;
(2) support the wide-scale implementation of the evidence-
based strategies identified pursuant to paragraph (1),
including through incorporating such strategies into health
care coverage supported by the Medicaid program under title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.), the
program under title XXVI of the Public Health Service Act (42
U.S.C. 300ff-11 et seq.; commonly referred to as the ``Ryan
White HIV/AIDS Program''), and health plans purchased through
an American Health Benefit Exchange established pursuant to
section 1311 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18031); and
(3) not later than 12 months after the date of the
enactment of this Act, submit a report to the Congress on the
status of activities under paragraphs (1) and (2).
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2023.
SEC. 746. IMPROVING ENTRY INTO AND RETENTION IN CARE AND ANTIRETROVIRAL
ADHERENCE FOR PERSONS WITH HIV.
(a) Sense of Congress.--It is the sense of the Congress that AIDS
research has led to scientific advancements that have--
(1) saved the lives of millions of people with HIV/AIDS;
(2) prevented millions of people from being infected; and
(3) had broad benefits that extend far beyond helping
people at risk for or living with HIV.
(b) In General.--The Secretary of Health and Human Services, acting
through the Director of the National Institutes of Health, shall
expand, intensify, and coordinate operational and translational
research and other activities of the National Institutes of Health
regarding methods--
(1) to increase adoption of evidence-based adherence
strategies within HIV care and treatment programs;
(2) to increase HIV testing and case detection rates;
(3) to reduce HIV-related health disparities;
(4) to ensure that research to improve adherence to HIV
care and treatment programs address the unique concerns of
women;
(5) to integrate HIV/AIDS prevention and care services with
mental health and substance use prevention and treatment
delivery systems;
(6) to increase knowledge on the implementation of
preexposure prophylaxis (PrEP), including with respect to--
(A) who can benefit most from PrEP;
(B) how to provide PrEP safely and efficiently;
(C) how to integrate PrEP with other essential
prevention methods such as condoms; and
(D) how to ensure high levels of adherence; and
(7) to increase knowledge of Undetectable = Untransmittable
(U=U) a person living with HIV who is on antiretroviral therapy
(ART) and is durably virally suppressed (defined as having a
consistent viral load of less than 200 copies/ml) cannot
sexually transmit HIV.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2023.
SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND ETHNIC MINORITY
COMMUNITIES.
(a) In General.--For the purpose of reducing HIV/AIDS in racial and
ethnic minority communities, the Secretary, acting through the Deputy
Assistant Secretary for Minority Health, may make grants to public
health agencies and faith-based organizations to conduct--
(1) outreach activities related to HIV/AIDS prevention and
testing activities;
(2) HIV/AIDS prevention activities; and
(3) HIV/AIDS testing activities.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2023.
SEC. 748. MINORITY AIDS INITIATIVE.
(a) Expanded Funding.--The Secretary, in collaboration with the
Deputy Assistant Secretary for 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) men who have sex with men;
(2) youth;
(3) persons who engage in intravenous drug abuse;
(4) women;
(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 $610,000,000 for
fiscal year 2019 and such sums as may be necessary for each of fiscal
years 2020 through 2023.
SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV/AIDS.
(a) In General.--The Secretary of Health and Human Services, acting
through the Administrator of the Health Resources and Services
Administration, shall expand, intensify, and coordinate workforce
initiatives of the Health Resources and Services Administration to
increase the capacity of the health workforce focusing primarily on
HIV/AIDS to meet the demand for culturally competent care, and may
award grants for any of the following:
(1) Development of curricula for training primary care
providers in HIV/AIDS prevention and care, including routine
HIV testing.
(2) Support to expand access to culturally and
linguistically accessible benefits counselors, trained peer
navigators, and mental and behavioral health professionals with
expertise in HIV/AIDS.
(3) Training health care professionals to provide care to
individuals with HIV/AIDS.
(4) Development by grant recipients under title XXVI of the
Public Health Service Act (42 U.S.C. 300ff-11 et seq.; commonly
referred to as the ``Ryan White HIV/AIDS Program'') and other
persons, of policies for providing culturally relevant and
sensitive treatment to individuals with HIV/AIDS, with
particular emphasis on treatment to racial and ethnic
minorities, men who have sex with men, and women, young people,
and children with HIV/AIDS.
(5) Development and implementation of programs to increase
the use of telehealth to respond to HIV/AIDS-specific health
care needs in rural and minority communities, with particular
emphasis given to medically underserved communities and insular
areas.
(6) Evaluating interdisciplinary medical provider care team
models that promote high-quality care, with particular emphasis
on care to racial and ethnic minorities.
(7) Training health care professionals to make them aware
of the high rates of chronic hepatitis B and chronic hepatitis
C in adult racial and ethnic populations, and the importance of
prevention, detection, and medical management of hepatitis B
and hepatitis C and of liver cancer screening.
(8) Development of curricula for training primary care
providers that HIV/AIDS and tuberculosis are significant mutual
comorbidities, and that a patient who tests positive for one
disease should be offered and encouraged to receive testing for
the other.
(b) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2023.
SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary may enter into an agreement with any
physician, nurse practitioner, or physician assistant under which--
(1) the physician, nurse practitioner, or physician
assistant agrees to serve as a medical provider for a period of
not less than 2 years--
(A) at a Ryan White-funded or title X-funded
facility with a critical shortage of doctors (as
determined by the Secretary); or
(B) in an area with a high incidence of HIV/AIDS;
and
(2) the Secretary agrees to make payments in accordance
with subsection (b) on the professional education loans of the
physician, nurse practitioner, or physician assistant.
(b) Manner of Payments.--The payments described in subsection (a)
shall be made by the Secretary as follows:
(1) Upon completion by the physician, nurse practitioner,
or physician assistant for whom the payments are to be made of
the first year of the service specified in the agreement
entered into with the Secretary under subsection (a), the
Secretary shall pay 30 percent of the principal of and the
interest on the individual's professional education loans.
(2) Upon completion by the physician, nurse practitioner,
or physician assistant of the second year of such service, the
Secretary shall pay another 30 percent of the principal of and
the interest on such loans.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of and the interest on such loans.
(c) Applicability of Certain Provisions.--The provisions of subpart
III of part D of title III of the Public Health Service Act (42 U.S.C.
254l et seq.) shall, except as inconsistent with this section, apply to
the program carried out under this section in the same manner and to
the same extent as such provisions apply to the National Health Service
Corps Loan Repayment Program.
(d) Reports.--Not later than 18 months after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
prepare and submit to the Congress a report describing the program
carried out under this section, including statements regarding the
following:
(1) The number of physicians, nurse practitioners, and
physician assistants enrolled in the program.
(2) The number and amount of loan repayments.
(3) The placement location of loan repayment recipients at
facilities described in subsection (a)(1).
(4) The default rate and actions required.
(5) The amount of outstanding default funds.
(6) To the extent that it can be determined, the reason for
the default.
(7) The demographics of individuals participating in the
program.
(8) An evaluation of the overall costs and benefits of the
program.
(e) Definitions.--In this section:
(1) HIV/AIDS.--The term ``HIV/AIDS'' means human
immunodeficiency virus and acquired immune deficiency syndrome.
(2) Nurse practitioner.--The term ``nurse practitioner''
means a registered nurse who has completed an accredited
graduate degree program in advanced nurse practice and has
successfully passed a national certification exam.
(3) Physician.--The term ``physician'' means a graduate of
a school of medicine who has completed postgraduate training in
general or pediatric medicine.
(4) Physician assistant.--The term ``physician assistant''
means a medical provider who completed an accredited physician
assistant training program and successfully passed the
Physician Assistant National Certifying Examination.
(5) Professional education loan.--The term ``professional
education loan''--
(A) means a loan that is incurred for the cost of
attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) at a
school of medicine, nursing, or physician assistant
training program; and
(B) includes only the portion of the loan that is
outstanding on the date the physician, nurse
practitioner, or physician assistant involved begins
the service specified in the agreement under subsection
(a).
(6) Ryan white-funded.--The term ``Ryan White-funded''
means, with respect to a facility, receiving funds under title
XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et
seq.).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) School of medicine.--The term ``school of medicine''
has the meaning given to that term in section 799B of the
Public Health Service Act (42 U.S.C. 295p).
(9) Title x-funded.--The term ``title X-funded'' means,
with respect to a facility, receiving funds under title X of
the Public Health Service Act (42 U.S.C. 300 et seq.).
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2023.
SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PROGRAM.
(a) In General.--The Secretary of Health and Human Services may
enter into an agreement with any dentist under which--
(1) the dentist agrees to serve as a dentist for a period
of not less than 2 years at a facility with a critical shortage
of dentists (as determined by the Secretary) in an area with a
high incidence of HIV/AIDS; and
(2) the Secretary agrees to make payments in accordance
with subsection (b) on the dental education loans of the
dentist.
(b) Manner of Payments.--The payments described in subsection (a)
shall be made by the Secretary as follows:
(1) Upon completion by the dentist for whom the payments
are to be made of the first year of the service specified in
the agreement entered into with the Secretary under subsection
(a), the Secretary shall pay 30 percent of the principal of and
the interest on the dental education loans of the dentist.
(2) Upon completion by the dentist of the second year of
such service, the Secretary shall pay another 30 percent of the
principal of and the interest on such loans.
(3) Upon completion by that individual of a third year of
such service, the Secretary shall pay another 25 percent of the
principal of and the interest on such loans.
(c) Applicability of Certain Provisions.--The provisions of subpart
III of part D of title III of the Public Health Service Act (42 U.S.C.
254l et seq.) shall, except as inconsistent with this section, apply to
the program carried out under this section in the same manner and to
the same extent as such provisions apply to the National Health Service
Corps Loan Repayment Program.
(d) Reports.--Not later than 18 months after the date of the
enactment of this Act, and annually thereafter, the Secretary shall
prepare and submit to the Congress a report describing the program
carried out under this section, including statements regarding the
following:
(1) The number of dentists enrolled in the program.
(2) The number and amount of loan repayments.
(3) The placement location of loan repayment recipients at
facilities described in subsection (a)(1).
(4) The default rate and actions required.
(5) The amount of outstanding default funds.
(6) To the extent that it can be determined, the reason for
the default.
(7) The demographics of individuals participating in the
program.
(8) An evaluation of the overall costs and benefits of the
program.
(e) Definitions.--In this section:
(1) Dental education loan.--The term ``dental education
loan''--
(A) means a loan that is incurred for the cost of
attendance (including tuition, other reasonable
educational expenses, and reasonable living costs) at a
school of dentistry; and
(B) includes only the portion of the loan that is
outstanding on the date the dentist involved begins the
service specified in the agreement under subsection
(a).
(2) Dentist.--The term ``dentist'' means a graduate of a
school of dentistry who has completed postgraduate training in
general or pediatric dentistry.
(3) HIV/AIDS.--The term ``HIV/AIDS'' means human
immunodeficiency virus and acquired immune deficiency syndrome.
(4) School of dentistry.--The term ``school of dentistry''
has the meaning given to that term in section 799B of the
Public Health Service Act (42 U.S.C. 295p).
(5) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(f) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for each of fiscal years 2019 through 2023.
SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECTING DRUG USERS.
(a) Sense of Congress.--It is the sense of the Congress that
providing sterile syringes and sterilized equipment to injecting drug
users substantially reduces risk of HIV infection, increases the
probability that they will initiate drug treatment, and does not
increase drug use.
(b) In General.--The Secretary of Health and Human Services may
provide grants and technical assistance for the purpose of reducing the
rate of HIV infections among injecting drug users through a
comprehensive package of services for such users, including the
provision of sterile syringes, education and outreach, access to
infectious disease testing, overdose prevention, and treatment for drug
dependence.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal years 2019 through 2023.
SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE POPULATIONS.
(a) In General.--The Secretary shall submit to the Congress and the
President an annual report on the impact of HIV/AIDS for racial and
ethnic minority communities, women, and youth aged 24 and younger.
(b) Contents.--The report under subsection (a) shall include
information on the--
(1) progress that has been made in reducing the impact of
HIV/AIDS in such communities;
(2) opportunities that exist to make additional progress in
reducing the impact of HIV/AIDS in such communities;
(3) challenges that may impede such additional progress;
and
(4) Federal funding necessary to achieve substantial
reductions in HIV/AIDS in racial and ethnic minority
communities.
SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS.
(a) National Observance Days.--It is the sense of the Congress that
national observance days highlighting the impact of HIV/AIDS on
communities of color include the following:
(1) National Black HIV/AIDS Awareness Day.
(2) National Latino AIDS Awareness Day.
(3) National Asian and Pacific Islander HIV/AIDS Awareness
Day.
(4) National Native American HIV/AIDS Awareness Day.
(5) National Youth HIV/AIDS Awareness Day.
(b) Call to Action.--It is the sense of the Congress that the
President should call on members of communities of color--
(1) to become involved at the local community level in HIV/
AIDS testing, policy, and advocacy;
(2) to become aware, engaged, and empowered on the HIV/AIDS
epidemic within their communities; and
(3) to urge members of their communities to reduce risk
factors, practice safe sex and other preventive measures, be
tested for HIV/AIDS, and seek care when appropriate.
SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, POLICIES, AND
REGULATIONS REGARDING THE CRIMINAL PROSECUTION OF
INDIVIDUALS FOR HIV-RELATED OFFENSES.
(a) Definitions.--
(1) HIV and hiv/aids.--The terms ``HIV'' and ``HIV/AIDS''
have the meanings given to such terms in section 2689 of the
Public Health Service Act (42 U.S.C. 300ff-88).
(2) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
(b) Sense of Congress Regarding Laws or Regulations Directed at
People Living With HIV/AIDS.--It is the sense of the Congress that
Federal and State laws, policies, and regulations regarding people
living with HIV/AIDS--
(1) should not place unique or additional burdens on such
individuals solely as a result of their HIV status; and
(2) should instead demonstrate a public health-oriented,
evidence-based, medically accurate, and contemporary
understanding of--
(A) the multiple factors that lead to HIV
transmission;
(B) the relative risk of HIV transmission routes;
(C) the current health implications of living with
HIV;
(D) the associated benefits of treatment and
support services for people living with HIV; and
(E) the impact of punitive HIV-specific laws and
policies on public health, on people living with or
affected by HIV, and on their families and communities.
(c) Review of All Federal and State Laws, Policies, and Regulations
Regarding the Criminal Prosecution of Individuals for HIV-Related
Offenses.--
(1) Review of federal and state laws.--
(A) In general.--No later than 90 days after the
date of the enactment of this Act, the Attorney
General, the Secretary of Health and Human Services,
and the Secretary of Defense acting jointly (in this
paragraph and paragraph (2) referred to as the
``designated officials'') shall initiate a national
review of Federal and State laws, policies,
regulations, and judicial precedents and decisions
regarding criminal and related civil commitment cases
involving people living with HIV/AIDS, including in
regards to the Uniform Code of Military Justice.
(B) Consultation.--In carrying out the review under
subparagraph (A), the designated officials shall ensure
diverse participation and consultation from each State,
including with--
(i) State attorneys general (or their
representatives);
(ii) State public health officials (or
their representatives);
(iii) State judicial and court system
officers, including judges, district attorneys,
prosecutors, defense attorneys, law
enforcement, and correctional officers;
(iv) members of the United States Armed
Forces, including members of other Federal
services subject to the Uniform Code of
Military Justice;
(v) people living with HIV/AIDS,
particularly those who have been subject to
HIV-related prosecution or who are from
communities whose members have been
disproportionately subject to HIV-specific
arrests and prosecutions;
(vi) legal advocacy and HIV/AIDS service
organizations that work with people living with
HIV/AIDS;
(vii) nongovernmental health organizations
that work on behalf of people living with HIV/
AIDS; and
(viii) trade organizations or associations
representing persons or entities described in
clauses (i) through (vii).
(C) Relation to other reviews.--In carrying out the
review under subparagraph (A), the designated officials
may utilize other existing reviews of criminal and
related civil commitment cases involving people living
with HIV/AIDS, including any such review conducted by
any Federal or State agency or any public health, legal
advocacy, or trade organization or association if the
designated officials determine that such reviews were
conducted in accordance with the principles set forth
in subsection (b).
(2) Report.--No later than 180 days after initiating the
review required by paragraph (1), the Attorney General shall
transmit to the Congress and make publicly available a report
containing the results of the review, which includes the
following:
(A) For each State and for the Uniform Code of
Military Justice, a summary of the relevant laws,
policies, regulations, and judicial precedents and
decisions regarding criminal cases involving people
living with HIV/AIDS, including, if applicable, the
following:
(i) A determination of whether such laws,
policies, regulations, and judicial precedents
and decisions place any unique or additional
burdens upon people living with HIV/AIDS.
(ii) A determination of whether such laws,
policies, regulations, and judicial precedents
and decisions demonstrate a public health-
oriented, evidence-based, medically accurate,
and contemporary understanding of--
(I) the multiple factors that lead
to HIV transmission;
(II) the relative risk of HIV
transmission routes;
(III) the current health
implications of living with HIV;
(IV) the associated benefits of
treatment and support services for
people living with HIV; and
(V) the impact of punitive HIV-
specific laws and policies on public
health, on people living with or
affected by HIV, and on their families
and communities.
(iii) An analysis of the public health and
legal implications of such laws, policies,
regulations, and judicial precedents, including
an analysis of the consequences of having a
similar penal scheme applied to comparable
situations involving other communicable
diseases.
(iv) An analysis of the proportionality of
punishments imposed under HIV-specific laws,
policies, regulations, and judicial precedents,
taking into consideration penalties attached to
violation of State laws against similar degrees
of endangerment or harm, such as driving while
intoxicated (DWI) or transmission of other
communicable diseases, or more serious harms,
such as vehicular manslaughter offenses.
(B) An analysis of common elements shared among
State laws, policies, regulations, and judicial
precedents.
(C) A set of best practice recommendations directed
to State governments, including State attorneys
general, public health officials, and judicial
officers, in order to ensure that laws, policies,
regulations, and judicial precedents regarding people
living with HIV/AIDS are in accordance with the
principles set forth in subsection (b).
(D) Recommendations for adjustments to the Uniform
Code of Military Justice, as may be necessary, in order
to ensure that laws, policies, regulations, and
judicial precedents regarding people living with HIV/
AIDS are in accordance with the principles set forth in
subsection (b).
(3) Guidance.--Within 90 days of the release of the report
required by paragraph (2), the Attorney General and the
Secretary of Health and Human Services, acting jointly, shall
develop and publicly release updated guidance for States based
on the set of best practice recommendations required by
paragraph (2)(C) in order to assist States dealing with
criminal and related civil commitment cases regarding people
living with HIV/AIDS.
(4) Monitoring and evaluation system.--Within 60 days of
the release of the guidance required by paragraph (3), the
Attorney General and the Secretary of Health and Human
Services, acting jointly, shall establish an integrated
monitoring and evaluation system which includes, where
appropriate, objective and quantifiable performance goals and
indicators to measure progress toward statewide implementation
in each State of the best practice recommendations required in
paragraph (2)(C), including to monitor, track, and evaluate the
effectiveness of assistance provided pursuant to subsection
(d).
(5) Adjustments to federal laws, policies, or
regulations.--Within 90 days of the release of the report
required by paragraph (2), the Attorney General, the Secretary
of Health and Human Services, and the Secretary of Defense,
acting jointly, shall develop and transmit to the President and
the Congress, and make publicly available, such proposals as
may be necessary to implement adjustments to Federal laws,
policies, or regulations, including to the Uniform Code of
Military Justice, based on the recommendations required by
paragraph (2)(D), either through Executive order or through
changes to statutory law.
(6) Authorization of appropriations.--
(A) In general.--There are authorized to be
appropriated such sums as may be necessary for the
purpose of carrying out this subsection. Amounts
authorized to be appropriated by the preceding sentence
are in addition to amounts otherwise authorized to be
appropriated for such purpose.
(B) Availability of funds.--Amounts appropriated
pursuant to the authorization of appropriations in
subparagraph (A) are authorized to remain available
until expended.
(d) Authorization To Provide Grants.--
(1) Grants by attorney general.--
(A) In general.--The Attorney General may provide
assistance to eligible State and local entities and
eligible nongovernmental organizations for the purpose
of incorporating the best practice recommendations
developed under subsection (c)(2)(C) within relevant
State laws, policies, regulations, and judicial
decisions regarding people living with HIV/AIDS.
(B) Authorized activities.--The assistance
authorized by subparagraph (A) may include--
(i) direct technical assistance to eligible
State and local entities in order to develop,
disseminate, or implement State laws, policies,
regulations, or judicial decisions that conform
with the best practice recommendations
developed under subsection (c)(2)(C);
(ii) direct technical assistance to
eligible nongovernmental organizations in order
to provide education and training, including
through classes, conferences, meetings, and
other educational activities, to eligible State
and local entities; and
(iii) subcontracting authority to allow
eligible State and local entities and eligible
nongovernmental organizations to seek technical
assistance from legal and public health experts
with a demonstrated understanding of the
principles underlying the best practice
recommendations developed under subsection
(c)(2)(C).
(2) Grants by secretary of health and human services.--
(A) In general.--The Secretary of Health and Human
Services, acting through the Director of the Centers
for Disease Control and Prevention, may provide
assistance to State and local public health departments
and eligible nongovernmental organizations for the
purpose of supporting eligible State and local entities
to incorporate the best practice recommendations
developed under subsection (c)(2)(C) within relevant
State laws, policies, regulations, and judicial
decisions regarding people living with HIV/AIDS.
(B) Authorized activities.--The assistance
authorized by subparagraph (A) may include--
(i) direct technical assistance to State
and local public health departments in order to
support the development, dissemination, or
implementation of State laws, policies,
regulations, or judicial decisions that conform
with the set of best practice recommendations
developed under subsection (c)(2)(C);
(ii) direct technical assistance to
eligible nongovernmental organizations in order
to provide education and training, including
through classes, conferences, meetings, and
other educational activities, to State and
local public health departments; and
(iii) subcontracting authority to allow
State and local public health departments and
eligible nongovernmental organizations to seek
technical assistance from legal and public
health experts with a demonstrated
understanding of the principles underlying the
best practice recommendations developed under
subsection (c)(2)(C).
(3) Limitation.--As a condition of receiving assistance
through this subsection, eligible State and local entities,
State and local public health departments, and eligible
nongovernmental organizations shall agree--
(A) not to place any unique or additional burdens
on people living with HIV/AIDS solely as a result of
their HIV status; and
(B) that if the entity, department, or organization
promulgates any laws, policies, regulations, or
judicial decisions regarding people living with HIV/
AIDS, such actions shall demonstrate a public health-
oriented, evidence-based, medically accurate, and
contemporary understanding of--
(i) the multiple factors that lead to HIV
transmission;
(ii) the relative risk of HIV transmission
routes;
(iii) the current health implications of
living with HIV;
(iv) the associated benefits of treatment
and support services for people living with
HIV; and
(v) the impact of punitive HIV-specific
laws and policies on public health, on people
living with or affected by HIV, and on their
families and communities.
(4) Report.--No later than 1 year after the date of the
enactment of this Act, and annually thereafter, the Attorney
General and the Secretary of Health and Human Services, acting
jointly, shall transmit to Congress and make publicly available
a report describing, for each State, the impact and
effectiveness of the assistance provided through this Act. Each
such report shall include--
(A) a detailed description of the progress each
State has made, if any, in implementing the best
practice recommendations developed under subsection
(c)(2)(C) as a result of the assistance provided under
this subsection, and based on the performance goals and
indicators established as part of the monitoring and
evaluation system in subsection (c)(4);
(B) a brief summary of any outreach efforts
undertaken during the prior year by the Attorney
General and the Secretary of Health and Human Services
to encourage States to seek assistance under this
subsection in order to implement the best practice
recommendations developed under subsection (c)(2)(C);
(C) a summary of how assistance provided through
this subsection is being utilized by eligible State and
local entities, State and local public health
departments, and eligible nongovernmental organizations
and, if applicable, any contractors, including with
respect to nongovernmental organizations, the type of
technical assistance provided, and an evaluation of the
impact of such assistance on eligible State and local
entities; and
(D) a summary and description of eligible State and
local entities, State and local public health
departments, and eligible nongovernmental organizations
receiving assistance through this subsection, including
if applicable, a summary and description of any
contractors selected to assist in implementing such
assistance.
(5) Definitions.--For the purposes of this subsection:
(A) Eligible state and local entities.--The term
``eligible State and local entities'' means the
relevant individuals, offices, or organizations that
directly participate in the development, dissemination,
or implementation of State laws, policies, regulations,
or judicial decisions, including--
(i) State governments, including State
attorneys general, State departments of
justice, and State National Guards, or their
equivalents;
(ii) State judicial and court systems,
including trial courts, appellate courts, State
supreme courts and courts of appeal, and State
correctional facilities, or their equivalents;
and
(iii) local governments, including city and
county governments, district attorneys, and
local law enforcement departments, or their
equivalents.
(B) State and local public health departments.--The
term ``State and local public health departments''
means the following:
(i) State public health departments, or
their equivalents, including the chief officer
of such departments and infectious disease and
communicable disease specialists within such
departments.
(ii) Local public health departments, or
their equivalents, including city and county
public health departments, the chief officer of
such departments, and infectious disease and
communicable disease specialists within such
departments.
(iii) Public health departments or
officials, or their equivalents, within State
or local correctional facilities.
(iv) Public health departments or
officials, or their equivalents, within State
National Guards.
(v) Any other recognized State or local
public health organization or entity charged
with carrying out official State or local
public health duties.
(C) Eligible nongovernmental organizations.--The
term ``eligible nongovernmental organizations'' means
the following:
(i) Nongovernmental organizations,
including trade organizations or associations
that represent--
(I) State attorneys general, or
their equivalents;
(II) State public health officials,
or their equivalents;
(III) State judicial and court
officers, including judges, district
attorneys, prosecutors, defense
attorneys, law enforcement, and
correctional officers;
(IV) State National Guards;
(V) people living with HIV/AIDS;
(VI) legal advocacy and HIV/AIDS
service organizations that work with
people living with HIV/AIDS; and
(VII) nongovernmental health
organizations that work on behalf of
people living with HIV/AIDS.
(ii) Nongovernmental organizations,
including trade organizations or associations
that demonstrate a public-health oriented,
evidence-based, medically accurate, and
contemporary understanding of--
(I) the multiple factors that lead
to HIV transmission;
(II) the relative risk of HIV
transmission routes;
(III) the current health
implications of living with HIV;
(IV) the associated benefits of
treatment and support services for
people living with HIV; and
(V) the impact of punitive HIV-
specific laws and policies on public
health, on people living with or
affected by HIV, and on their families
and communities.
(6) Authorization of appropriations.--
(A) In general.--In addition to amounts otherwise
made available, there are authorized to be appropriated
to the Attorney General and the Secretary of Health and
Human Services such sums as may be necessary to carry
out this subsection for each of the fiscal years 2019
through 2023.
(B) Availability of funds.--Amounts appropriated
pursuant to the authorizations of appropriations in
subparagraph (A) are authorized to remain available
until expended.
SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRISONS.
(a) Authority To Allow Community Organizations To Provide STI
Counseling, STI Prevention Education, and Sexual Barrier Protection
Devices in Federal Correctional Facilities.--
(1) Directive to attorney general.--Not later than 30 days
after the date of enactment of this Act, the Attorney General
shall direct the Bureau of Prisons to allow community
organizations to distribute sexual barrier protection devices
and to engage in STI counseling and STI prevention education in
Federal correctional facilities. These activities shall be
subject to all relevant Federal laws and regulations which
govern visitation in correctional facilities.
(2) Information requirement.--Any community organization
permitted to distribute sexual barrier protection devices under
paragraph (1) shall ensure that the persons to whom the devices
are distributed are informed about the proper use and disposal
of sexual barrier protection devices in accordance with
established public health practices. Any community organization
conducting STI counseling or STI prevention education under
paragraph (1) shall offer comprehensive sexuality education.
(3) Possession of device protected.--No Federal
correctional facility may, because of the possession or use of
a sexual barrier protection device--
(A) take adverse action against an incarcerated
person; or
(B) consider possession or use as evidence of
prohibited activity for the purpose of any Federal
correctional facility administrative proceeding.
(4) Implementation.--The Attorney General and Bureau of
Prisons shall implement this section according to established
public health practices in a manner that protects the health,
safety, and privacy of incarcerated persons and of correctional
facility staff.
(b) Sense of Congress Regarding Distribution of Sexual Barrier
Protection Devices in State Prison Systems.--It is the sense of the
Congress that States should allow for the legal distribution of sexual
barrier protection devices in State correctional facilities to reduce
the prevalence and spread of STIs in those facilities.
(c) Survey of and Report on Correctional Facility Programs Aimed at
Reducing the Spread of STIs.--
(1) Survey.--The Attorney General, after consulting with
the Secretary of Health and Human Services, State officials,
and community organizations, shall, to the maximum extent
practicable, conduct a survey of all Federal and State
correctional facilities, not later than 180 days after the date
of enactment of this Act and annually thereafter for 5 years,
to determine the following:
(A) Counseling, treatment, and supportive
services.--Whether the correctional facility requires
incarcerated persons to participate in counseling,
treatment, and supportive services related to STIs, or
whether it offers such programs to incarcerated
persons.
(B) Access to sexual barrier protection devices.--
Whether incarcerated persons can--
(i) possess sexual barrier protection
devices;
(ii) purchase sexual barrier protection
devices;
(iii) purchase sexual barrier protection
devices at a reduced cost; and
(iv) obtain sexual barrier protection
devices without cost.
(C) Incidence of sexual violence.--The incidence of
sexual violence and assault committed by incarcerated
persons and by correctional facility staff.
(D) Prevention education offered.--The type of
prevention education, information, or training offered
to incarcerated persons and correctional facility staff
regarding sexual violence and the spread of STIs,
including whether such education, information, or
training--
(i) constitutes comprehensive sexuality
education;
(ii) is compulsory for new incarcerated
persons and for new staff; and
(iii) is offered on an ongoing basis.
(E) STI testing.--Whether the correctional facility
tests incarcerated persons for STIs or gives them the
option to undergo such testing--
(i) at intake;
(ii) on a regular basis; and
(iii) prior to release.
(F) STI test results.--The number of incarcerated
persons who are tested for STIs and the outcome of such
tests at each correctional facility, disaggregated to
include results for--
(i) the type of sexually transmitted
infection tested for;
(ii) the race and/or ethnicity of
individuals tested;
(iii) the age of individuals tested; and
(iv) the gender of individuals tested.
(G) Prerelease referral policy.--Whether
incarcerated persons are informed prior to release
about STI-related services or other health services in
their communities, including free and low-cost
counseling and treatment options.
(H) Prerelease referrals made.--The number of
referrals to community-based organizations or public
health facilities offering STI-related or other health
services provided to incarcerated persons prior to
release, and the type of counseling or treatment for
which the referral was made.
(I) Reinstatement of medicaid benefits.--Whether
the correctional facility assists incarcerated persons
that were enrolled in the State Medicaid program prior
to their incarceration, in reinstating their enrollment
upon release and whether such individuals receive
referrals as provided by subparagraph (G) to entities
that accept the State Medicaid program, including if
applicable--
(i) the number of such individuals,
including those diagnosed with the human
immunodeficiency virus, that have been
reinstated;
(ii) a list of obstacles to reinstating
enrollment or to making determinations of
eligibility for reinstatement, if any; and
(iii) the number of individuals denied
enrollment.
(J) Other actions taken.--Whether the correctional
facility has taken any other action, in conjunction
with community organizations or otherwise, to reduce
the prevalence and spread of STIs in that facility.
(2) Privacy.--In conducting the survey, the Attorney
General shall not request or retain the identity of any person
who has sought or been offered counseling, treatment, testing,
or prevention education information regarding an STI (including
information about sexual barrier protection devices), or who
has tested positive for an STI.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available the results of the survey
required under paragraph (1), both for the Nation as a whole
and disaggregated as to each State and each correctional
facility. To the maximum extent possible, the Attorney General
shall issue the first report no later than 1 year after the
date of enactment of this Act and shall issue reports annually
thereafter for 5 years.
(d) Strategy.--
(1) Directive to attorney general.--The Attorney General,
in consultation with the Secretary of Health and Human
Services, State officials, and community organizations, shall
develop and implement a 5-year strategy to reduce the
prevalence and spread of STIs in Federal and State correctional
facilities. To the maximum extent possible, the strategy shall
be developed, transmitted to Congress, and made publicly
available no later than 180 days after the transmission of the
first report required under subsection (c)(3).
(2) Contents of strategy.--The strategy shall include the
following:
(A) Prevention education.--A plan for improving
prevention education, information, and training offered
to incarcerated persons and correctional facility
staff, including information and training on sexual
violence and the spread of STIs, and comprehensive
sexuality education.
(B) Sexual barrier protection device access.--A
plan for expanding access to sexual barrier protection
devices in correctional facilities.
(C) Sexual violence reduction.--A plan for reducing
the incidence of sexual violence among incarcerated
persons and correctional facility staff, developed in
consultation with the National Prison Rape Elimination
Commission.
(D) Counseling and supportive services.--A plan for
expanding access to counseling and supportive services
related to STIs in correctional facilities.
(E) Testing.--A plan for testing incarcerated
persons for STIs during intake, during regular health
exams, and prior to release, and that--
(i) is conducted in accordance with
guidelines established by the Centers for
Disease Control and Prevention;
(ii) includes pretest counseling;
(iii) requires that incarcerated persons
are notified of their option to decline testing
at any time;
(iv) requires that incarcerated persons are
confidentially notified of their test results
in a timely manner; and
(v) ensures that incarcerated persons
testing positive for STIs receive post-test
counseling, care, treatment, and supportive
services.
(F) Treatment.--A plan for ensuring that
correctional facilities have the necessary medicine and
equipment to treat and monitor STIs and for ensuring
that incarcerated persons living with or testing
positive for STIs receive and have access to care and
treatment services.
(G) Strategies for demographic groups.--A plan for
developing and implementing culturally appropriate,
sensitive, and specific strategies to reduce the spread
of STIs among demographic groups heavily impacted by
STIs.
(H) Linkages with communities and facilities.--A
plan for establishing and strengthening linkages to
local communities and health facilities that--
(i) provide counseling, testing, care, and
treatment services;
(ii) may receive persons recently released
from incarceration who are living with STIs;
and
(iii) accept payment through the State
Medicaid program.
(I) Enrollment in state medicaid programs.--Plans
to ensure that incarcerated persons who were--
(i) enrolled in their State Medicaid
program prior to incarceration in a
correctional facility are automatically
reenrolled in such program upon their release;
and
(ii) not enrolled in their State Medicaid
program prior to incarceration, but who are
diagnosed with the human immunodeficiency virus
while incarcerated in a correctional facility,
are automatically enrolled in such program upon
their release.
(J) Other plans.--Any other plans developed by the
Attorney General for reducing the spread of STIs or
improving the quality of health care in correctional
facilities.
(K) Monitoring system.--A monitoring system that
establishes performance goals related to reducing the
prevalence and spread of STIs in correctional
facilities and which, where feasible, expresses such
goals in quantifiable form.
(L) Monitoring system performance indicators.--
Performance indicators that measure or assess the
achievement of the performance goals described in
subparagraph (K).
(M) Cost estimate.--A detailed estimate of the
funding necessary to implement the strategy at the
Federal and State levels for all 5 years, including the
amount of funds required by community organizations to
implement the parts of the strategy in which they take
part.
(3) Report.--The Attorney General shall transmit to
Congress and make publicly available an annual progress report
regarding the implementation and effectiveness of the strategy
described in paragraph (1). The progress report shall include
an evaluation of the implementation of the strategy using the
monitoring system and performance indicators provided for in
subparagraphs (K) and (L) of paragraph (2).
(e) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated
such sums as may be necessary to carry out this section for
each of fiscal years 2019 through 2023.
(2) Availability of funds.--Amounts made available under
paragraph (1) are authorized to remain available until
expended.
(f) Definitions.--For the purposes of this section:
(1) Community organization.--The term ``community
organization'' means a public health care facility or a
nonprofit organization which provides health- or STI-related
services according to established public health standards.
(2) Comprehensive sexuality education.--The term
``comprehensive sexuality education'' means sexuality education
that includes information about abstinence and about the proper
use and disposal of sexual barrier protection devices and which
is--
(A) evidence-based;
(B) medically accurate;
(C) age and developmentally appropriate;
(D) gender and identity sensitive;
(E) culturally and linguistically appropriate; and
(F) structured to promote critical thinking, self-
esteem, respect for others, and the development of
healthy attitudes and relationships.
(3) Correctional facility.--The term ``correctional
facility'' means any prison, penitentiary, adult detention
facility, juvenile detention facility, jail, or other facility
to which persons may be sent after conviction of a crime or act
of juvenile delinquency within the United States.
(4) Incarcerated person.--The term ``incarcerated person''
means any person who is serving a sentence in a correctional
facility after conviction of a crime.
(5) Sexually transmitted infection.--The term ``sexually
transmitted infection'' or ``STI'' means any disease or
infection that is commonly transmitted through sexual activity,
including HIV/AIDS, gonorrhea, chlamydia, syphilis, genital
herpes, viral hepatitis, and human papillomavirus.
(6) Sexual barrier protection device.--The term ``sexual
barrier protection device'' means any FDA-approved physical
device which has not been tampered with and which reduces the
probability of STI transmission or infection between sexual
partners, including female condoms, male condoms, and dental
dams.
(7) State.--The term ``State'' includes the District of
Columbia, American Samoa, the Commonwealth of the Northern
Mariana Islands, Guam, Puerto Rico, and the United States
Virgin Islands.
SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT IN MEDICAID FOR PEOPLE
WHO TEST POSITIVE FOR HIV BEFORE REENTERING COMMUNITIES.
(a) In General.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a(e)) is amended by adding at the end the following:
``(15) Enrollment of ex-offenders.--
``(A) Automatic enrollment or reinstatement.--
``(i) In general.--The State plan shall
provide for the automatic enrollment or
reinstatement of enrollment of an eligible
individual--
``(I) if such individual is
scheduled to be released from a public
institution due to the completion of
sentence, not less than 30 days prior
to the scheduled date of the release;
and
``(II) if such individual is to be
released from a public institution on
parole or on probation, as soon as
possible after the date on which the
determination to release such
individual was made, and before the
date such individual is released.
``(ii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date by
which the individual would be enrolled
under clause (i), such clause shall not
apply to such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(B) Relationship of enrollment to payment for
services.--
``(i) In general.--Subject to subparagraph
(A)(ii), an eligible individual who is
enrolled, or whose enrollment is reinstated,
under subparagraph (A) shall be eligible for
medical assistance that is provided after the
date that the eligible individual is released
from the public institution.
``(ii) Relationship to payment prohibition
for inmates.--No provision of this paragraph
may be construed to permit payment for care or
services for which payment is excluded under
section 1905(a)(3)(A).
``(C) Treatment of continuous eligibility.--
``(i) Suspension for inmates.--Any period
of continuous eligibility under this title
shall be suspended on the date an individual
enrolled under this title becomes an inmate of
a public institution (except as a patient of a
medical institution).
``(ii) Determination of remaining period.--
Notwithstanding any changes to State law
related to continuous eligibility during the
time that an individual is an inmate of a
public institution (except as a patient of a
medical institution), subject to clause (iii),
with respect to an eligible individual who was
subject to a suspension under clause (i), on
the date that such individual is released from
a public institution the suspension of
continuous eligibility under such clause shall
be lifted for a period that is equal to the
time remaining in the period of continuous
eligibility for such individual on the date
that such period was suspended under such
clause.
``(iii) Exception.--If a State makes a
determination that an individual is not
eligible to be enrolled under the State plan--
``(I) on or before the date that
the suspension of continuous
eligibility is lifted under clause
(ii), such clause shall not apply to
such individual; or
``(II) after such date, the State
may terminate the enrollment of such
individual.
``(D) Automatic enrollment or reinstatement of
enrollment defined.--For purposes of this paragraph,
the term `automatic enrollment or reinstatement of
enrollment' means that the State determines eligibility
for medical assistance under the State plan without a
program application from, or on behalf of, the eligible
individual, but an individual can only be automatically
enrolled in the State Medicaid plan if the individual
affirmatively consents to being enrolled through
affirmation in writing, by telephone, orally, through
electronic signature, or through any other means
specified by the Secretary.
``(E) Eligible individual defined.--For purposes of
this paragraph, the term `eligible individual' means an
individual who is an inmate of a public institution
(except as a patient in a medical institution)--
``(i) who was enrolled under the State plan
for medical assistance immediately before
becoming an inmate of such an institution; or
``(ii) who is diagnosed with human
immunodeficiency virus.''.
(b) Supplemental Funding for State Implementation of Automatic
Reinstatement of Medicaid Benefits.--
(1) In general.--Subject to paragraph (6), for each State
for which the Secretary of Health and Human Services has
approved an application under paragraph (3), the Federal
matching payments (including payments based on the Federal
medical assistance percentage) made to such State under section
1903 of the Social Security Act (42 U.S.C. 1396b) shall be
increased by 5.0 percentage points for payments to the State
for the activities permitted under paragraph (2) or a period of
one year.
(2) Use of funds.--A State may only use increased matching
payments authorized under paragraph (1)--
(A) to strengthen the State's enrollment and
administrative resources for the purpose of improving
processes for enrolling (or reinstating the enrollment
of) eligible individuals (as such term is defined in
subparagraph (E) of paragraph (15) of section 1902(e)
of the Social Security Act (as amended by subsection
(a))); and
(B) for medical assistance (as such term is defined
in section 1905(a) of the Social Security Act) provided
to such eligible individuals.
(3) Application and agreement.--The Secretary may only make
payments to a State in the increased amount if--
(A) the State has amended the State plan under
section 1902(e) of the Social Security Act to
incorporate the requirements of paragraph (15) of such
section (as added by subsection (a));
(B) the State has submitted an application to the
Secretary that includes a plan for implementing the
requirements of section 1902(e)(15) of the Social
Security Act under the State's amended State plan
before the end of the 90-day period beginning on the
date that the State receives increased matching
payments under paragraph (1);
(C) the State's application meets the satisfaction
of the Secretary; and
(D) the State enters an agreement with the
Secretary that states that--
(i) the State will only use the increased
matching funds for the uses permitted under
paragraph (2); and
(ii) at the end of the period under
paragraph (1), the State will submit to the
Secretary, and make publicly available, a
report that contains the information required
under paragraph (4).
(4) Required report information.--The information that is
required in the report under paragraph (3)(D)(ii) includes--
(A) the results of an evaluation of the impact of
the implementation of the requirements of section
1902(e)(15) of the Social Security Act on improving the
State's processes for enrolling of individuals who are
released from public institutions into the Medicaid
program;
(B) the number of individuals who were
automatically enrolled (or whose enrollment is
reinstated) under such section 1902(e)(15) during the
period under paragraph (1); and
(C) any other information that is required by the
Secretary.
(5) Increase in cap on medicaid payments to territories.--
Subject to paragraph (6), the amounts otherwise determined for
Puerto Rico, the United States Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa under subsections
(f) and (g) of section 1108 of the Social Security Act (42
U.S.C. 1308) shall each be increased by the necessary amount to
allow for the increase in the Federal matching payments under
paragraph (1), but only for the period under such paragraph for
such State. In the case of such an increase for a territory,
subsection (a)(1) of such section 1108 shall be applied without
regard to any increase in payment made to the territory under
part E of title IV of such Act that is attributable to the
increase in Federal medical assistance percentage effected
under paragraph (1) for the territory.
(6) Limitations.--
(A) Timing.--With respect to a State, at the end of
the period under paragraph (1), no increased matching
payments may be made to such State under this
subsection.
(B) Maintenance of eligibility.--
(i) In general.--Subject to clause (ii), a
State is not eligible for an increase in its
Federal matching payments under paragraph (1),
or an increase in a cap amount under paragraph
(5), if eligibility standards, methodologies,
or procedures under its State plan under title
XIX of the Social Security Act (including any
waiver under such title or under section 1115
of such Act (42 U.S.C. 1315)) are more
restrictive than the eligibility standards,
methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on the
date of enactment of this Act.
(ii) State reinstatement of eligibility
permitted.--A State that has restricted
eligibility standards, methodologies, or
procedures under its State plan under title XIX
of the Social Security Act (including any
waiver under such title or under section 1115
of such Act (42 U.S.C. 1315)) after the date of
enactment of this Act, is no longer ineligible
under subparagraph (A) beginning with the first
calendar quarter in which the State has
reinstated eligibility standards,
methodologies, or procedures that are no more
restrictive than the eligibility standards,
methodologies, or procedures, respectively,
under such plan (or waiver) as in effect on
such date.
(C) No waiver authority.--The Secretary may not
waive the application of this subsection under section
1115 of the Social Security Act or otherwise.
(D) Limitation of matching payments to 100
percent.--In no case shall an increase in Federal
matching payments under this subsection result in
Federal matching payments that exceed 100 percent.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by subsection (a) shall take effect 180 days
after the date of the enactment of this Act and shall apply to
services furnished on or after such date.
(2) Rule for changes requiring state legislation.--In the
case of a State plan for medical assistance under title XIX of
the Social Security Act which the Secretary of Health and Human
Services determines requires State legislation (other than
legislation appropriating funds) in order for the plan to meet
the additional requirement imposed by the amendments made by
this section, the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet this additional requirement before
the first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that begins after the date of the enactment of this Act. For
purposes of the previous sentence, in the case of a State that
has a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of the State
legislature.
SEC. 758. STOP AIDS IN PRISON.
(a) Short Title.--This section may be cited as the ``Stop AIDS in
Prison Act''.
(b) In General.--The Bureau of Prisons (hereinafter in this section
referred to as the ``Bureau'') shall develop a comprehensive policy to
provide HIV testing, treatment, and prevention for inmates within the
correctional setting and upon reentry.
(c) Purpose.--The purposes of this policy shall be as follows:
(1) To stop the spread of HIV/AIDS among inmates.
(2) To protect prison guards and other personnel from HIV/
AIDS infection.
(3) To provide comprehensive medical treatment to inmates
who are living with HIV/AIDS.
(4) To promote HIV/AIDS awareness and prevention among
inmates.
(5) To encourage inmates to take personal responsibility
for their health.
(6) To reduce the risk that inmates will transmit HIV/AIDS
to other persons in the community following their release from
prison.
(d) Consultation.--The Bureau shall consult with appropriate
officials of the Department of Health and Human Services, the Office of
National Drug Control Policy, the Office of National AIDS Policy, and
the Centers for Disease Control and Prevention regarding the
development of this policy.
(e) Time Limit.--The Bureau shall draft appropriate regulations to
implement this policy not later than 1 year after the date of the
enactment of this Act.
(f) Requirements for Policy.--The policy created under subsection
(b) shall provide for the following:
(1) Testing and counseling upon intake.--
(A) Health care personnel shall provide routine HIV
testing to all inmates as a part of a comprehensive
medical examination immediately following admission to
a facility. Health care personnel need not provide
routine HIV testing to an inmate who is transferred to
a facility from another facility if the inmate's
medical records are transferred with the inmate and
indicate that the inmate has been tested previously.
(B) To all inmates admitted to a facility prior to
the effective date of this policy, health care
personnel shall provide routine HIV testing within no
more than 6 months. HIV testing for these inmates may
be performed in conjunction with other health services
provided to these inmates by health care personnel.
(C) All HIV tests under this paragraph shall comply
with the opt-out provision.
(2) Pre-test and post-test counseling.--Health care
personnel shall provide confidential pre-test and post-test
counseling to all inmates who are tested for HIV. Counseling
may be included with other general health counseling provided
to inmates by health care personnel.
(3) HIV/AIDS prevention education.--
(A) Health care personnel shall improve HIV/AIDS
awareness through frequent educational programs for all
inmates. HIV/AIDS educational programs may be provided
by community-based organizations, local health
departments, and inmate peer educators.
(B) HIV/AIDS educational materials shall be made
available to all inmates at orientation, at health care
clinics, at regular educational programs, and prior to
release. Both written and audiovisual materials shall
be made available to all inmates.
(C)(i) The HIV/AIDS educational programs and
materials under this paragraph shall include
information on--
(I) modes of transmission, including
transmission through tattooing, sexual contact,
and intravenous drug use;
(II) prevention methods;
(III) treatment; and
(IV) disease progression.
(ii) The programs and materials shall be culturally
sensitive, written or designed for low-literacy levels,
available in a variety of languages, and present
scientifically accurate information in a clear and
understandable manner.
(4) HIV testing upon request.--
(A) Health care personnel shall allow inmates to
obtain HIV tests upon request once per year or whenever
an inmate has a reason to believe the inmate may have
been exposed to HIV. Health care personnel shall, both
orally and in writing, inform inmates, during
orientation and periodically throughout incarceration,
of their right to obtain HIV tests.
(B) Health care personnel shall encourage inmates
to request HIV tests if the inmate is sexually active,
has been raped, uses intravenous drugs, receives a
tattoo, or if the inmate is concerned that the inmate
may have been exposed to HIV/AIDS.
(C) An inmate's request for an HIV test shall not
be considered an indication that the inmate has put
him/herself at risk of infection and/or committed a
violation of prison rules.
(5) HIV testing of pregnant woman.--
(A) Health care personnel shall provide routine HIV
testing to all inmates who become pregnant.
(B) All HIV tests under this paragraph shall comply
with the opt-out provision.
(6) Comprehensive treatment.--
(A) Health care personnel shall provide all inmates
who test positive for HIV--
(i) timely, comprehensive medical
treatment;
(ii) confidential counseling on managing
their medical condition and preventing its
transmission to other persons; and
(iii) voluntary partner notification
services.
(B) Health care provided under this paragraph shall
be consistent with current Department of Health and
Human Services guidelines and standard medical
practice. Health care personnel shall discuss treatment
options, the importance of adherence to antiretroviral
therapy, and the side effects of medications with
inmates receiving treatment.
(C) Health care personnel and pharmacy personnel
shall ensure that the facility formulary contains all
Food and Drug Administration-approved medications
necessary to provide comprehensive treatment for
inmates living with HIV/AIDS, and that the facility
maintains adequate supplies of such medications to meet
inmates' medical needs. Health care personnel and
pharmacy personnel shall also develop and implement
automatic renewal systems for these medications to
prevent interruptions in care.
(D) Correctional staff, health care personnel, and
pharmacy personnel shall develop and implement
distribution procedures to ensure timely and
confidential access to medications.
(7) Protection of confidentiality.--
(A) Health care personnel shall develop and
implement procedures to ensure the confidentiality of
inmate tests, diagnoses, and treatment. Health care
personnel and correctional staff shall receive regular
training on the implementation of these procedures.
Penalties for violations of inmate confidentiality by
health care personnel or correctional staff shall be
specified and strictly enforced.
(B) HIV testing, counseling, and treatment shall be
provided in a confidential setting where other routine
health services are provided and in a manner that
allows the inmate to request and obtain these services
as routine medical services.
(8) Testing, counseling, and referral prior to reentry.--
(A) Health care personnel shall provide routine HIV
testing to all inmates no more than 3 months prior to
their release and reentry into the community. Inmates
who are already known to be infected need not be tested
again. This requirement may be waived if an inmate's
release occurs without sufficient notice to the Bureau
to allow health care personnel to perform a routine HIV
test and notify the inmate of the results.
(B) All HIV tests under this paragraph shall comply
with the opt-out provision.
(C) To all inmates who test positive for HIV and
all inmates who already are known to have HIV/AIDS,
health care personnel shall provide--
(i) confidential prerelease counseling on
managing their medical condition in the
community, accessing appropriate treatment and
services in the community, and preventing the
transmission of their condition to family
members and other persons in the community;
(ii) referrals to appropriate health care
providers and social service agencies in the
community that meet the inmate's individual
needs, including voluntary partner notification
services and prevention counseling services for
people living with HIV/AIDS; and
(iii) a 30-day supply of any medically
necessary medications the inmate is currently
receiving.
(9) Opt-out provision.--Inmates shall have the right to
refuse routine HIV testing. Inmates shall be informed both
orally and in writing of this right. Oral and written
disclosure of this right may be included with other general
health information and counseling provided to inmates by health
care personnel. If an inmate refuses a routine test for HIV,
health care personnel shall make a note of the inmate's refusal
in the inmate's confidential medical records. However, the
inmate's refusal shall not be considered a violation of prison
rules or result in disciplinary action. Any reference in this
section to the ``opt-out provision'' shall be deemed a
reference to the requirement of this paragraph.
(10) Exclusion of tests performed under section 4014(b)
from the definition of routine hiv testing.--HIV testing of an
inmate under section 4014(b) of title 18, United States Code,
is not routine HIV testing for the purposes of the opt-out
provision. Health care personnel shall document the reason for
testing under section 4014(b) of title 18, United States Code,
in the inmate's confidential medical records.
(11) Timely notification of test results.--Health care
personnel shall provide timely notification to inmates of the
results of HIV tests.
(g) Changes in Existing Law.--
(1) Screening in general.--Section 4014(a) of title 18,
United States Code, is amended--
(A) by striking ``for a period of 6 months or
more'';
(B) by striking ``, as appropriate,''; and
(C) by striking ``if such individual is determined
to be at risk for infection with such virus in
accordance with the guidelines issued by the Bureau of
Prisons relating to infectious disease management'' and
inserting ``unless the individual declines. The
Attorney General shall also cause such individual to be
so tested before release unless the individual
declines.''.
(2) Inadmissibility of hiv test results in civil and
criminal proceedings.--Section 4014(d) of title 18, United
States Code, is amended by inserting ``or under the Stop AIDS
in Prison Act'' after ``under this section''.
(3) Screening as part of routine screening.--Section
4014(e) of title 18, United States Code, is amended by adding
at the end the following: ``Such rules shall also provide that
the initial test under this section be performed as part of the
routine health screening conducted at intake.''.
(h) Reporting Requirements.--
(1) Report on hepatitis, liver, and other diseases.--Not
later than 1 year after the date of the enactment of this Act,
the Bureau shall provide a report to the Congress on Bureau
policies and procedures to provide testing, treatment, and
prevention education programs for hepatitis, liver failure, and
other liver-related diseases transmitted through sexual
activity, intravenous drug use, or other means. The Bureau
shall consult with appropriate officials of the Department of
Health and Human Services, the Office of National Drug Control
Policy, the Office of National AIDS Policy, and the Centers for
Disease Control and Prevention regarding the development of
this report.
(2) Annual reports.--
(A) Generally.--Not later than 2 years after the
date of the enactment of this Act, and then annually
thereafter, the Bureau shall report to Congress on the
incidence among inmates of diseases transmitted through
sexual activity and intravenous drug use.
(B) Matters pertaining to various diseases.--
Reports under paragraph (1) shall discuss--
(i) the incidence among inmates of HIV/
AIDS, hepatitis, and other diseases transmitted
through sexual activity and intravenous drug
use; and
(ii) updates on Bureau testing, treatment,
and prevention education programs for these
diseases.
(C) Matters pertaining to hiv/aids only.--Reports
under paragraph (1) shall also include--
(i) the number of inmates who tested
positive for HIV upon intake;
(ii) the number of inmates who tested
positive prior to reentry;
(iii) the number of inmates who were not
tested prior to reentry because they were
released without sufficient notice;
(iv) the number of inmates who opted-out of
taking the test;
(v) the number of inmates who were tested
under section 4014(b) of title 18, United
States Code; and
(vi) the number of inmates under treatment
for HIV/AIDS.
(D) Consultation.--The Bureau shall consult with
appropriate officials of the Department of Health and
Human Services, the Office of National Drug Control
Policy, the Office of National AIDS Policy, and the
Centers for Disease Control and Prevention regarding
the development of reports under paragraph (1).
SEC. 759. SUPPORT DATA SYSTEM REVIEW AND INDICATORS FOR MONITORING HIV
CARE.
The Secretary of Health and Human Services, in collaboration with
the Assistant Secretary for Health, the Director of the Office of HIV/
AIDS and Infectious Disease Policy, the Director of the Centers for
Disease Control and Prevention, the Administrator of the Substance
Abuse and Mental Health Services Administration, the Director of the
Department of Housing and Urban Development, the Director of the Office
of AIDS Research, the Administrator of the Health Resources and
Services Administration, and the Administrator of the Centers for
Medicare & Medicaid Services, shall expand and coordinate efforts to
align metrics across agencies and modify Federal data systems, to--
(1) adopt the Institute of Medicine's clinical HIV care
indicators as the core metrics for monitoring the quality of
HIV care, mental health, substance abuse, and supportive
services;
(2) better enable assessment of the impact of the National
HIV/AIDS Strategy and the Patient Protection and Affordable
Care Act on improving HIV/AIDS care and access to supportive
services for individuals with HIV;
(3) expand the demographic data elements to be captured by
Federal data systems relevant to HIV care to permit calculation
of the indicators for subgroups of the population of people
with diagnosed HIV infection, including--
(A) age;
(B) race;
(C) ethnicity;
(D) sex (assigned at birth);
(E) gender identity;
(F) sexual orientation;
(G) current geographic marker of residence;
(H) income or poverty level; and
(I) primary means of reimbursement for medical
services (including Medicaid, Medicare, the Ryan White
HIV/AIDS Program, private insurance, health maintenance
organizations, and no coverage); and
(4) streamline data collection and systematically review
all existing reporting requirements for federally funded HIV/
AIDS programs to ensure that only essential data are collected.
SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
STRATEGY.
Title II of the Public Health Service Act (42 U.S.C. 202 et seq.)
is amended by inserting after section 241 the following:
``SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION OF NATIONAL HIV/AIDS
STRATEGY.
``(a) Transfer Authorization.--Of the discretionary appropriations
made available to the Department of Health and Human Services for any
fiscal year for programs and activities that, as determined by the
Secretary of Health and Human Services, pertain to HIV/AIDS, the
Secretary, in coordination with the Director of the Office of National
HIV/AIDS Policy, may transfer up to 1 percent of such appropriations to
the Office of the Assistant Secretary for Health for implementation of
the National HIV/AIDS Strategy.
``(b) Congressional Notification.--Not less than 30 days before
making any transfer under this section, the Secretary shall give notice
of the transfer to the Congress.
``(c) Definitions.--In this section:
``(1) HIV/AIDS.--The term `HIV/AIDS' has the meaning given
to such term in section 2689.
``(2) National hiv/aids strategy.--The term `National HIV/
AIDS Strategy' means the National HIV/AIDS Strategy for the
United States issued by the President in July 2010 and includes
any subsequent revisions to such Strategy.''.
SEC. 761. REPORT ON THE IMPLEMENTATION OF GOAL 4 (IMPROVED
COORDINATION) OF THE NATIONAL HIV/AIDS STRATEGY.
(a) Report Required.--The President, in consultation with the heads
of all relevant Federal departments and agencies including the
Department of Education, the Department of Health and Human Services,
the Department of Housing and Urban Development, the Department of
Justice, the Department of Labor, the Department of Veteran Affairs,
and the Social Security Administration, shall transmit to the Congress
and make publicly available a report on the status of implementation of
Goal 4 of the National HIV/AIDS Strategy.
(b) Contents.--The report required by subsection (a) shall include
a description, an analysis, and an evaluation of--
(1) the extent to which the National HIV/AIDS Strategy has
improved coordination of efforts, enhanced capacity, and
strengthened infrastructure in order to maximize the effective
delivery of HIV/AIDS prevention, care, and treatment services
at the community level, including coordination--
(A) within and among Federal agencies and
departments;
(B) between the Federal Government and State and
local governments and health departments;
(C) between the Federal Government and nonprofit
foundations and civil society organizations, including
community- and faith-based organizations focused on
addressing the issue of HIV/AIDS; and
(D) between the Federal Government and private
businesses; and
(2) efforts by the Federal Government to educate, involve,
and establish and strengthen partnerships with civil society
organizations, including community- and faith-based
organizations, in order to implement the National HIV/AIDS
Strategy and achieve its goals.
(c) Definition.--In this section, the term ``National HIV/AIDS
Strategy'' means the National HIV/AIDS Strategy for the United States
issued by the President in July 2010, the revision to such Strategy
issued in July 2015, and any subsequent revisions to such Strategy.
Subtitle F--Diabetes
SEC. 771. RESEARCH, TREATMENT, AND EDUCATION.
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 NIH shall expand, intensify, and
support ongoing research and other activities with respect to
prediabetes and diabetes, particularly type 2, in minority populations.
``(b) Research.--
``(1) Description.--Research under subsection (a) shall
include investigation into--
``(A) the causes of diabetes, including
socioeconomic, geographic, clinical, environmental,
genetic, and other factors that may contribute to
increased rates of diabetes in minority populations;
and
``(B) the causes of increased incidence of diabetes
complications in minority populations, and possible
interventions to decrease such incidence.
``(2) Inclusion of minority participants.--In conducting
and supporting research described in subsection (a), the
Director of NIH shall seek to include minority participants as
study subjects in clinical trials.
``(c) Report; Comprehensive Plan.--
``(1) In general.--The Diabetes Mellitus Interagency
Coordinating Committee shall--
``(A) prepare and submit to the Congress, not later
than 6 months after the date of enactment of this
section, a report on Federal research and public health
activities with respect to prediabetes and diabetes in
minority populations; and
``(B) develop and submit to the Congress, not later
than 1 year after the date of enactment of this
section, an effective and comprehensive Federal plan
(including all appropriate Federal health programs) to
address prediabetes and diabetes in minority
populations.
``(2) Contents.--The report under paragraph (1)(A) shall at
minimum address each of the following:
``(A) Research on diabetes and prediabetes in
minority populations, including such research on--
``(i) genetic, behavioral, and
environmental factors; and
``(ii) prevention and complications among
individuals within these populations who have
already developed diabetes.
``(B) Surveillance and data collection on diabetes
and prediabetes in minority populations, including with
respect to--
``(i) efforts to better determine the
prevalence of diabetes among Asian-American and
Pacific Islander subgroups; and
``(ii) efforts to coordinate data
collection on the American Indian population.
``(C) Community-based interventions to address
diabetes and prediabetes targeting minority
populations, including--
``(i) the evidence base for such
interventions;
``(ii) the cultural appropriateness of such
interventions; and
``(iii) efforts to educate the public on
the causes and consequences of diabetes.
``(D) Education and training programs for health
professionals (including community health workers) on
the prevention and management of diabetes and its
related complications that is supported by the Health
Resources and Services Administration, including such
programs supported by--
``(i) the National Health Service Corps; or
``(ii) the community health centers program
under section 330.
``(d) Education.--The Director of NIH shall--
``(1) through the National Institute on Minority Health and
Health Disparities and the National Diabetes Education
Program--
``(A) make grants to programs funded under section
464z-4 (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.
``(e) Definitions.--For purposes of this section:
``(1) Diabetes mellitus interagency coordinating
committee.--The `Diabetes Mellitus Interagency Coordinating
Committee' means the Diabetes Mellitus Interagency Coordinating
Committee established under section 429.
``(2) Minority population.--The term `minority population'
means a racial and ethnic minority group, as defined in section
1707.''.
SEC. 772. 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 317X of such Act, as
added, the following section:
``SEC. 317Y. 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 public health 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) Further enhancing the National Health and
Nutrition Examination Survey by oversampling Asian
American, Native Hawaiian, and 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. The Secretary shall ensure that any such
oversampling does not reduce the oversampling of other
minority populations including African-American and
Latino populations.
``(B) Through the Division of Diabetes
Translation--
``(i) providing for prevention research to
better understand how to influence health care
systems changes to improve quality of care
being delivered to such populations;
``(ii) carrying out model demonstration
projects to design, implement, and evaluate
effective diabetes prevention and control
interventions for minority populations,
including culturally appropriate community-
based interventions;
``(iii) developing and implementing a
strategic plan to reduce diabetes in minority
populations through applied research to reduce
disparities and culturally and linguistically
appropriate community-based interventions;
``(iv) supporting, through the national
diabetes prevention program under section 399V-
3, diabetes prevention program sites in
underserved regions highly impacted by
diabetes; and
``(v) implementing, through the national
diabetes prevention program under section 399V-
3, a demonstration program developing new
metrics measuring health outcomes related to
diabetes that can be stratified by specific
minority populations.
``(b) Education.--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 both programs to educate
the public on diabetes in minority populations and programs to educate
minority populations about the causes and effects of diabetes.
``(c) Diabetes; Health Promotion, Prevention Activities, and
Access.--The Secretary, acting through the Director of the Centers for
Disease Control and Prevention and the National Diabetes Education
Program, shall conduct and support programs to educate specific
minority populations through culturally appropriate and linguistically
appropriate information campaigns about prevention of, and managing,
diabetes.
``(d) Definition.--For purposes of this section, the term `minority
population' means a racial and ethnic minority group, as defined in
section 1707.''.
SEC. 773. 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 new section:
``SEC. 399V-9. 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) Giving priority, under the primary care training and
enhancement program under section 747--
``(A) to awarding grants to focus on or address
diabetes; and
``(B) to adding minority populations to the list of
vulnerable populations that should be served by such
grants.
``(2) Providing additional funds for the Health Careers
Opportunity Program, the 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 focused on diabetes treatment and care within
underserved regions highly impacted by diabetes.
``(3) Developing a diabetes focus within, and providing
additional funds for, the National Health Service Corps
Scholarship Program--
``(A) to place individuals in areas that are
disproportionately affected by diabetes and to provide
diabetes treatment and care in such areas; and
``(B) to provide such individuals continuing
medical education specific to diabetes care.''.
SEC. 774. 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. 399V-10. RESEARCH, EDUCATION, AND OTHER ACTIVITIES REGARDING
DIABETES IN AMERICAN INDIAN POPULATIONS.
``In addition to activities under sections 399V-6 and 434B, the
Secretary, acting through the Indian Health Service and in
collaboration with other appropriate Federal agencies, shall--
``(1) conduct and support research and other activities
with respect to diabetes; and
``(2) coordinate the collection of data on clinically and
culturally appropriate diabetes treatment, care, prevention,
and services by health care professionals to the American
Indian population.''.
SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES.
The Secretary of Health and Human Services shall seek to enter into
an arrangement with the Institute of Medicine under which the Institute
will--
(1) not later than 1 year after the date of enactment of
this Act, submit to the Congress an updated version of the
Institute's 2002 report entitled ``Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care''; and
(2) in such updated version, address how racial and ethnic
health disparities have changed since the publication of the
original report.
Subtitle G--Lung Disease
SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDUCATION AND PREVENTION
PROGRAM.
(a) Findings.--The Congress finds as follows:
(1) The prevalence of asthma has increased since 1980 and
affects 25 million Americans.
(2) Significant disparities in asthma morbidity and
mortality exist for both adults and children particularly for
low-income and minority populations, particularly African
Americans and Puerto Ricans.
(3) African-American children are twice as likely to have
asthma as White children.
(4) In 2010, almost 4.5 million non-Hispanic African
Americans reported having asthma. African Americans with asthma
are three times as likely to visit the emergency department and
twice as likely to get hospitalized as White patients with
asthma.
(5) Puerto Ricans are 3.4 times as likely to die from
asthma compared with all other Hispanic or Latino groups.
Overall Hispanic Americans are 30 percent more likely to be
hospitalized for asthma than non-Hispanic Whites.
(6) More than 65 percent of adults with asthma are women.
(b) In General.--Not later than 2 years after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
convene a working group comprised of patient groups, nonprofit
organizations, medical societies, and other relevant governmental and
nongovernmental entities, including those that participate in the
National Asthma Education and Prevention Program, to develop a report
to Congress that--
(1) catalogs, with respect to asthma prevention,
management, and surveillance--
(A) the activities of the Federal Government,
including identifying all Federal programs that carry
out asthma-related activities, as well as assessment of
the progress of the Federal Government and States, with
respect to achieving the goals of the Healthy People
2020 initiative; and
(B) the activities of other entities that
participate in the program, including nonprofit
organizations, patient advocacy groups, and medical
societies; and
(2) makes recommendations for the future direction of
asthma activities, in consultation with researchers from the
National Institutes of Health and other member bodies of the
National Asthma Education and Prevention Program who are
qualified to review and analyze data and evaluate
interventions, including--
(A) a description of how the Federal Government may
better coordinate and improve its response to asthma
including identifying any barriers that may exist;
(B) a description of how the Federal Government may
continue, expand, and improve its private-public
partnerships with respect to asthma including
identifying any barriers that may exist;
(C) identification of steps that may be taken to
reduce the--
(i) morbidity, mortality, and overall
prevalence of asthma;
(ii) financial burden of asthma on society;
(iii) burden of asthma on
disproportionately affected areas, particularly
those in medically underserved populations (as
defined in section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3))); and
(iv) burden of asthma as a chronic disease;
(D) identification of programs and policies that
have achieved the steps described in subparagraph (C),
and steps that may be taken to expand such programs and
policies to benefit larger populations; and
(E) recommendations for future research and
interventions.
(c) Report to Congress.--At the end of the 5-year period following
the submission of the report under this section, the National Asthma
Education and Prevention Program shall evaluate the analyses and
recommendations under such report and determine whether a new report to
the Congress is necessary, and make appropriate recommendations to the
Congress.
SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL
AND PREVENTION.
Section 317I of the Public Health Service Act (42 U.S.C. 247b-10)
is amended to read as follows:
``SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
``(a) Program for Providing Information and Education to the
Public.--The Secretary, acting through the Director of the Centers for
Disease Control and Prevention, shall collaborate with State and local
health departments to conduct activities, including the provision of
information and education to the public regarding asthma including--
``(1) deterring the harmful consequences of uncontrolled
asthma; and
``(2) disseminating health education and information
regarding prevention of asthma episodes and strategies for
managing asthma.
``(b) Development of State Asthma Plans.--The Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
shall collaborate with State and local health departments to develop
State plans incorporating public health responses to reduce the burden
of asthma, particularly regarding disproportionately affected
populations.
``(c) Compilation of Data.--The Secretary, acting through the
Director of the Centers for Disease Control and Prevention, shall, in
cooperation with State and local public health officials--
``(1) conduct asthma surveillance activities to collect
data on the prevalence and severity of asthma, the
effectiveness of public health asthma interventions, and the
quality of asthma management, including--
``(A) collection of household data on the local
burden of asthma;
``(B) surveillance of health care facilities; and
``(C) collection of data not containing
individually identifiable information from electronic
health records or other electronic communications;
``(2) compile and annually publish data regarding the
prevalence and incidence of childhood asthma, the child
mortality rate, and the number of hospital admissions and
emergency department visits by children associated with asthma
nationally and in each State and at the county level by age,
sex, race, and ethnicity, as well as lifetime and current
prevalence; and
``(3) compile and annually publish data regarding the
prevalence and incidence of adult asthma, the adult mortality
rate, and the number of hospital admissions and emergency
department visits by adults associated with asthma nationally
and in each State and at the county level by age, sex, race,
ethnicity, industry, and occupation, as well as lifetime and
current prevalence.
``(d) Coordination of Data Collection.--The Director of the Centers
for Disease Control and Prevention, in conjunction with State and local
health departments, shall coordinate data collection activities under
subsection (c)(2) so as to maximize comparability of results.
``(e) Collaboration.--The Centers for Disease Control and
Prevention are encouraged to collaborate with national, State, and
local nonprofit organizations to provide information and education
about asthma, and to strengthen such collaborations when possible.
``(f) Additional Funding.--In addition to any other authorization
of appropriations that is available to the Centers for Disease Control
and Prevention for the purpose of carrying out this section, there are
authorized to be appropriated to such Centers such sums as may be
necessary for each of fiscal years 2019 through 2023 for the purpose of
carrying out this section.''.
SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAMPAIGN.
(a) In General.--The Secretary of Health and Human Services shall--
(1) enhance the annual campaign by the Department of Health
and Human Services to increase the number of people vaccinated
each year for influenza and pneumonia; and
(2) include in such campaign the use of written educational
materials, public service announcements, physician education,
and any other means which the Secretary deems effective.
(b) Materials and Announcements.--In carrying out the annual
campaign described in subsection (a), the Secretary of Health and Human
Services shall ensure that--
(1) educational materials and public service announcements
are readily and widely available in communities experiencing
disparities in the incidence and mortality rates of influenza
and pneumonia; and
(2) the campaign uses targeted, culturally appropriate
messages and messengers to reach underserved communities.
(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 2019 through 2023.
SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACTION PLAN.
(a) Findings.--The Congress finds as follows:
(1) Chronic obstructive pulmonary disease (``COPD'') refers
to chronic bronchitis and emphysema, incurable diseases that
make it difficult to exhale all the air from one's lungs, and
that can cause persistent coughing, shortness of breath, and
sputum.
(2) COPD exacerbations--episodes of acute difficulty
breathing and moderate to severe fatigue--are dangerous, and
their treatment often requires hospitalization.
(3) While smoking is the primary risk factor for COPD,
other risk factors include air pollution, occupational
exposures, heredity, a history of childhood respiratory
infections, and socioeconomic status.
(4) Over 13.5 million United States adults are estimated to
have COPD.
(5) COPD is the third-leading cause of death in America,
claiming over 134,000 lives in 2010.
(6) Since 2000, deaths for women with COPD have exceeded
deaths in men.
(7) Although African Americans have a lower prevalence of
COPD in the United States, researchers have shown that African
Americans may be underdiagnosed. Furthermore, research has
shown that African Americans develop COPD with less cumulative
smoke exposure and at a younger age.
(b) In General.--The Director of the Centers for Disease Control
and Prevention shall conduct, support, and expand public health
strategies, prevention, diagnosis, surveillance, and public and
professional awareness activities regarding chronic obstructive
pulmonary disease.
(c) National Action Plan.--
(1) Development.--Not later than 2 years after the date of
the enactment of this Act, the Director of the National Heart,
Lung, and Blood Institute, in consultation with the Director of
the Centers for Disease Control and Prevention, shall develop a
national action plan to address chronic obstructive pulmonary
disease in the United States with participation from patients,
caregivers, health professionals, patient advocacy
organizations, researchers, providers, public health
professionals, and other stakeholders.
(2) Contents.--At a minimum, such plan shall include
recommendations for--
(A) public health interventions for the purpose of
implementation of the national plan;
(B) biomedical, health services, and public health
research on chronic obstructive pulmonary disease; and
(C) inclusion of chronic obstructive pulmonary
disease in the health data collections of all Federal
agencies.
(3) Consideration.--In developing such plan, the Director
of the National Heart, Lung, and Blood Institute shall consider
the recommendations and findings of the Institute of Medicine
in the report entitled ``A Nationwide Framework for
Surveillance of Cardiovascular and Chronic Lung Diseases''
(July 22, 2011).
(d) Chronic Disease Prevention Programs.--The Director of the
National Heart, Lung, and Blood Institute shall carry out the
following:
(1) Conduct public education and awareness activities with
patient and professional organizations to stimulate earlier
diagnosis and improve patient outcomes from treatment of
chronic obstructive pulmonary disease. To the extent known and
relevant, such public education and awareness activities shall
reflect differences in chronic obstructive pulmonary disease by
cause (tobacco, environmental, occupational, biological, and
genetic) and include a focus on outreach to undiagnosed and, as
appropriate, minority populations.
(2) Supplement and expand upon the activities of the
National Heart, Lung, and Blood Institute by making grants to
nonprofit organizations, State and local jurisdictions, and
Indian Tribes for the purpose of reducing the burden of chronic
obstructive pulmonary disease, especially in disproportionately
impacted communities, through public health interventions and
related activities.
(3) Coordinate with the Centers for Disease Control and
Prevention, the Indian Health Service, the Health Resources and
Services Administration, and the Department of Veterans Affairs
to develop pilot programs to demonstrate best practices for the
diagnosis and management of chronic obstructive pulmonary
disease.
(4) Develop improved techniques and identify best
practices, in coordination with the Secretary of Veterans
Affairs, for assisting chronic obstructive pulmonary disease
patients to successfully stop smoking, including identification
of subpopulations with different needs. Initiatives under this
paragraph may include research to determine whether successful
smoking cessation strategies are different for chronic
obstructive pulmonary disease patients compared to such
strategies for patients with other chronic diseases.
(e) Environmental and Occupational Health Programs.--The Director
of the Centers for Disease Control and Prevention shall--
(1) support research into the environmental and
occupational causes and biological mechanisms that contribute
to chronic obstructive pulmonary disease; and
(2) develop and disseminate public health interventions
that will lessen the impact of environmental and occupational
causes of chronic obstructive pulmonary disease.
(f) Data Collection.--Not later than 180 days after the enactment
of this Act, the Director of the National Heart, Lung, and Blood
Institute and the Director of the Centers for Disease Control and
Prevention, acting jointly, shall assess the depth and quality of
information on chronic obstructive pulmonary disease that is collected
in surveys and population studies conducted by the Centers for Disease
Control and Prevention, including whether there are additional
opportunities for information to be collected in the National Health
and Nutrition Examination Survey, the National Health Interview Survey,
and the Behavioral Risk Factors Surveillance System surveys. The
Director of the National Heart, Lung, and Blood Institute shall include
the results of such assessment in the national action plan under
subsection (b).
(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2019 through 2023.
Subtitle H--Tuberculosis
SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS.
(a) Short Title.--This subtitle be cited as the ``End Tuberculosis
Act''.
(b) Findings.--The Congress makes the following findings:
(1) In the United States, 9,272 people were diagnosed with
tuberculosis (referred to in this section as ``TB'') in 2016.
(2) Disparities in TB exist and significantly impact
minority communities in the United States. The Centers for
Disease Control and Prevention (referred to in this section as
``CDC'') finds that 87 percent of people diagnosed with TB in
2016 self-identified as racial and ethnic minorities.
(3) African Americans comprised 21 percent of people
diagnosed with TB during 2016. The population-adjusted rate of
TB among African Americans is 1.7 times higher than the
national total, and 8.2 times higher than among Whites.
(4) Asian Americans, Native Hawaiians, and other Pacific
Islanders comprised 35 percent of people diagnosed with TB
during 2016. The population-adjusted rate of TB among Asian
Americans is 6.2 times higher than the national total, and 30
times higher than among Whites. The population-adjusted rate of
TB among Native Hawaiians and other Pacific Islanders is 4.8
times higher than the national total, and 23.2 times higher
than among Whites.
(5) Hispanics and Latinos comprised 28 percent of people
diagnosed with TB during 2016. The population-adjusted rate of
TB among Hispanics and Latinos is 1.6 times higher than the
national total, and 7.5 times higher than among Whites.
(6) TB is both preventable and curable, but the current
rate of decline of TB in the United States remains too slow to
achieve TB elimination in this century.
(7) TB is transmitted through the air when a person who has
TB disease in their lungs coughs or sneezes. People who are in
close proximity to the person with TB can breathe in the TB
bacteria, and the bacteria will initially settle in their
lungs. Without proper and timely diagnosis and access to
treatment, the TB bacteria may grow and spread to other parts
of their body.
(8) As many as 13,000,000 people in the United States may
have Latent TB Infection (referred to in this section as
``LTBI''). People with LTBI have TB bacteria in their bodies,
but their immune system is containing the bacteria, and they
are not sick, nor do they have any current risk of spreading TB
to others. LTBI can activate into infectious, life-threatening
TB if not treated. Modeling has shown that eliminating TB is
not possible without addressing LTBI.
(9) Comorbidities associated with TB include cancer,
diabetes mellitus, and HIV. People with these medical
conditions and compromised immune systems are more likely to
develop active TB disease and to have worse outcomes from TB.
(10) Forms of active TB that do not show drug resistance
are classified as Drug-susceptible TB (referred to in this
section as ``DS-TB''). Drug-resistant TB (referred to in this
section as ``DR-TB'') is a rising threat to the public health
of the United States. DR-TB that exhibits resistance to two or
more first-line drugs is referred to as multi-drug resistant TB
(referred to in this section as ``MDR-TB''). MDR-TB that also
is resistant to at least one injectable second-line medication
and at least one fluoroquinolone is classified as extensively
drug-resistant TB (referred to in this section as ``XDR-TB'').
(11) Approximately 78 people in the United States were
diagnosed with MDR-TB in 2016. One person was diagnosed with
XDR-TB in the same year.
(12) In the United States, direct treatment costs average
$17,000 to treat a patient with DS-TB, $150,000 to treat a
patient with MDR-TB, and $482,000 to treat a patient with XDR-
TB. When factoring in productivity losses during treatment, DS-
TB averages $46,000, MDR-TB averages $294,000 and XDR-TB
averages $694,000. Treatment is often difficult, with daily
complex multi-pill regimens and injections, with side-effects
ranging from hearing and vision loss to mental health issues.
(13) Recognizing the public health, economic and societal
costs to the threat of MDR-TB, the National Action Plan to
Combat MDR-TB (NAP) was developed by the White House to provide
the United States with a comprehensive three-pronged strategy
to address MDR-TB by strengthening domestic capacity to combat
MDR-TB; improve international capacity and cooperation to
combat MDR-TB; accelerate basic and applied research and
development for new therapies, diagnostics and prevention
strategies to combat MDR-TB.
(14) Additional Federal support is necessary to expand TB
control efforts in case finding and treatment to address LTBI
in a national prevention initiative. Key policy and research
breakthroughs increase the success of a TB prevention
initiative: the U.S. Preventative Services Task Force
recommendation's ``B'' rating, screening for LTBI among high-
risk adults as a covered service increases the likelihood that
impacted racial and ethnic minority groups can get tested for
TB; a new, shorter course treatment regimen (3HP) reduces the
length of treatment for LTBI from every day for 6 to 9 months
to one dose per week for 12 weeks, increasing likelihood of
treatment completion; and the use of blood-based diagnostic
tests, Interferon-gamma release assays or IGRAs, increases
ability to detect LTBI among patients in affected communities.
SEC. 782. ADDITIONAL FUNDING FOR STATES IN COMBATING AND ELIMINATING
TUBERCULOSIS.
Section 317E(f) of the Public Health Act (42 U.S.C. 247b6(f)) is
amended by adding at the end the following:
``(3) Additional funding for states in combating and
eliminating tuberculosis.--In addition to amounts otherwise
authorized to be appropriated to carry out this section, there
are authorized to be appropriated such sums as may be necessary
to carry out sections 247-b(1)(2)(3) for each of fiscal years
2019 through 2021.''.
SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING FOR TUBERCULOSIS.
(a) In General.--The Secretary of Health and Human Services shall
expand and intensify support for current and prospective research
activities of the National Institutes of Health, the Biomedical
Advanced Research and Development Authority, and the Centers for
Disease Control and Prevention Division of Tuberculosis Elimination to
develop new therapeutics, diagnostics, vaccines, and other prevention
modalities in addressing all forms of tuberculosis (in this section
referred to as ``TB'').
(b) Included Research Activities.--Research activities under
subsection (a) shall include--
(1) research to develop novel, safe drugs and drug regimens
for the treatment of TB, including in adolescent and pediatric
populations and in pregnant and lactating women;
(2) research to develop rapid diagnostic tests for all
forms of TB, including diagnostics that can be used for
pediatric populations and people living with HIV, diagnostics
that can detect extra pulmonary TB and drug resistance, and
diagnostics that can be used at the point of care;
(3) research to advance basic knowledge of the pathogenesis
of TB and its major comorbidities, including HIV and diabetes
mellitus;
(4) research to improve knowledge and understandings of the
role of latency in TB and the factors that increase the risk of
latent TB infection progressing to active, symptomatic TB
disease;
(5) awarding grants and contracts to specifically develop
new and needed vaccines to address TB;
(6) awarding grants and contracts to support the training
and development of clinical researchers whose research improves
the landscape of tools to combat TB; and
(7) awarding grants and contracts to support capacity-
building and develop clinical trial site infrastructure in the
United States and in TB endemic countries to support the
aforementioned research activities.
Subtitle I--Osteoarthritis and Musculoskeletal Diseases
SEC. 785. FINDINGS.
The Congress finds as follows:
(1) Eighty percent of African-American women and nearly 74
percent of Hispanic men are either overweight or obese,
speeding the onset and progression of arthritis.
(2) Arthritis affects 46 million Americans, and that number
will rise to 67 million by the year 2030.
(3) Twenty-seven million Americans suffer from
osteoarthritis, the most common form of arthritis, making it
the leading cause of disability in the United States.
Osteoarthritis is sometimes referred to as degenerative joint
disease.
(4) Obesity accelerates the onset of arthritis: 70 percent
of obese adults with mild osteoarthritis of the knee at age 60
will develop advanced end-stage disease by age 80. In contrast,
just 43 percent of nonobese adults will have end-stage disease
over the same time period.
(5) Arthritis affects one in five Americans, and is the
single greatest cause of chronic pain and disability in the
United States.
(6) Women, African Americans, and Hispanics have more
severe arthritis and functional limitations. These same
individuals are more likely to be obese, diabetic, and have
higher incidence of heart disease--medical conditions that can
be improved with physical activity. Instead of moving; however,
these groups have an inactivity rate of 40 to 50 percent, which
continues to increase.
(7) Arthritis costs $128 billion a year, including $81
billion in direct costs (medical) and $47 billion in indirect
costs (lost earnings). Each year, $309 billion in direct and
indirect costs is lost due to disparities in osteoarthritis and
musculoskeletal diseases.
(8) Obesity and other chronic health conditions exacerbate
the debilitating impact of arthritis, leading to inactivity,
loss of independence, and a perpetual cycle of comorbid chronic
conditions.
(9) Sixty-one percent of arthritis sufferers are women, and
women represent 64 percent of an estimated 43 million annual
visits to physicians' offices and outpatient clinics where
arthritis was the primary diagnosis. Women also represented 60
percent of approximately 1 million hospitalizations that
occurred in 2003 for which arthritis was the primary diagnosis.
(10) Women ages 65 and older have up to 2\1/2\ times more
disabilities than men of the same age. Higher rates of obesity
and arthritis among this group explained up to 48 percent of
the gender gap in disability, above all other common chronic
health conditions.
(11) The primary indication for total knee arthroplasty
(TKA), also known as knee replacement, is relief of
significant, disabling pain caused by severe arthritis.
(12) Knee replacement is surgery for people with severe
knee damage. Knee replacement can relieve pain and allow you to
be more active. When you have a total knee replacement, the
surgeon removes damaged cartilage and bone from the surface of
your knee joint and replaces them with a man-made surface of
metal and plastic. In a partial knee replacement, the surgeon
only replaces one part of your knee joint.
(13) Total hip replacement, also called total hip
arthroplasty (THA), is used if your hip pain interferes with
daily activities and more conservative treatments have not
helped. Arthritis damage is the most common reason to need hip
replacement.
(14) The odds of a family practice physician recommending
TKA to a male patient with moderate arthritis are twice that of
a female patient, while the odds of an orthopaedic surgeon
recommending TKA to a male patient with moderate arthritis are
22 times that of a female patient.
(15) African Americans with doctor-diagnosed arthritis have
a higher prevalence of severe pain attributable to arthritis,
compared with Whites (34.0 percent versus 22.6 percent).
African Americans, compared to Whites, report a higher
proportion of work limitations (39.5 percent versus 28.0
percent) and a higher prevalence of arthritis-attributable work
limitation (6.6 percent versus 4.6 percent).
(16) Hispanics are 50 percent more likely than non-Hispanic
Whites to report needing assistance with at least one
instrumental activity of daily living and to have difficulty
walking.
(17) African Americans and Hispanics were 1.3 times more
likely to have activity limitation, 1.6 times more likely to
have work limitations, and 1.9 times more likely to have severe
joint pain than Whites.
(18) In 2003, the Institute of Medicine reported that the
rates of TKA and THA among African-American and Hispanic
patients are significantly lower than for Whites--even for
those with equitable health care coverage such as through
Medicare or the Department of Veterans Affairs.
(19) According to the Centers for Disease Control and
Prevention, in 2000, African-American Medicare enrollees were
37 percent less likely than White Medicare enrollees to undergo
total knee replacements. In 2006, the disparity increased to 39
percent.
(20) Even after adjusting for insurance and health access,
Hispanics and African Americans are almost 50 percent less
likely to undergo total knee replacement than Whites.
SEC. 786. OSTEOARTHRITIS AND OTHER MUSCULOSKELETAL HEALTH-RELATED
ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(a) Education and Awareness Activities.--The Secretary of Health
and Human Services, acting through the Director of the Centers for
Disease Control and Prevention, shall direct the National Center for
Chronic Disease Prevention and Health Promotion to conduct and expand
the Health Community Program and Arthritis Program to educate the
public on--
(1) the causes of, preventive health actions for, and
effects of arthritis and other musculoskeletal conditions in
minority patient populations; and
(2) the effects of such conditions on other comorbidities
including obesity, hypertension, and cardiovascular disease.
(b) Programs on Arthritis and Musculoskeletal Conditions.--
Education and awareness programs of the Centers for Disease Control and
Prevention on arthritis and other musculoskeletal conditions in
minority communities shall--
(1) be culturally and linguistically appropriate to
minority patients, targeting musculoskeletal health promotion
and prevention programs of each major ethnic group, including--
(A) Native Americans and Alaska Natives;
(B) Asian Americans;
(C) African Americans/Blacks;
(D) Hispanic/Latino Americans; and
(E) Native Hawaiians and Pacific Islanders; and
(2) include public awareness campaigns directed toward
these patient populations that emphasize the importance of
musculoskeletal health, physical activity, diet and healthy
lifestyle, and weight reduction for overweight and obese
patients.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as are necessary for
fiscal year 2019 and each subsequent fiscal year.
SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS AND MUSCULOSKELETAL
DISEASE HEALTH EDUCATION WITHIN HEALTH PROFESSIONS
SCHOOLS.
(a) Program Authorized.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary''), in coordination
with the Secretary of Education, shall award grants, on a competitive
basis, to academic health science centers, health professions schools,
and other institutions of higher education to enable such institutions
to provide people with comprehensive education on arthritis and
musculoskeletal health, particularly--
(1) obesity-related musculoskeletal diseases;
(2) arthritis and osteoarthritis;
(3) arthritis and musculoskeletal health disparities; and
(4) the relationship between arthritis and musculoskeletal
diseases and metabolic activity, psychological health, and
comorbidities such as diabetes, cardiovascular disease, and
hypertension.
(b) Duration.--Grants awarded under this section shall be for a
period of 5 years.
(c) Applications.--An academic health science center, health
professions school, or other institution of higher education seeking a
grant under this section shall submit an application to the Secretary
at such time, in such manner, and containing such information as the
Secretary may require.
(d) Priority.--In awarding grants under this section, the Secretary
shall give priority to an institution of higher education that--
(1) has an enrollment of needy students, as defined in
section 318(b) of the Higher Education Act of 1965 (20 U.S.C.
1059e(b));
(2) is a Hispanic-serving institution, as defined in
section 502(a) of such Act (20 U.S.C. 1101a(a));
(3) is a Tribal College or University, as defined in
section 316(b) of such Act (20 U.S.C. 1059c(b));
(4) is an Alaska Native-serving institution, as defined in
section 317(b) of such Act (20 U.S.C. 1059d(b));
(5) is a Native Hawaiian-serving institution, as defined in
section 317(b) of such Act (20 U.S.C. 1059d(b));
(6) is a Predominately Black Institution, as defined in
section 318(b) of such Act (20 U.S.C. 1059e(b));
(7) is a Native American-serving, non-Tribal institution,
as defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
(8) is an Asian-American and Native American Pacific
Islander-serving institution, as defined in section 320(b) of
such Act (20 U.S.C. 1059g(b)); or
(9) is a minority institution, as defined in section 365 of
such Act (20 U.S.C. 1067k), with an enrollment of needy
students, as defined in section 312 of such Act (20 U.S.C.
1058).
(e) Uses of Funds.--An institution of higher education receiving a
grant under this section may use grant funds to integrate issues
relating to comprehensive arthritis and musculoskeletal health into the
academic or support sectors of the institution in order to reach a
large number of students, by carrying out 1 or more of the following
activities:
(1) Developing educational content for issues relating to
comprehensive arthritis and musculoskeletal health education
that will be incorporated into first-year orientation or core
courses.
(2) Creating innovative technology-based approaches to
deliver arthritis and musculoskeletal health education to
students, faculty, and staff.
(3) Developing and employing peer-outreach and education
programs to generate discussion, educate, and raise awareness
among students about issues relating to arthritis and
musculoskeletal health disorders, and their relationship to
diabetes, hypertension, cardiovascular disease, psychological
health, and other comorbid conditions.
(f) Report to Congress.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for a period
of 5 years, the Secretary shall prepare and submit to the
appropriate committees of Congress a report on the activities
to provide health professions students with comprehensive
arthritis and musculoskeletal health education funded under
this section.
(2) Report elements.--The report described in paragraph (1)
shall include information about--
(A) the number of entities that are receiving grant
funds;
(B) the specific activities supported by grant
funds;
(C) the number of students served by grant
programs; and
(D) the status of program evaluations.
Subtitle J--Sleep and Circadian Rhythm Disorders
SEC. 791. SHORT TITLE; FINDINGS.
(a) Short Title.--This subtitle may be cited as the ``Sleep and
Circadian Rhythm Disorders Health Disparities Act''.
(b) Findings.--The Congress finds the following:
(1) Decrements in sleep health such as sleep apnea,
insufficient sleep time, and insomnia, affect 50-70 million
United States adults. Twelve to eighteen million United States
adults have sleep apnea, a chronic disorder characterized by
one or more pauses in breathing which can last from a few
seconds to minutes. They may occur 30 times or more an hour,
disrupting sleep and resulting in excessive daytime sleepiness
and loss in productivity.
(2) Seventy percent of high school students are not getting
enough sleep on school nights, while 33 percent of Americans
get fewer than 7 hours of sleep per night, and roughly 6,000
fatal motor vehicle crashes are caused by drowsy drivers.
(3) Insufficient sleep and insomnia are more prevalent in
women. Women who are pregnant and have sleep apnea are at an
increased risk of cardiovascular complications during
pregnancy. The impact of disparities in sleep health is
associated with a growing number of health problems, including
the following:
(A) Hypertension.
(B) Cancer.
(C) Stroke.
(D) Cardiac arrhythmia.
(E) Chronic heart failure and heart disease.
(F) Diabetes.
(G) Cognitive functioning and behavior.
(H) Depression and bipolar disorder.
(I) Substance abuse.
(4) A ``sleep disparity'' exists in that poor sleep quality
is strongly associated with poverty and race. Factors such as
employment, education, and health status, amongst others,
significantly mediated this effect only in poor subjects,
suggesting a differential vulnerability to these factors in
poor relative to nonpoor individuals in the context of sleep
quality.
(5) African Americans sleep worse than Caucasian Americans.
African Americans take longer to fall asleep, report poorer
sleep quality, have more light and less deep sleep, and nap
more often and longer.
(6) African Americans and individuals in lower
socioeconomic status groups may be at an increased risk for
sleep disturbances and associated health consequences.
(7) Among young African Americans, the likelihood of having
sleep disordered breathing and exhibiting risk factors for poor
sleep is twice that in young Caucasians. Frequent snoring is
more common among African American and Hispanic women and
Hispanic men compared to non-Hispanic Caucasians, independent
of other factors including obesity.
(8) African Americans with sleep-disordered breathing
develop symptoms at a younger age than Caucasians but appear
less likely to be diagnosed and treated in a timely manner.
This delay may at least in part be due to reduced access to
care.
(9) Sleep loss contributes to increased risk for chronic
conditions such as obesity, diabetes, and hypertension, all of
which have increased prevalence in underserved,
underrepresented minorities. Racial and ethnic disparities
related to obesity may also contribute to disparities in health
outcomes related to sleep-disordered breathing.
(10) Non-Caucasian adults report an insomnia rate of 12.9
percent compared to only 6.6 percent for Caucasians.
(11) African-American women have a higher incidence of
insomnia than African-American men, perhaps related in part to
higher risk for chronic persisting symptoms.
SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RESEARCH ACTIVITIES OF
THE NATIONAL INSTITUTES OF HEALTH.
(a) In General.--The Director of the National Institutes of Health,
acting through the Director of the National Heart, Lung, and Blood
Institute, shall--
(1) continue to expand research activities addressing sleep
health disparities; and
(2) continue implementation of the ``NIH Sleep Disorders
Research Plan'' across all institutes and centers of the
National Institutes of Health to improve treatment and
prevention of sleep health disparities.
(b) Required Research Activities.--In conducting or supporting
research relating to sleep and circadian rhythm, the Director of the
National Heart, Lung, and Blood Institute shall--
(1) advance epidemiology and clinical research to achieve a
more complete understanding of disparities in domains of sleep
health and across population subgroups for which cardiovascular
and metabolic health disparities exist, including--
(A) prevalence and severity of sleep apnea;
(B) habitual sleep duration;
(C) sleep timing and regularity; and
(D) insomnia;
(2) develop study designs and analytical approaches to
explain and predict multilevel and life-course determinants of
sleep health and to elucidate the sleep-related causes of
cardiovascular and metabolic health disparities across the age
spectrum, including such determinants and causes that are--
(A) environmental;
(B) biological or genetic;
(C) psychosocial;
(D) societal;
(E) political; or
(F) economic;
(3) determine the contribution of sleep impairments such as
sleep apnea, insufficient sleep duration, irregular sleep
schedules, and insomnia to unexplained disparities in
cardiovascular and metabolic risk and disease outcomes;
(4) develop study designs, data sampling and collection
tools, and analytical approaches to optimize understanding of
mediating and moderating factors, and feedback mechanisms
coupling sleep to cardiovascular and metabolic health
disparities;
(5) advance research to understand cultural and linguistic
barriers (on the person, provider, or system level) to access
to care, medical diagnosis, and treatment of sleep disorders in
diverse population groups;
(6) develop and test multilevel interventions (including
sleep health education in diverse communities) to reduce
disparities in sleep health that will impact ability to improve
disparities in cardiovascular and metabolic risk or disease;
(7) create opportunities to integrate sleep and health
disparity science by strategically utilizing resources
(existing or anticipated cohorts), exchanging scientific data
and ideas (cross-over into scientific meetings), and develop
multidisciplinary investigator-initiated grant applications;
and
(8) enhance the diversity and foster career development of
young investigators involved in sleep and health disparities
science.
(c) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal year 2019 and each subsequent fiscal year.
SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DISPARITIES-RELATED
ACTIVITIES OF THE CENTERS FOR DISEASE CONTROL AND
PREVENTION.
(a) In General.--The Director of the Centers for Disease Control
and Prevention shall conduct, support, and expand public health
strategies and prevention, diagnosis, surveillance, and public and
professional awareness activities regarding sleep and circadian rhythm
disorders.
(b) Findings.--The Congress finds as follows:
(1) Sleep disorders and sleep deficiency unrelated to a
primary sleep disorder are underdiagnosed and are increasingly
detrimental to health status.
(2) The consequences to society include additional
diseases, motor vehicle accidents, decreased longevity,
elevated direct medical costs, and indirect costs related to
work absenteeism and property damage.
(c) Required Surveillance and Education Awareness Activities.--In
conducting or supporting research relating to sleep and circadian
rhythm disorders surveillance and education awareness activities, the
Director of the Centers for Disease Control and Prevention shall--
(1) ensure that such activities are culturally and
linguistically appropriate to minority patients, targeting
sleep and circadian rhythm health promotion and prevention
programs of each major ethnic group, including--
(A) Native Americans and Alaska Natives;
(B) Asian Americans;
(C) African Americans/Blacks;
(D) Hispanic/Latino-Americans; and
(E) Native Hawaiians and Pacific Islanders;
(2) collect and compile national and State surveillance
data on sleep disorders health disparities;
(3) continue to develop and implement new sleep questions
in public health surveillance systems to increase public
awareness of sleep health and sleep disorders and their impact
on health;
(4) publish monthly reports highlighting geographic,
racial, and ethnic disparities in sleep health, as well as
relationships between insufficient sleep and chronic disease,
health risk behaviors, and other outcomes as determined
necessary by the Director; and
(5) include public awareness campaigns that inform patient
populations from major ethnic groups about the prevalence of
sleep and circadian rhythm disorders and emphasize the
importance of sleep health.
(d) Authorization of Appropriations.--To carry out this section,
there are authorized to be appropriated such sums as may be necessary
for fiscal year 2019 and each subsequent fiscal year.
SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIRCADIAN HEALTH EDUCATION
WITHIN HEALTH PROFESSIONS SCHOOLS.
(a) Program Authorized.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary''), in coordination
with the Secretary of Education, shall award grants, on a competitive
basis, to academic health science centers, health professions schools,
and other institutions of higher education to enable such institutions
to provide people with comprehensive education on sleep and circadian
health, particularly--
(1) poor sleep health;
(2) sleep disorders;
(3) sleep health disparities; and
(4) the relationship between sleep and circadian health on
metabolic activity, neurological activity, comorbidities, and
other diseases.
(b) Duration.--Grants awarded under this section shall be for a
period of 5 years.
(c) Applications.--Any academic health science center, health
professions school, or other institutions of higher education seeking a
grant under this section shall submit an application to the Secretary
at such time, in such manner, and containing such information as the
Secretary may require.
(d) Priority.--In awarding grants under this section, the Secretary
shall give priority to an institution that--
(1) has an enrollment of needy students, as defined in
section 318(b) of the Higher Education Act of 1965 (20 U.S.C.
1059e(b));
(2) is a Hispanic-serving institution, as defined in
section 502(a) of such Act (20 U.S.C. 1101a(a));
(3) is a Tribal College or University, as defined in
section 316(b) of such Act (20 U.S.C. 1059c(b));
(4) is an Alaska Native-serving institution, as defined in
section 317(b) of such Act (20 U.S.C. 1059d(b));
(5) is a Native Hawaiian-serving institution, as defined in
section 317(b) of such Act (20 U.S.C. 1059d(b));
(6) is a Predominately Black Institution, as defined in
section 318(b) of such Act (20 U.S.C. 1059e(b));
(7) is a Native American-serving, nontribal institution, as
defined in section 319(b) of such Act (20 U.S.C. 1059f(b));
(8) is an Asian-American and Native American Pacific
Islander-serving institution, as defined in section 320(b) of
such Act (20 U.S.C. 1059g(b)); or
(9) is a minority institution, as defined in section 365 of
such Act (20 U.S.C. 1067k), with an enrollment of needy
students, as defined in section 312 of such Act (20 U.S.C.
1058).
(e) Uses of Funds.--An institution of higher education receiving a
grant under this section may use grant funds to integrate issues
relating to comprehensive sleep and circadian health into the academic
or support sectors of the institution in order to reach a large number
of students, by carrying out 1 or more of the following activities:
(1) Developing educational content for issues relating to
comprehensive sleep and circadian health education that will be
incorporated into first-year orientation or core courses.
(2) Creating innovative technology-based approaches to
deliver sleep health education to students, faculty, and staff.
(3) Developing and employing peer-outreach and education
programs to generate discussion, educate, and raise awareness
among students about issues relating to poor quality sleep,
sleep and circadian disorders, and the role sleep health plays
in other diseases and comorbidities.
(f) Report to Congress.--
(1) In general.--Not later than 1 year after the date of
the enactment of this Act, and annually thereafter for a period
of 5 years, the Secretary shall prepare and submit to the
appropriate committees of Congress a report on the activities
to provide health professions students with comprehensive sleep
and circadian health education funded under this section.
(2) Report elements.--The report described in paragraph (1)
shall include information about--
(A) the number of eligible entities and
institutions of higher education that are receiving
grant funds;
(B) the specific activities supported by grant
funds;
(C) the number of students served by grant
programs; and
(D) the status of program evaluations.
SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN HEALTH DISORDERS IN
VULNERABLE AND RACIAL/ETHNIC POPULATIONS.
(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services shall submit to
the Congress and the President a report on the impact of sleep and
circadian health disorders for racial and ethnic minority communities
and other vulnerable populations.
(b) Contents.--The report under subsection (a) shall include
information on the--
(1) progress that has been made in reducing the impact of
sleep and circadian health disorders in such communities and
populations;
(2) opportunities that exist to make additional progress in
reducing the impact of sleep and circadian health disorders in
such communities and populations;
(3) challenges that may impede such additional progress;
and
(4) Federal funding necessary to achieve substantial
reductions in sleep and circadian health disorders in racial
and ethnic minority communities.
Subtitle K--Sickle Cell Disease Research, Surveillance, Prevention, and
Treatment
SEC. 796. SHORT TITLE.
This subtitle may be cited as the ``Sickle Cell Disease Research,
Surveillance, Prevention, and Treatment Act of 2018''.
SEC. 796A. SICKLE CELL DISEASE RESEARCH.
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:
``SEC. 399V-11. NATIONAL SICKLE CELL DISEASE RESEARCH, SURVEILLANCE,
PREVENTION, AND TREATMENT PROGRAM.
``(a) Research.--The Secretary may conduct or support research to
expand the understanding of the cause of, and to find a cure for,
sickle cell disease.''.
SEC. 796B. SICKLE CELL DISEASE SURVEILLANCE.
Section 399V-11 of the Public Health Service Act, as added by
section 796A, is amended by adding at the end the following:
``(b) Surveillance.--
``(1) Grants.--The Secretary may, for each fiscal year for
which appropriations are available to carry out this
subsection, make grants--
``(A) to conduct surveillance and maintain data on
the prevalence and distribution of sickle cell disease
and its associated health outcomes, complications, and
treatments;
``(B) to conduct public health initiatives with
respect to sickle cell disease, including--
``(i) increasing efforts to improve access
to, and receipt of, high-quality sickle cell
disease-related health care, including the use
of treatments approved under section 505 of the
Federal Food, Drug, and Cosmetic Act or
licensed under section 351 of this Act;
``(ii) working with partners to improve
health outcomes of people with sickle cell
disease over their lifespan by promoting
guidelines for sickle cell disease screening,
prevention, and treatment, including management
of sickle cell disease complications;
``(iii) providing support to community-
based organizations and State and local health
departments in conducting sickle cell disease
education and training activities for patients,
communities, and health care providers; and
``(iv) supporting and training State health
departments and regional laboratories in
comprehensive testing to identify specific
forms of sickle cell disease in people of all
ages; and
``(C) to identify and evaluate promising strategies
for prevention and treatment of sickle cell disease
complications, including through--
``(i) improving estimates of the national
incidence and prevalence of sickle cell
disease, including estimates about the specific
types of sickle cell disease;
``(ii) identifying health disparities
related to sickle cell disease;
``(iii) assessing the utilization of
therapies and strategies to prevent
complications related to sickle cell disease;
and
``(iv) evaluating the impact of genetic,
environmental, behavioral, and other risk
factors that may affect sickle cell disease
health outcomes.
``(2) Population included.--The Secretary shall, to the
extent practicable, award grants under this subsection to
States, academic institutions, or nonprofit organizations
across the United States so as to include data on the majority
of the United States population with sickle cell disease.
``(3) Application.--To seek a grant under this subsection,
a State, academic institution, or nonprofit organization shall
submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary may
require.
``(4) Definitions.--In this subsection:
``(A) Secretary.--The term `Secretary' means the
Secretary of Health and Human Services, acting through
the Director of the National Center on Birth Defects
and Developmental Disabilities.
``(B) State.--The term `State' includes the 50
States, the District of Columbia, the Commonwealth of
Puerto Rico, the United States Virgin Islands, the
Commonwealth of the Northern Mariana Islands, American
Samoa, Guam, the Federated States of Micronesia, the
Republic of the Marshall Islands, and the Republic of
Palau.''.
SEC. 796C. SICKLE CELL DISEASE PREVENTION AND TREATMENT.
(a) Reauthorization.--Section 712(c) of the American Jobs Creation
Act of 2004 (Public Law 108-357; 42 U.S.C. 300b-1 note) is amended--
(1) by striking ``Sickle Cell Disease'' each place it
appears and inserting ``sickle cell disease'';
(2) in paragraph (1)(A), by striking ``grants to up to 40
eligible entities for each fiscal year in which the program is
conducted under this section for the purpose of developing and
establishing systemic mechanisms to improve the prevention and
treatment of Sickle Cell Disease'' and inserting ``grants to up
to 25 eligible entities for each fiscal year in which the
program is conducted under this section for the purpose of
developing and establishing systemic mechanisms to improve the
prevention and treatment of sickle cell disease in populations
with a high density of sickle cell disease patients'';
(3) in paragraph (1)(B)--
(A) by striking clause (ii) (relating to priority);
and
(B) by striking ``Grant award requirements'' and
all that follows through ``the administrator shall''
and inserting ``Geographic diversity.--The
Administrator shall'';
(4) in paragraph (2), by adding the following new
subparagraph at the end:
``(E) To expand, coordinate, and implement
transition services for adolescents with sickle cell
disease making the transition to adult health care.'';
and
(5) in paragraph (6), by striking ``$10,000,000 for each of
fiscal years 2005 through 2009'' and inserting ``$4,455,000 for
each of fiscal years 2019 through 2023''.
(b) Technical Changes.--Subsection (c) of section 712 of the
American Jobs Creation Act of 2004 (Public Law 108-357; 42 U.S.C. 300b-
1 note), as amended by subsection (a), is--
(1) transferred to the Public Health Service Act (42 U.S.C.
201 et seq.); and
(2) inserted at the end of section 399V-11 of such Act, as
added and amended by sections 796A and 796B.
SEC. 796D. COLLABORATION WITH COMMUNITY-BASED ENTITIES.
Section 399V-11 of the Public Health Service Act, as amended by
section 796C, is further amended by adding at the end the following:
``(d) Collaboration With Community-Based Entities.--To be eligible
to receive a grant or other assistance under subsection (b) or (c), an
entity must have in effect a collaborative agreement with a community-
based organization with 5 or more years of experience in providing
services to sickle cell disease patients.''.
TITLE VIII--HEALTH INFORMATION TECHNOLOGY
SEC. 800. DEFINITIONS.
In this title:
(1) Certified electronic health record technology.--The
term ``Certified Electronic Health Record Technology'' has the
meaning given to that term in section 3000 of the Public Health
Service Act (42 U.S.C. 300jj).
(2) EHR.--The term ``EHR'' means an electronic health
record.
Subtitle A--Reducing Health Disparities Through Health IT
SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR PROMOTION OF HEALTH IT.
The Secretary of Health and Human Services, acting through the
Administrator of the Health Resources and Services Administration,
shall expand and intensify the programs and activities of the
Administration (directly or through grants or contracts) to provide
technical assistance and resources to health centers (as defined in
section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a)) to
adopt and meaningfully use Certified Electronic Health Record
Technology for the management of chronic diseases and health conditions
and reduction of health disparities.
SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RACIAL AND ETHNIC
MINORITY COMMUNITIES; OUTREACH AND ADOPTION OF HEALTH IT
IN SUCH COMMUNITIES.
(a) National Coordinator for Health Information Technology.--
(1) In general.--The National Coordinator for Health
Information Technology shall conduct an evaluation of the level
of use and accessibility of electronic health records in racial
and ethnic minority communities focusing on whether patients in
those communities have providers with electronic health
records, stratified by providers participating in Medicare and
Medicaid programs, and whether such providers have received EHR
incentive payments under the HITECH Act, and by providers
participating in the Merit-Based Incentive Payment System
(MIPS) under the Quality Payment Program (QPP) established by
the Medicare Access and CHIP Reauthorization Act of 2015
(MACRA).
(2) Content.--In conducting the evaluation under paragraph
(1), the National Coordinator shall publish the results of a
study regarding the 100,000 providers recruited by the Regional
Extension Center established under section 3012 of the Public
Health Service Act (42 U.S.C. 300jj-32), including the race and
ethnicity of such providers and the populations served by such
providers, with the populations stratified by providers
participating in Medicare and Medicaid programs, and whether
such providers have received EHR incentive payments under the
HITECH Act, and by providers participating in the MIPS.
(b) National Center for Health Statistics.--As soon as practicable
after the date of enactment of this Act, the Director of the National
Center for Health Statistics shall provide to Congress a more detailed
analysis of the data presented in NCHS Data Brief No. 236, Adoption of
Certified Electronic Health Record Systems and Electronic Information
Sharing in Physician Offices: United States, 2013 and 2014 the Data
Brief 79.
(c) Centers for Medicare & Medicaid Services.--
(1) In general.--As part of the process of collecting
information, with respect to a provider, at registration and
attestation for purposes of the Medicare and Medicaid
Electronic Health Records Incentive Programs and MIPS, the
Secretary of Health and Human Services shall collect the race
and ethnicity of such provider.
(2) Medicare and medicaid electronic health records
incentive programs defined.--For purposes of paragraph (1), the
term ``Medicare and Medicaid Electronic Health Records
Incentive Programs'' means the incentive programs under section
1814(l)(3), subsections (a)(7) and (o) of section 1848,
subsections (l) and (m) of section 1853, subsections
(b)(3)(B)(ix)(I) and (n) of section 1886, and subsections
(a)(3)(F) and (t) of section 1903 of the Social Security Act
(42 U.S.C. 1395f(l)(3), 1395w-4, 1395w-23, 1395ww, and 1396b).
(d) National Coordinator's Assessment of Impact of HIT.--Section
3001(c)(6)(C) of the Public Health Service Act (42 U.S.C. 300jj-
11(c)(6)(C)) is amended--
(1) in the heading by inserting ``, racial and ethnic
minority communities,'' after ``health disparities'';
(2) by inserting ``, in communities with a high proportion
of individuals from racial and ethnic minority groups (as
defined in section 1707(g)), including people with disabilities
in these groups,'' after ``communities with health
disparities''; and
(3) by adding at the end the following new sentence: ``In
any publication under the previous sentence, the National
Coordinator shall include best practices for encouraging
partnerships between the Federal Government, States, and
private entities to expand outreach for and the adoption of
certified EHR technology in communities with a high proportion
of individuals from racial and ethnic minority groups (as so
defined), while also maintaining the accessibility requirements
of section 508 of the Rehabilitation Act to encourage patient
involvement in patient health care. The National Coordinator
shall--
``(i) not later than 6 months after the
submission to the Congress of the report
required by section 822 of the Health Equity
and Accountability Act of 2018, establish
criteria for evaluating the impact of health
information technology on communities with a
high proportion of individuals from racial and
ethnic minority groups (as so defined) taking
into account the findings in such report; and
``(ii) not later than 12 months after the
submission to the Congress of such reports,
conduct and publish the results of an
evaluation of such impact.''.
Subtitle B--Modifications To Achieve Parity in Existing Programs
SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE HEALTH IT INFRASTRUCTURE
IN RACIAL AND ETHNIC MINORITY COMMUNITIES.
Section 3011 of the Public Health Service Act (42 U.S.C. 300jj-31)
is amended--
(1) in subsection (a), by adding at the end the following
new paragraph:
``(8) Activities described in the previous paragraphs of
this subsection with respect to communities with a high
proportion of individuals from racial and ethnic minority
groups (as defined in section 1707(g)).''; and
(2) by adding at the end the following new subsection:
``(e) Annual Report on Expenditures.--The National Coordinator
shall report annually to the Congress on activities and expenditures
under this section.''.
SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DEVELOPMENT OF LOAN
PROGRAMS TO FACILITATE ADOPTION OF CERTIFIED ELECTRONIC
HEALTH RECORD TECHNOLOGY BY PROVIDERS SERVING RACIAL AND
ETHNIC MINORITY GROUPS.
Section 3014(e) of the Public Health Service Act (42 U.S.C. 300jj-
34(e)) is amended--
(1) in paragraph (3), by striking at the end ``or'';
(2) in paragraph (4), by striking the period at the end and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(5) carry out any of the activities described in a
previous paragraph of this subsection with respect to
communities with a high proportion of individuals from racial
and ethnic minority groups (as defined in section 1707(g)).''.
SEC. 813. AUTHORIZATION OF APPROPRIATIONS.
Section 3018 of the Public Health Service Act (42 U.S.C. 300jj-38)
is amended by striking ``fiscal years 2009 through 2013'' and inserting
``fiscal years 2019 through 2024''.
Subtitle C--Additional Research and Studies
SEC. 821. DATA COLLECTION AND ASSESSMENTS CONDUCTED IN COORDINATION
WITH MINORITY-SERVING INSTITUTIONS.
Section 3001(c)(6) of the Public Health Service Act (42 U.S.C.
300jj-11(c)(6)) is amended by adding at the end the following new
subparagraph:
``(F) Data collection and assessments conducted in
coordination with minority-serving institutions.--
``(i) In general.--In carrying out
subparagraph (C) with respect to communities
with a high proportion of individuals from
racial and ethnic minority groups (as defined
in section 1707(g)), the National Coordinator
shall, to the greatest extent possible,
coordinate with an entity described in clause
(ii).
``(ii) Minority-serving institutions.--For
purposes of clause (i), an entity described in
this clause is a historically Black college or
university, a Hispanic-serving institution, a
Tribal college or university, or an Asian-
American-, Native American-, Pacific Islander-
serving institution with an accredited public
health, health policy, or health services
research program.''.
SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY IN MEDICALLY
UNDERSERVED COMMUNITIES.
(a) In General.--Not later than 24 months after the date of
enactment of this Act, the Secretary of Health and Human Services
shall--
(1) enter into an agreement with the National Academies of
Sciences, Engineering, and Medicine to conduct a study on the
development, implementation, and effectiveness of health
information technology within medically underserved areas (as
described in subsection (c)); and
(2) submit a report to Congress describing the results of
such study, including any recommendations for legislative or
administrative action.
(b) Study.--The study described in subsection (a)(1) shall--
(1) identify barriers to successful implementation of
health information technology in medically underserved areas;
(2) examine the impact of health information technology on
providing quality care and reducing the cost of care to
individuals in such areas, including the impact of such
technology on improved health outcomes for individuals,
including which technology worked for which population and how
it improved health outcomes for that population;
(3) examine the impact of health information technology on
improving health care-related decisions by both patients and
providers in such areas;
(4) identify specific best practices for using health
information technology to foster the consistent provision of
physical accessibility and reasonable policy accommodations in
health care to individuals with disabilities in such areas;
(5) assess the feasibility and costs associated with the
use of health information technology in such areas;
(6) evaluate whether the adoption and use of qualified
electronic health records (as described in section 3000(13) of
the Public Health Service Act (42 U.S.C. 300jj(13)) is
effective in reducing health disparities, including analysis of
clinical quality measures reported by Medicare and Medicaid
providers pursuant to programs to encourage the adoption and
use of Certified Electronic Health Record Technology;
(7) identify providers in medically underserved areas that
are not electing to adopt and use electronic health records and
determine what barriers are preventing those providers from
adopting and using such records; and
(8) examine urban and rural community health systems and
determine the impact that health information technology may
have on the capacity of primary health providers in those
systems.
(c) Medically Underserved Area.--The term ``medically underserved
area'' means--
(1) a population that has been designated as a medically
underserved population under section 330(b)(3) of the Public
Health Service Act (42 U.S.C. 254b(b)(3));
(2) an area that has been designated as a health
professional shortage area under section 332 of the Public
Health Service Act (42 U.S.C. 254e);
(3) an area or population that has been designated as a
medically underserved community under section 799B(6) of the
Public Health Service Act (42 U.S.C. 295p(6)); or
(4) an area or population that--
(A) is not described in paragraphs (1) through (3)
of this subsection;
(B) experiences significant barriers to accessing
quality health services; and
(C) has a high prevalence of diseases or conditions
described in title VII of this Act, with such diseases
or conditions having a disproportionate impact on
racial and ethnic minority groups (as defined in
section 1707(g) of the Public Health Service Act (42
U.S.C. 300u-6(g))) or a subgroup of people with
disabilities who have specific functional impairments.
Subtitle D--Closing Gaps in Funding To Adopt Certified EHRs
SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAYMENTS TO REHABILITATION
FACILITIES, LONG-TERM CARE FACILITIES, AND HOME HEALTH
AGENCIES.
Section 1903(t)(2)(B) of the Social Security Act (42 U.S.C.
1396b(t)(2)(B)) is amended--
(1) in clause (i), by striking ``, or'' and inserting a
semicolon;
(2) in clause (ii), by striking the period at the end and
inserting a semicolon; and
(3) by inserting after clause (ii) the following new
clauses:
``(iii) a rehabilitation facility (as defined in section
1886(j)(1)) that furnishes acute or subacute rehabilitation
services;
``(iv) a long-term care hospital (as defined in section
1886(d)(1)(B)(iv)(I)); or
``(v) a home health agency (as defined in section
1861(o)).''.
SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY FOR MEDICAID
ELECTRONIC HEALTH RECORD INCENTIVE PAYMENTS.
(a) In General.--Section 1903(t)(3)(B)(v) of the Social Security
Act (42 U.S.C. 1396b(t)(3)(B)(v)) is amended to read as follows:
``(v) physician assistant.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to amounts expended under section 1903(a)(3)(F) of
the Social Security Act (42 U.S.C. 1396b(a)(3)(F)) for calendar
quarters beginning on or after the date of the enactment of this Act.
TITLE IX--ACCOUNTABILITY AND EVALUATION
SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL ASSISTED HEALTH CARE
SERVICES AND RESEARCH PROGRAMS ON THE BASIS OF SEX, RACE,
COLOR, NATIONAL ORIGIN, MARITAL STATUS, FAMILIAL STATUS,
SEXUAL ORIENTATION, GENDER IDENTITY, OR DISABILITY
STATUS.
(a) In General.--No person in the United States shall, on the basis
of sex, race, color, national origin, marital status, familial status,
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 program or activity, including any
health research program or activity, receiving Federal financial
assistance.
(b) Definition.--In this section, the term ``familial status''
means, with respect to one or more individuals--
(1) being domiciled with any individual related by blood or
affinity whose close association with the individual is the
equivalent of a family relationship;
(2) being in the process of securing legal custody of any
individual; or
(3) being pregnant.
SEC. 902. TREATMENT OF MEDICARE PAYMENTS 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, or 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. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES.
Title XXXIV of the Public Health Service Act, as amended by titles
I, II, and III of this Act, is further amended by inserting after
subtitle B the following:
``Subtitle C--Strengthening Accountability
``SEC. 3441. 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', `In
the Nation's Compelling Interest: Ensuring Diversity in the
Health Care Workforce', `The National Partnership for Action to
End Health Disparities', and `The Health of Lesbian, Gay,
Bisexual, and Transgender People', 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, gender identity, sexual
orientation, sex, disability status, socioeconomic status, 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 3442.
``(7) Ensuring--
``(A) at a minimum, compliance with the 1997 Office
of Management and Budget Standards for Maintaining,
Collecting, and Presenting Federal Data on Race and
Ethnicity; and
``(B) consideration of available data and language
standards such as--
``(i) the standards for collecting and
reporting data under section 3101; and
``(ii) the National Standards on Culturally
and Linguistically Appropriate Services of the
Office of Minority Health within the Department
of Health and Human Services.
``(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;
``(F) civil rights; and
``(G) social, behavioral, and economic determinants
of health.
``(d) Report.--Not later than December 31, 2019, and annually
thereafter, the Secretary, in collaboration with the Director of the
Office for Civil Rights and the Deputy Assistant Secretary for 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 2019 through 2024.
``SEC. 3442. 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, disability, sexual orientation, and gender
identity; and
``(2) promotes the reduction and elimination of disparities
in health and health care based on race, national origin,
language, ethnicity, sex, age, disability, sexual orientation,
and gender identity.
``(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, disability, sexual
orientation, and gender identity.
``(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 and section 1557 of the Patient Protection
and Affordable Care Act 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; compliance with, at a minimum, the
1997 Office of Management and Budget Standards for Maintaining,
Collecting, and Presenting Federal Data on Race and Ethnicity;
and consideration of available data and language standards such
as--
``(A) the standards for collecting and reporting
data under section 3101; and
``(B) the National Standards on Culturally and
Linguistically Appropriate Services of the Office of
Minority Health within the Department of Health and
Human Services.
``(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, including health service programs.''.
SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS.
(a) Coordination Within Department of Justice of Activities
Regarding Health Disparities.--Section 3(a) of the Civil Rights
Commission Act of 1983 (42 U.S.C. 1975a(a)) is amended--
(1) in paragraph (1), by striking ``and'' at the end;
(2) in paragraph (2), by striking the period at the end 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 2019, and such sums as may be necessary for
each of the fiscal years 2020 through 2024.''.
SEC. 905. 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) Lesbian, gay, bisexual, transgender, queer, and
questioning (LGBTQ) populations experience significant personal
and structural barriers to obtaining high-quality health care.
(4) Efforts to improve minority health have been limited by
inadequate resources (funding, staffing, and stewardship) and
lack of accountability.
(b) Sense of Congress.--It is the sense of Congress that--
(1) health disparities negatively impact outcomes for
health and human security of the Nation;
(2) reducing racial, ethnic, sexual, and gender disparities
in prevention and treatment are unique civil and human rights
challenges and as such Federal agencies and health care
entities and systems receiving Federal funds must be
accountable for their role in causing disparities and inequity;
(3) funding should be doubled by fiscal year 2020 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;
(4) adequate funding by fiscal year 2020, and subsequent
funding increases, should be provided for health and human
service professions training programs, the Racial and Ethnic
Approaches to Community Health (REACH) Initiative at the
Centers 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;
(5) funding should be fully restored to the Racial and
Ethnic Approaches to Community Health (REACH) Initiative at the
Centers for Disease Control and Prevention, which has been a
successful program at the community health level, and efforts
should continue to place a strong emphasis on building
community capacity to secure financial resources and technical
assistance to eliminate health disparities;
(6) adequate funding for fiscal year 2020 and increased
funding for future years should be provided for the REACH
Initiative's United States Risk Factor Survey to ensure
adequate data collection to track health disparities, and there
should be appropriate avenues provided to disseminate findings
to the general public;
(7) 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 2020; and
(8) stewardship and accountability should be provided to
the Congress and the President for measurable and sustainable
progress toward health disparity elimination.
SEC. 906. GAO AND NIH REPORTS.
(a) GAO Report on NIH Grant Racial and Ethnic Diversity.--
(1) In general.--The Comptroller General of the United
States shall conduct a study on the racial and ethnic diversity
among the following groups:
(A) All applicants for grants, contracts, and
cooperative agreements awarded by the National
Institutes of Health during the period beginning on
January 1, 2006, and ending December 31, 2017.
(B) All recipients of such grants, contracts, and
cooperative agreements.
(C) All members of the peer review panels of such
applicants and recipients, respectively.
(2) Report.--Not later than six months after the date of
the enactment of this Act, the Comptroller General shall
complete the study under paragraph (1) and submit to Congress a
report containing the results of such study.
(b) NIH Report on Certain Authority of National Institute on
Minority Health and Health Disparities.--Not later than six months
after the date of the enactment of this Act, and biennially thereafter,
the Director of the National Institutes of Health, in collaboration
with the Director of the National Institute on Minority Health and
Health Disparities, shall submit to Congress a report that details and
evaluates--
(1) the steps taken during the applicable report period by
the Director of the National Institutes of Health to enforce
the expanded planning, coordination, review, and evaluation
authority provided the National Institute on Minority Health
and Health Disparities under section 464z-3(h) of the Public
Health Service Act (42 U.S.C. 285(h)), as added by section
10334(c) of the Patient Protection and Affordable Care Act,
over all minority health and health disparity research that is
conducted or supported by the Institutes and Centers at the
National Institutes of Health; and
(2) the outcomes of such steps.
(c) GAO Report Related to Recipients of PPACA Funding.--Not later
than one year after the date of the enactment of this Act and
biennially thereafter until 2022, the Comptroller General of the United
States shall submit to Congress a report that identifies--
(1) the racial and ethnic diversity of community-based
organizations that applied for Federal enrollment funding
provided pursuant to the provisions of (and amendments made by)
the Patient Protection and Affordable Care Act;
(2) the percentage of such organizations that were awarded
such funding; and
(3) the impact of such community-based organizations'
enrollment efforts on the insurance status of their
communities.
(d) Annual Report on Activities of National Institute on Minority
Health and Health Disparities.--The Director of the National Institute
on Minority Health and Health Disparities shall prepare an annual
report on the activities carried out or to be carried out by the
Institute, and shall submit each such report to the Committee on
Health, Education, Labor, and Pensions of the Senate, the Committee on
Energy and Commerce of the House of Representatives, the Secretary of
Health and Human Services, and the Director of the National Institutes
of Health. With respect to the fiscal year involved, the report shall--
(1) describe and evaluate the progress made in health
disparities research conducted or supported by institutes and
centers of the National Institutes of Health;
(2) summarize and analyze expenditures made for activities
with respect to health disparities research conducted or
supported by the National Institutes of Health;
(3) include a separate statement applying the requirements
of paragraphs (1) and (2) specifically to minority health
disparities research; and
(4) contain such recommendations as the Director of the
Institute considers appropriate.
TITLE X--ADDRESSING SOCIAL DETERMINANTS AND IMPROVING ENVIRONMENTAL
JUSTICE
Subtitle A--In General
SEC. 1001. DEFINITIONS.
(a) Determinants of Health.--The term ``determinants of health''--
(1) refers to the range of personal, social, economic, and
environmental factors that influence health status; and
(2) includes social determinants of health (which are
sometimes referred to as ``social and economic determinants of
health'' or ``socioeconomic determinants of health''),
environmental determinants of health, and personal determinants
of health.
(b) Environmental Determinants of Health.--The term ``environmental
determinants of health'' refers to the broad physical, psychological,
social, and aesthetic environment.
(c) Personal Determinants of Health.--The term ``personal
determinants of health'' refers to an individual's behavior, biology,
and genetics.
(d) Social Determinants of Health.--The term ``social determinants
of health'' refers to a subset of determinants of the health of
individuals and environments (such as communities, neighborhoods, and
societies) that describe people's social identity, describe the social
and economic resources to which people have access, and describe the
conditions in which people work, live, and play.
SEC. 1002. FINDINGS.
The Congress finds as follows:
(1) There are more opportunities to improve health for
everyone when we understand that health starts, first, not in a
medical setting, but in our families, in our schools and
workplaces, in our neighborhoods, and in the air we breathe and
water we drink.
(2) The social determinants of health are the largest
predictors of health outcomes.
(3) Healthy People 2020 identifies health and health care
quality as a function of not only access to health care, but
also the social determinants of health, categorized into the
following: neighborhoods and the built environment; social and
community context; education; and economic stability. The
following examples illustrate the nexus between the unequal
distribution of the social determinants of health and health
disparities:
(A) The built environment influences residents'
level of physical activity. Neighborhoods with high
levels of poverty are significantly less likely to have
places where children can be physically active, such as
parks, green spaces, and bike paths and lanes.
Neighborhoods and communities can provide opportunities
for physical activity and support active lifestyles
through accessible and safe parks and open spaces and
through land use policy, zoning, and healthy community
design.
(B) Emotional and physical health and well-being
are directly impacted by perceived levels of safety,
such as unlit streets at night. Community members have
expressed that safety is not only a barrier to
accessing programs and services that increase quality
of life but they are also not able to access physical
activity in their community through the built
environment.
(C) In many workplace environments, toxic chemicals
have lasting detrimental effects on employees' health.
The hazardous compounds found in most nail salon
products affect the respiratory system, reproductive
system, and central nervous system, and also cause
kidney and liver damage. Recognizing the importance of
addressing occupational hazards as a matter of public
health, especially for Asian-American women who
constitute 40 percent of nail salon technicians--with
Vietnamese-American women accounting for 37 percent of
this--the White House Initiative on Asian American
Pacific Islanders has created an interagency working
group to coordinate efforts by the Environmental
Protection Agency, Occupational and Safety Health
Administration, Food and Drug Administration, and other
Federal agencies to create programming, draft
regulations, and conduct more outreach on educating
workers on health and safety issues.
(D) Historical and institutional discrimination
against certain racial groups in the United States has
shaped the way in which social and economic resources
and exposure to health promoting environments are
distributed. Income, education, occupation,
neighborhood conditions, schools, workplaces, the use
of and health and social services, and experiences with
the criminal justice system are all highly patterned by
race, with racial minorities (compared to Whites)
experiencing more that is health harming. Finding ways
to uncouple the link between race and access to
resources and healthy environments is a principal means
of reducing health disparities. Additionally, the
anticipation of racism itself causes higher
psychological and cardiovascular stress levels that are
linked to poor health outcomes. Remedying
discriminatory practices at the individual and systemic
levels will likely reduce health disparities caused by
this unequal distribution of stress.
(E) Poor health among Native Americans has largely
been driven by post-colonial oppression and historical
trauma. The expropriation of native lands and
territories to the American state had severe
consequences on Native American health. This resulted
in the deprivation of traditional food sources--and
nutrients--for Native Americans and also the
destruction of traditional economies and community
organization. Today, Native Americans have twice the
rate of diabetes than non-Hispanic Whites. Recognition
of the origins of the diabetes as having a social and
community context, rather than just individual
responsibility and genetic predisposition, will shape
better policy to provide food security.
(F) In the context of prisons, overcrowding has led
to the deterioration of the physical and mental health
of individuals after they leave prison. In particular,
the mass incarceration of African-American males as a
result of unequal contact with and treatment in the
criminal justice system has contributed to an
overburdening of certain infectious diseases within the
African-American community. As a social institution,
incarceration amplifies existing adverse health
conditions by concentrating diseases and harm health
behaviors such as tobacco use, drug use, and violence.
(G) Educational attainment is the strongest
predictor of adult mortality. It is a basic component
of socioeconomic status by shaping earning potential to
access resources that promote health. People with more
education are less likely to report that they are in
poor health, and are also less likely to have diabetes
and other chronic diseases.
(H) Similarly, reading ability is a strong
predictor of adult health status and is often
correlated with other child health issues, such as
developmental problems, vision and hearing impairments,
and frequent school absence due to illness.
(I) Individuals with lower levels of educational
attainment are much more likely to report to be current
smokers. In 2015, smoking prevalence was 34.1 percent
among adults with a GED diploma, 24.2 percent with less
than a high school diploma, and 19.8 percent with a
high school diploma, while dropping significantly to
7.4 percent among adults with an undergraduate college
degree and 3.6 percent with a postgraduate college
degree.
(J) Social class differences account for a large
part of health disparities. For example, children
living in poverty experience poorer housing conditions,
increased exposure to indoor allergens and toxins (such
as pesticides, lead, mercury, radon, air pollution, and
carcinogens), and more psychological stress. These
experiences culminate in worse adult health as compared
with children with higher socioeconomic status.
Specifically, children living in socioeconomic
neighborhoods have higher rates of asthma due to higher
rates of psychological stress resulting from higher
rates of violence.
(K) Lesbian, gay, bisexual, transgender, queer,
questioning, questioning and intersex (LGBTQIA)
individuals face health disparities linked to societal
stigma, discrimination, and denial of their civil and
human rights. Discrimination against LGBTQIA
individuals has been associated with high rates of
psychiatric disorders, substance abuse, and suicide.
Experiences of violence and victimization are frequent
for LGBTQIA individuals, and have long-lasting effects
on the individual and the community. Personal, family,
and social acceptance of sexual orientation and gender
identity affects the mental health and personal safety
of LGBTQIA individuals.
(L) Individuals in older and cheaper housing are at
higher risks to be exposed to lead, particularly in
housing built prior to 1960. The threat of lead
poisoning disproportionally affects vulnerable
populations, with children living in poverty (5.6
percent) and Black children (5.6) experiencing the
highest rates. According to the Department of Housing
and Urban Development, about 3.6 million homes
nationwide that house young children have lead hazards
such as peeling paint, contaminated dust, or toxic
soil. The combined cost of medical treatment and
special education for lead poisoned children averages
about $5,600 per child per year, and lead poisoning
costs the United States an estimated $50 billion
annually.
(4) Laws and regulations that improve opportunities to live
in safe neighborhoods, with more social cohesion, attain higher
education, sustain stable employment, and bridge class
differences help foster the health and safety of individuals.
(5) The global public health community has reached
consensus through the Rio Political Declaration of Social
Determinants of Health that ``[c]ollaboration in coordinated
and intersectoral policy actions has proven to be effective.
Health in All Policies, together with intersectoral cooperation
and action, is one promising approach to enhance accountability
in other sectors of health, as well as the promotion of health
equity and more inclusive and productive societies.''.
SEC. 1003. HEALTH IMPACT ASSESSMENTS.
(a) Findings.--Congress makes the following findings:
(1) Health Impact Assessment is a tool to help planners,
health officials, decisionmakers, and the public make more
informed decisions about the potential health effects of
proposed plans, policies, programs, and projects in order to
maximize health benefits and minimize harms.
(2) Health Impact Assessments can be done at a fraction of
the cost and time typically required for other planning and
permitting reviews.
(3) Health Impact Assessments can build community support
and reduce opposition to a project or policy, thereby
facilitating economic growth by aiding the development of
consensus regarding new development proposals.
(4) Health Impact Assessments facilitate collaboration
across sectors.
(b) Purposes.--It is the purpose of this section to--
(1) provide more information about the potential human
health effects of policy decisions and the distribution of
those effects;
(2) improve how health is considered in planning and
decisionmaking processes; and
(3) build stronger, healthier communities through the use
of Health Impact Assessment.
(c) Health Impact Assessments.--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:
``SEC. 399V-12. HEALTH IMPACT ASSESSMENTS.
``(a) Definitions.--In this section and section 399V-13:
``(1) Administrator.--The term `Administrator' means the
Administrator of the Environmental Protection Agency.
``(2) Built environment.--The term `built environment'
means the components of the environment, and the location of
these components in a geographically defined space, that are
created or modified by individuals to form the physical and
social characteristics of a community or enhance quality of
human life, including--
``(A) homes, schools, and places of work and
worship;
``(B) parks, recreation areas, and greenways;
``(C) transportation systems;
``(D) business, industry, and agriculture; and
``(E) land-use plans, projects, and policies that
impact the physical or social characteristics of a
community, including access to services and amenities.
``(3) Director.--The term `Director' means the Director of
the Centers for Disease Control and Prevention.
``(4) Eligible entity.--The term `eligible entity' means a
unit of State or Tribal government the jurisdiction of which
includes individuals or populations the health of which are, or
will be, affected by an activity or a proposed activity.
``(5) Eligible institution.--The term `eligible
institution' means a public agency or private nonprofit
institution that submits to the Secretary, in consultation with
the Administrator, an application for a grant authorized under
such section at such time, in such manner, and containing such
agreements, assurances, and information as the Secretary and
Administrator may require.
``(6) Health impact assessment.--The term `Health Impact
Assessment' means a systematic process that uses an array of
data sources and analytic methods and considers input from
stakeholders to determine the potential effects of a proposed
policy, plan, program, or project on the health of a population
and the distribution of those effects within the population.
Such term includes identifying and recommending appropriate
actions on monitoring and maximizing potential benefits and
minimizing the potential harms.
``(7) Health disparities.--The term `health disparities'
are a particular type of health differences that are closely
linked with social, economic, and/or environmental
disadvantage. Health disparities adversely affect groups of
people who have systematically experienced greater obstacles to
health based on their racial or ethnic group; religion;
socioeconomic status; gender; age; mental health; cognitive,
sensory, or physical disability; sexual orientation or gender
identity; geographic location; or other characteristics
historically linked to discrimination or exclusion.
``(8) Proposed activity.--The term `proposed activity'
means a proposed policy, program, plan, or project currently
under consideration by a local, State, Tribal, or Federal
agency or government.
``(b) Establishment.--The Secretary, acting through the Director
and in collaboration with the Administrator, shall carry out the
following:
``(1) Establish a program at the National Center for
Environmental Health at the Centers for Disease Control and
Prevention focused on advancing the field of Health Impact
Assessment. In developing and implementing the program, the
Director of the National Center for Environmental Health shall
consult with the Director of the National Center for Chronic
Disease Prevention and Health Promotion as well as relevant
offices within the Department of Housing and Urban Development,
the Department of Transportation, and the Department of
Agriculture. The program shall include--
``(A) collecting and disseminating best practices;
``(B) administering capacity building grants to
States to support grantees in initiating Health Impact
Assessments, in accordance with subsection (d);
``(C) providing technical assistance;
``(D) developing training tools and providing
training on conducting Health Impact Assessment and the
implementation of built environment and health
indicators;
``(E) making information available, as appropriate,
regarding the existence of other community healthy
living tools, checklists, and indices that help connect
public health to other sectors, and tools to help
examine the effect of the indoor built environment and
building codes on population health;
``(F) conducting research and evaluations of Health
Impact Assessments; and
``(G) awarding competitive extramural research
grants.
``(2) In accordance with subsection (c), develop guidance
and guidelines to conduct Health Impact Assessments.
``(3) In accordance with subsection (d), establish a grant
program to allow States to fund eligible entities to conduct
Health Impact Assessments.
``(c) Guidance.--The Director, in consultation with the Director of
the National Center for Environmental Health and, the Director of the
National Center for Chronic Disease Prevention and Health Promotion,
and relevant offices within the Department of Housing and Urban
Development, the Department of Transportation, and the Department of
Agriculture, shall--
``(1) develop guidance for conducting Health Impact
Assessment, including--
``(A) background on national and international
efforts to bridge urban planning and public health
institutions and disciplines, including a review of
Health Impact Assessment best practices
internationally;
``(B) evidence-based direct and indirect pathways
that link land-use planning, transportation, and
housing policy and objectives to human health outcomes;
``(C) data resources and quantitative and
qualitative forecasting methods to evaluate both the
status of health determinants and health effects,
including identification of existing programs that can
disseminate these resources;
``(D) best practices for inclusive public
involvement in conducting Health Impact Assessments;
and
``(E) technical assistance for other agencies
seeking to develop their own guidelines and procedures
for Health Impact Assessment;
``(2) in developing the guidance, consider available
international Health Impact Assessment guidance, North American
Health Impact Assessment Practice Standards, and
recommendations from the National Academy of Science; and
``(3) not later than 1 year after the date of enactment of
this section, publish the guidance.
``(d) Grant Program.--The Secretary, acting through the Director
and in collaboration with the Administrator, shall establish a program
under which the Secretary shall award grants to States to fund eligible
entities for capacity building or to prepare Health Impact Assessments,
and shall ensure that States receiving a grant under this subsection
further support training and technical assistance for grantees under
the program by funding and overseeing appropriate local, State, Tribal,
Federal, university, or nonprofit Health Impact Assessment experts to
provide technical assistance. Such assessments shall--
``(1) ensure that appropriate health factors are taken into
consideration as early as practicable during the planning,
review, or decisionmaking processes;
``(2) assess the effect on the health of individuals and
populations of proposed policies, projects, or plans that
result in modifications to the built environment; and
``(3) assess the distribution of health effects across
various factors, such as race, income, ethnicity, age,
disability status, gender, and geography.
``(e) Applications.--
``(1) In general.--To be eligible to receive a grant under
this section, an eligible entity shall submit to the Secretary
an application in accordance with this subsection, at such
time, in such manner, and containing such additional
information as the Secretary may require.
``(2) Inclusion.--An application under this subsection
shall include a list of proposed activities that require or
would benefit from conducting a Health Impact Assessment within
six months of awarding funds. The list should be accompanied by
supporting documentation, including letters of support, from
potential conductors of Health Impact Assessments for the
listed proposed activities. Each application should also
include an assessment by the eligible entity of the health of
the population of its jurisdiction and describe potential
adverse or positive effects on health that the proposed
activities may create.
``(3) Preference.--Preference in awarding funds under this
section may be given to eligible entities that demonstrate the
potential to significantly improve population health or lower
health care costs as a result of potential Health Impact
Assessment work.
``(f) Use of Funds.--
``(1) In general.--An eligible entity shall use amounts
provided under a grant under this section to conduct Health
Impact Assessment capacity building or to conduct or fund
subgrantees to conduct a Health Impact Assessment for a
proposed activity in accordance with this subsection.
``(2) Purposes.--The purposes of a Health Impact Assessment
under this subsection are--
``(A) to facilitate the involvement of Tribal,
State, and local public health officials in community
planning, transportation, housing, and land use
decisions and other decisions affecting the built
environment to identify any potential health concern or
health benefit relating to an activity or proposed
activity;
``(B) to provide for an investigation of any
health-related issue of concern raised in a planning
process, an environmental impact assessment process, or
policy appraisal relating to a proposed activity;
``(C) to describe and compare alternatives
(including no-action alternatives) to a proposed
activity to provide clarification with respect to the
potential health outcomes associated with the proposed
activity and, where appropriate, to the related
benefit-cost or cost-effectiveness of the proposed
activity and alternatives;
``(D) to contribute, when applicable, to the
findings of a planning process, policy appraisal, or an
environmental impact statement with respect to the
terms and conditions of implementing a proposed
activity or related mitigation recommendations, as
necessary;
``(E) to ensure that the disproportionate
distribution of negative impacts among vulnerable
populations is minimized as much as possible;
``(F) to engage affected community members and
ensure adequate opportunity for public comment on all
stages of the Health Impact Assessment;
``(G) where appropriate, to consult with local and
county health departments and appropriate
organizations, including planning, transportation, and
housing organizations and providing them with
information and tools regarding how to conduct and
integrate Health Impact Assessment into their work; and
``(H) to inspect homes, water systems, and other
elements that pose risks to lead exposure, with an
emphasis on areas that pose a higher risk to children.
``(3) Eligible activities.--
``(A) In general.--Eligible entities funded under
this subsection shall conduct an evaluation of any
proposed activity to determine whether it will have a
significant adverse or positive effect on the health of
the affected population in the jurisdiction of the
eligible entity, based on the criteria described in
subparagraph (B).
``(B) Criteria.--The criteria described in this
subparagraph include, as applicable to the proposed
activity, the following:
``(i) Any substantial adverse effect or
significant health benefit on health outcomes
or factors known to influence health, including
the following:
``(I) Physical activity.
``(II) Injury.
``(III) Mental health.
``(IV) Accessibility to health-
promoting goods and services.
``(V) Respiratory health.
``(VI) Chronic disease.
``(VII) Nutrition.
``(VIII) Land use changes that
promote local, sustainable food
sources.
``(IX) Infectious disease.
``(X) Health disparities.
``(XI) Existing air quality, ground
or surface water quality or quantity,
or noise levels.
``(XII) Lead exposure.
``(ii) Other factors that may be
considered, including--
``(I) the potential for a proposed
activity to result in systems failure
that leads to a public health
emergency;
``(II) the probability that the
proposed activity will result in a
significant increase in tourism,
economic development, or employment in
the jurisdiction of the eligible
entity;
``(III) any other significant
potential hazard or enhancement to
human health, as determined by the
eligible entity; or
``(IV) whether the evaluation of a
proposed activity would duplicate
another analysis or study being
undertaken in conjunction with the
proposed activity.
``(C) Factors for consideration.--In evaluating a
proposed activity under subparagraph (A), an eligible
entity may take into consideration any reasonable,
direct, indirect, or cumulative effect that can be
clearly related to potential health effects and that is
related to the proposed activity, including the effect
of any action that is--
``(i) included in the long-range plan
relating to the proposed activity;
``(ii) likely to be carried out in
coordination with the proposed activity;
``(iii) dependent on the occurrence of the
proposed activity; or
``(iv) likely to have a disproportionate
impact on high-risk or vulnerable populations.
``(4) Requirements.--A Health Impact Assessment prepared
with funds awarded under this subsection shall incorporate the
following, after conducting the screening phase (identifying
projects or policies for which a Health Impact Assessment would
be valuable and feasible) through the application process:
``(A) Scoping.--Identifying which health effects to
consider and the research methods to be utilized.
``(B) Assessing risks and benefits.--Assessing the
baseline health status and factors known to influence
the health status in the affected community, which may
include aggregating and synthesizing existing health
assessment evidence and data from the community.
``(C) Developing recommendations.--Suggesting
changes to proposals to promote positive or mitigate
adverse health effects.
``(D) Reporting.--Synthesizing the assessment and
recommendations and communicating the results to
decisionmakers.
``(E) Monitoring and evaluating.--Tracking the
decision and implementation effect on health
determinants and health status.
``(5) Plan.--An eligible entity that is awarded a grant
under this section shall develop and implement a plan, to be
approved by the Director, for meaningful and inclusive
stakeholder involvement in all phases of the Health Impact
Assessment. Stakeholders may include community-based
organizations, youth-serving organizations, planners, public
health experts, State and local public health departments and
officials, health care experts or officials, housing experts or
officials, and transportation experts or officials.
``(6) Submission of findings.--An eligible entity that is
awarded a grant under this section shall submit the findings of
any funded Health Impact Assessment activities to the Secretary
and make these findings publicly available.
``(7) Assessment of impacts.--An eligible entity that is
awarded a grant under this section shall ensure the assessment
of the distribution of health impacts (related to the proposed
activity) across race, ethnicity, income, age, gender,
disability status, and geography.
``(8) Conduct of assessment.--To the greatest extent
feasible, a Health Impact Assessment shall be conducted under
this section in a manner that respects the needs and timing of
the decisionmaking process it evaluates.
``(9) Methodology.--In preparing a Health Impact Assessment
under this subsection, an eligible entity or partner shall
follow the guidance published under subsection (c).
``(g) Health Impact Assessment Database.--The Secretary, acting
through the Director and in collaboration with the Administrator, shall
establish, maintain, and make publicly available a Health Impact
Assessment database, including--
``(1) a catalog of Health Impact Assessments received under
this section;
``(2) an inventory of tools used by eligible entities to
conduct Health Impact Assessments; and
``(3) guidance for eligible entities with respect to the
selection of appropriate tools described in paragraph (2).
``(h) Evaluation of Grantee Activities.--The Secretary shall award
competitive grants to Prevention Research Centers, or nonprofit
organizations or academic institutions with expertise in Health Impact
Assessments to--
``(1) assist grantees with the provision of training and
technical assistance in the conducting of Health Impact
Assessments;
``(2) evaluate the activities carried out with grants under
subsection (d); and
``(3) assist the Secretary in disseminating evidence, best
practices, and lessons learned from grantees.
``(i) Report to Congress.--Not later than 1 year after the date of
enactment of this section, the Secretary shall submit to Congress a
report concerning the evaluation of the programs under this section,
including recommendations as to how lessons learned from such programs
can be incorporated into future guidance documents developed and
provided by the Secretary and other Federal agencies, as appropriate.
``(j) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary.
``SEC. 399V-13. IMPLEMENTATION OF RESEARCH FINDINGS TO IMPROVE HEALTH
OUTCOMES THROUGH THE BUILT ENVIRONMENT.
``(a) Research Grant Program.--
``(1) Grants.--The Secretary, in collaboration with the
Administrator, shall award grants to eligible institutions to
implement evidence-based programming to improve the built
environment and subsequently human health. Factors that
influence health that may be considered include--
``(A) levels of physical activity;
``(B) consumption of nutritional foods;
``(C) rates of crime;
``(D) air, water, and soil quality;
``(E) risk or rate of injury;
``(F) accessibility to health-promoting goods and
services;
``(G) chronic disease rates;
``(H) community design;
``(I) housing; and
``(J) other indicators as determined appropriate by
the Secretary.
``(2) Research.--The Secretary, in consultation with the
Administrator, shall support research under this section that--
``(A) uses evidence-based research to improve the
built environment and human health;
``(B) examines--
``(i) the scope and intensity of the impact
that the built environment (including the
various characteristics of the built
environment) has on the human health; or
``(ii) the distribution of such impacts
by--
``(I) location; and
``(II) population subgroup;
``(C) is used to develop--
``(i) measures and indicators to address
health impacts and the connection of health to
the built environment;
``(ii) efforts to link the measures to
transportation, land use, and health databases;
and
``(iii) efforts to enhance the collection
of built environment surveillance data;
``(D) distinguishes carefully between personal
attitudes and choices and external influences on
behavior to determine how much the 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 focusing on enhancements to the
built environment that promote increased use physical
activity, access to nutritious foods, or other health-
promoting activities by residents; and
``(ii) in developing the intervention strategies
under clause (i), ensures that the intervention
strategies will reach out to high-risk or vulnerable
populations, including low-income urban and rural
communities and aging populations, in addition to the
general population.
``(3) Surveys.--The Secretary may use funds appropriated
under this section to support the expansion of national surveys
and data tracking systems to provide more detailed information
about the connection between the built environment and health.
``(4) Priority.--In providing assistance under the grant
program under this section, the Secretary and the Administrator
shall give priority to programming that incorporates--
``(A) interdisciplinary approaches; or
``(B) the expertise of the public health, physical
activity, urban planning, land use, and transportation
research communities in the United States and abroad.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section.
Not to exceed 20 percent of amounts appropriated for each fiscal year
under this subsection may be used for the research component of the
program under this section.''.
SEC. 1004. 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 help 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 timeframes 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 put into
operation environmental justice in 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.
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 paragraphs
(1), (2), and (3). Thereafter, the Administrator shall provide
semiannual 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).
(d) Federal Action Plan for Saving Lives, Protecting People and
Their Families From Radon.--
(1) In general.--Because radon is a naturally occurring
radioactive gas that is recognized as the leading cause of lung
cancer among nonsmokers and is a particular environmental
threat for low-income and minority individuals because of the
lack of information about radon levels in their own homes, the
Administrator of the Environmental Protection Agency shall
within 6 months after the date of the enactment of this Act,
implement the action plan entitled ``Protecting People and
Families from Radon: A Federal Action Plan for Saving Lives''
(June 20, 2011), working with the Secretary of Health and Human
Services acting through the Director of the Centers for Disease
Control and Prevention, and with the other Federal agencies
mentioned in and as set forth in the action plan.
(2) Specific steps.--In carrying out paragraph (1), the
Administrator shall take steps to achieve each of the
following:
(A) The recommendation that the workgroup comprised
of the Federal agencies participating in the
development of the action plan referred to in paragraph
(1) implement specific steps within the current
authority and activities of each Federal agency to
reduce exposure to radon.
(B) The recommendation that such workgroup meet on
the 1-year anniversary of the plan to assess and
recognize achievements of the plan.
(3) Report.--The Administrator shall report to the Congress
on the 1-year assessment of the plan's implementation,
including the challenges remaining and the progress in reducing
radon exposure particularly to low-income and minority
families.
(e) Federal Action Plan for Preventing Childhood Lead Poisoning.--
(1) Findings.--The Congress finds the following:
(A) The effects of lead poisoning are irreversible
and cost the United States millions annually in medical
and education costs.
(B) The cognitive effects suffered by lead exposed
children result in a lifetime of health and behavioral
problems, which makes prevention efforts more critical.
(C) The risk is especially high for vulnerable
minority populations who are more likely to live in
older homes, where lead-based paint is more likely to
be present.
(2) Action plan.--The Administrator of the Environmental
Protection Agency shall, not later than 6 months after the date
of the enactment of this Act, develop an action plan, working
with the Secretary of Health and Human Services acting through
the Director of the Centers for Disease Control and Prevention,
and other Federal agencies as necessary.
(3) Specific steps.--In carrying out paragraph (2), the
Administrator of the Environmental Protection Agency shall take
steps to achieve each of the following:
(A) The establishment of a working group, comprised
of representatives of the Federal agencies
participating in the development of the action plan
referred to in paragraph (2), to make recommendations
for implementation of specific steps within the
existing authority and activities of each Federal
agency to reduce exposure to lead.
(B) The development by Federal agencies of
materials on the hazards of lead-based paint aimed at
educating tenants and landlords, and how to both
recognize potential causes for exposure and how to
remediate them.
SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRONMENTAL HEALTH IMPROVEMENT
ACTIVITIES AND TO IMPROVE SOCIAL DETERMINANTS OF HEALTH.
(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) bears a disproportionate burden of exposure to
unhealthy living conditions, low standard housing
conditions, low socioeconomic status, poor nutrition,
less opportunity for educational attainment,
disproportionate unemployment rates, or lower literacy
levels;
(C) has established a coalition--
(i) with not less than 1 community-based
organization or demonstration program; and
(ii) with not less than 1--
(I) public health entity;
(II) health care provider
organization;
(III) academic institution,
including any minority-serving
institution (including a Hispanic-
serving institution, a historically
Black college or university, and a
Tribal college or university);
(IV) child-serving institution; or
(V) landlord or housing provider
working on lead remediation;
(D) ensures planned activities and funding streams
are coordinated to improve community health; and
(E) 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 and to improve social
determinants of health.
(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;
(2) to address environmental health disparities among all
populations, including children; and
(3) to address racial and ethnic disparities in social
determinants of health.
(e) Amount of Cooperative Agreement.--
(1) In general.--The Director shall award grants to
eligible entities at the 3 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
decisionmaking 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) geography;
(II) the built environment;
(III) air quality;
(IV) water quality;
(V) land use;
(VI) solid waste;
(VII) housing;
(VIII) crime;
(IX) socioeconomic status;
(X) ethnicity, social construct and
language preference;
(XI) educational attainment;
(XII) employment;
(XIII) food safety;
(XIV) nutrition;
(XV) health care services; and
(XVI) injuries;
(ii) building partnerships between
planning, public health, and other sectors,
including child-serving institutions, 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, musculoskeletal
diseases, respiratory conditions, dental, oral
and mental health conditions, poverty, 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, lower limb prostheses, and
hip, knee, and other joint
replacements; and
(iv) convening intervention and
demonstration programs that examine the role of
the social environment in connection with the
physical and chemical environment in--
(I) determining access to
nutritional food;
(II) improving physical activity to
reduce overweight, obesity, and co-
morbidities and increase quality of
life; and
(III) location and access to
medical facilities.
(4) Level 3 cooperative agreements.--
(A) In general.--An eligible entity awarded a grant
under this paragraph shall use the funds to identify
and address racial and ethnic disparities in social
determinants of health by creating demonstration
programs that assess the feasibility of establishing a
federally funded comprehensive program and describe key
outcomes that address racial and ethnic disparities in
social determinants of health.
(B) Program design.--
(i) Evaluation.--No later than 1 year after
enactment of this Act, the Director shall
evaluate the best practices of existing
programs from the private, public, community
based, and academically supported initiatives
focused on reducing disparities in the social
determinants of health for racial and ethnic
populations.
(ii) Demonstration projects.--Not later
than two years after the date of enactment of
this Act, the Director shall implement at least
ten demonstration projects including at least
one project for each major racial and ethnic
minority group, each of which is unique to the
cultural and linguistic needs of each of the
following groups:
(I) Native Americans and Alaska
Natives.
(II) Asian Americans.
(III) African Americans/Blacks.
(IV) Hispanic/Latino-Americans.
(V) Native Hawaiians and Pacific
Islanders.
(iii) Report to congress.--No later than 2
years after the implementation of the initial
demonstration projects, the Director shall
submit to Congress a report which includes--
(I) a description of each
demonstration project and design;
(II) an evaluation of the cost-
effectiveness of each project's
prevention and treatment efforts;
(III) an evaluation of the cultural
and linguistic appropriateness of each
project by racial and ethnic group; and
(IV) an evaluation of the
beneficiary's health status improvement
under the demonstration project.
(iv) Any other information deemed
appropriate by the director.--The Director
shall require any other information deemed
appropriate to be shared by or developed by
eligible entities awarded a grant under this
paragraph, including the following:
(I) Developing models and
evaluating methods that improve the
cultural and linguistically appropriate
services provided through the Centers
for Disease Control and Prevention to
target individuals impacted by health
disparities based on their race,
ethnicity, and gender.
(II) Promoting the collaboration
between primary and specialty care
health care providers and patients, to
ensure patients impacted by health
disparities based on race, ethnicity,
and gender are receiving comprehensive
and organized treatment and care.
(III) Educating health care
professionals on the causes and effects
of disparities in the social
determinants of health as it relates to
minority and racial and ethnic
communities and the need for culturally
and linguistically appropriate care in
the prevention and treatment of high-
impact diseases.
(IV) Encouraging collaboration
among community and patient-based
organizations which work to address
disparities in the social determinants
of health as it relates to high-impact
diseases in minority and racial and
ethnic populations.
(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section--
(1) $25,000,000 for fiscal year 2019; and
(2) such sums as may be necessary for fiscal years 2020
through 2022.
SEC. 1006. 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) degree of mobility due to factors such as
musculoskeletal diseases, arthritis, and obesity;
(C) consumption of nutritional foods;
(D) rates of crime;
(E) air, water, and soil quality;
(F) risk of injury;
(G) accessibility to health care services;
(H) levels of educational attainment; and
(I) 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 (including
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;
(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, low-income
urban and rural communities, and children.
(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, nutrition and health care (including child
health), urban planning, and transportation research
communities in the United States and abroad.
SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORATION.
(a) Findings.--
(1) General findings.--The Congress finds as follows:
(A) As human beings, we share our environment with
a wide variety of habitats and ecosystems that nurture
and sustain a diversity of species.
(B) The abundance of natural resources in our
environment forms the basis for our economy and has
greatly contributed to human development throughout
history.
(C) The accelerated pace of human development over
the last several hundred years has significantly
impacted our natural environment and its resources, the
health and diversity of plant and animal wildlife, the
availability of critical habitats, the quality of our
air and our water, and our global climate.
(D) The intervention of the Federal Government is
necessary to minimize and mitigate human impact on the
environment for the benefit of public health, to
maintain air quality and water quality, to sustain the
diversity of plants and animals, to combat global
climate change, and to protect the environment.
(E) Laws and regulations in the United States have
been created and promulgated to minimize and mitigate
human impact on the environment for the benefit of
public health, to maintain air quality and water
quality, to sustain wildlife, and to protect the
environment.
(F) Such laws include the Antiquities Act of 1906
(16 U.S.C. 431 et seq.) initiated by President Theodore
Roosevelt to create the national park system, the
National Environmental Policy Act of 1969 (42 U.S.C.
4321 et seq.), the Clean Air Act (42 U.S.C. 7401 et
seq.), the Federal Water Pollution Control Act (33
U.S.C. 1251 et seq.), the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980 (42
U.S.C. 9601 et seq.), the Endangered Species Act of
1973 (Public Law 93-205), and the National Forest
Management Act of 1976 (Public Law 94-588).
(G) Attempts to repeal or weaken key environmental
safeguards pose dangers to the public health, air
quality, water quality, wildlife, and the environment.
(2) Findings on changes and proposed changes in law.--The
Congress finds that, since 2001, the following changes and
proposed changes to existing law or regulations have negatively
impacted or will negatively impact the environment and public
health:
(A) Clean water.--
(i) On May 9, 2002, the Environmental
Protection Agency (EPA) and the Army Corps of
Engineers put forth a final rule that
reconciled regulations implementing section 404
of the Federal Water Pollution Control Act by
redefining the term ``fill material'' and
amending the definition of the term ``discharge
of fill material'', reversing a 25-year-old
regulation. The new rule fails to restrict the
dumping of hardrock mining waste, construction
debris, and other industrial wastes into
rivers, streams, lakes, and wetlands. The rule
further allows destructive mountaintop removal
coal mining companies to dump waste into
streams and lakes, polluting the surrounding
natural habitat and poisoning plants and
animals that depend on those water sources.
(ii) On February 12, 2003, the
Environmental Protection Agency published the
rule ``National Pollutant Discharge Elimination
System Permit Regulation and Effluent
Limitation Guidelines and Standards for
Concentrated Animal Feeding Operations'', new
livestock waste regulations that aimed to
control factory farm pollution but which would
severely undermine existing protections under
the Federal Water Pollution Control Act. This
regulation allows large-scale animal factories
to foul the Nation's waters with animal waste,
allows livestock owners to draft their own
pollution-management plans and avoid ground
water monitoring, legalizes the discharge of
contaminated runoff water rich in nitrogen,
phosphorus, bacteria, and metals, and ensures
that large factory farms are not held liable
for the environmental damage they cause. In a
2005 Federal court decision (``Waterkeeper
Alliance, et al. v. Environmental Protection
Agency'', 399 F.3d 486 (2nd Cir. 2005)), major
parts of the rule were upheld, others vacated,
and still others remanded back to the EPA. On
November 20, 2008, the Environmental Protection
Agency published a revised final rule which
undermines environmental protection provisions
by removing mandatory permitting requirements
and allowing large animal farms to self-certify
the absence of pollutant discharge activity.
(iii) On March 19, 2003, the Environmental
Protection Agency published a new rule
regarding the Total Maximum Daily Load program
of the Federal Water Pollution Control Act that
regulates the maximum amount of a particular
pollutant that can be present in a body of
water and still meet water quality standards.
The new rule withdrew the existing regulation
put forth on July 13, 2000, and halted momentum
in cleaning up polluted waterways throughout
the Nation. By abandoning the existing rule,
the Environmental Protection Agency is
undermining the effectiveness of cleanup plans
and is allowing States to avoid cleaning
polluted waters entirely by dropping them from
their cleanup lists. Waterways play a crucial
role in the lives of the people of the United
States and are critical to the livelihood of
fish and wildlife. The result of dropping the
July 2000 rule is that the restoration of
polluted rivers, shorelines, and lakes will be
delayed, harming more fish and wildlife and
worsening the quality of drinking water.
(iv) On December 2, 2008, the Environmental
Protection Agency and the Army Corps of
Engineers jointly issued a guidance document in
the form of a legal memorandum, titled ``Clean
Water Act Jurisdiction Following the U.S.
Supreme Court's Decision in Rapanos v. United
States & Carabell v. United States''. This new
guidance dictates enforcement actions under the
Federal Water Pollution Control Act and calls
for a complicated ``case-by-case'' analysis to
determine jurisdiction for waterways that do
not flow all year. Such actions endanger small
streams and wetlands that serve as important
habitats for aquatic life, which play a
fundamental role in safeguarding sources of
clean drinking water and mitigate the risks and
effects of floods and droughts. Further, the
definition provided therein for ``waters of the
United States'' is applicable to the Federal
Water Pollution Control Act as a whole,
potentially affecting programs that control
industrial pollution and sewage levels, prevent
oil spills, and set water quality standards for
all waters in the United States protected under
the Federal Water Pollution Control Act.
(B) Forests and land management.--
(i) On December 3, 2003, the President
signed into law the Healthy Forests Restoration
Act of 2003 (Public Law 108-148; 16 U.S.C. 6501
et seq.). Although the law attempts to reduce
the risk of catastrophic forest fires, it
provides a boon to timber companies by
accelerating the aggressive thinning of
backcountry forests that are far from at-risk
communities. The law allows for increased
logging of large, fire-resistant trees that are
not in close proximity of homes and
communities; it undermines critical protections
for endangered species by exempting Federal
land management agencies from consulting with
the United States Fish and Wildlife Service
before approving any action that could harm
endangered plants or wildlife; and it limits
public participation by reducing the number of
environmental project reviews.
(ii) On April 21, 2008, the Department of
Agriculture issued a Final Planning Rule and
Record of Decision for National Forest System
Land Management Planning. Similar to rules
enacted by the Administration on January 5,
2005, later remanded back to the agency in
Federal district court for violating the
National Environmental Policy Act of 1969, the
Endangered Species Act of 1973, and the
Administrative Procedure Act (``Citizens for
Better Forestry v. United States Department of
Agriculture'', 481 F. Supp. 2d 1059 (N.D. Cal.
2007)), this revised rule eliminates strict
forest planning standards established in 1982,
and opens millions of acres of public lands to
damaging and invasive logging, mining, and
drilling operations. These regulations would
reverse more than 20 years of protection for
wildlife and national forests by removing the
overall goal of ensuring ecological
sustainability in managing the national forest
system, weakening the National Forest
Management Act of 1976, and effectively ending
the review of forest management plans under the
National Environmental Policy Act of 1969.
(iii) On September 20, 2006, the District
Court for the Northern District of California
vacated the Protection of Inventoried Roadless
Areas rule, enacted on May 13, 2005, which gave
State Governors 18 months to petition the
Federal Government to either restore the
previous rule for their States, or submit a new
management and development plan for national
forest areas inventoried under the rule.
Despite the enjoinment of the Administration's
2005 rule, and the subsequent restoration of
the original Roadless Area Conservation Rule,
the United States Forest Service has continued
to allow States to petition for a special rule
under the authority of the Administrative
Procedure Act, publishing a final special rule
for Idaho on October 16, 2008. As a result,
58.5 million acres of wild national forests are
still vulnerable to logging, road building, and
other developments that may fragment natural
habitats and negatively impact fish and
wildlife.
(iv) On November 17, 2008, the Department
of the Interior's Bureau of Land Management
(BLM) signed the Record of Decision (ROD)
amending 12 resource management plans in
Colorado, Utah, and Wyoming, opening 2,000,000
acres of public lands to commercial tar sands
and oil shale exploration and development. On
November 18, 2008, the BLM published a final
rule for Oil Shale Management setting the
policies and procedures for a commercial
leasing program for the management of federally
owned oil shale in those three States.
Previously barred by a congressional moratorium
on the commercial leasing regulations for oil
shale until September 30, 2008, the development
of oil shale on public lands poses a serious
threat to land conservation, endangered and
threatened species, and critical habitat.
Domestic shale oil production allowed by these
regulations is highly water and energy
intensive, the impacts of which will intensify
existing water scarcity in the arid Western
Region and potentially degrade air and water
quality for surrounding populations.
(C) Scientific review.--On December 16, 2008, the
United States Fish and Wildlife Service of the
Department of the Interior and the National Oceanic and
Atmospheric Administration of the Department of
Commerce jointly issued a new rule amending regulations
governing interagency cooperation under section 7 of
the Endangered Species Act of 1973 (ESA). This rule
undermines the intention of the ESA to protect species
and the ecosystems upon which they depend by allowing
Federal agencies to carry out, permit, or fund an
action without proper environmental review and expert
third-party consultation from Federal wildlife experts.
Under this new rule, Federal agencies can unilaterally
circumvent the formal review process, eliminating
longstanding and scientifically grounded safeguards
that serve to protect the biodiversity of our Nation's
ecosystems and avert harm to thousands of endangered
and threatened species.
(b) Statement of Policy.--It is the policy of the United States
Government to work in conjunction with States, territories, Tribal
governments, international organizations, and foreign governments in
order to act as a steward of the environment for the benefit of public
health, to maintain air quality and water quality, to sustain the
diversity of plant and animal species, to combat global climate change,
and to protect the environment for future generations to enjoy.
(c) Study and Report on Public Health or Environmental Impact of
Revised Rules, Regulations, Laws, or Proposed Laws.--
(1) Study.--Not later than 30 days after the date of
enactment of this Act, the President shall enter into an
arrangement under which the National Academy of Sciences will
conduct a study to determine the impact on public health, air
quality, water quality, wildlife, and the environment of the
following regulations, laws, and proposed laws:
(A) Clean water.--
(i) Final revisions to the Federal Water
Pollution Control Act regulatory definitions of
``fill material'' and ``discharge of fill
material'', finalized and published in the
Federal Register on May 9, 2002 (67 Fed. Reg.
31129), amending part 232 of title 40, Code of
Federal Regulations.
(ii) Revised National Pollutant Discharge
Elimination System Permit Regulation and
Effluent Limitation Guidelines and Standards
for Concentrated Animal Feeding Operations in
response to the ``Waterkeeper Alliance, et al.
v. Environmental Protection Agency'' decision,
finalized and published in the Federal Register
on November 20, 2008 (73 Fed. Reg. 225),
amending parts 9, 122, and 412 of title 40,
Code of Federal Regulations.
(iii) A March 19, 2003, rule published in
the Federal Register (68 Fed. Reg. 13608)
withdrawing a July 13, 2000, rule revising the
Total Maximum Daily Load program of the Federal
Water Pollution Control Act (65 Fed. Reg.
43586), amending parts 9, 122, 123, 124, and
130 of title 40, Code of Federal Regulations.
(iv) Official Guidance Document, ``Clean
Water Act Jurisdiction Following the United
States Supreme Court's Decision in Rapanos v.
United States & Carabell v. United States'',
issued on December 2, 2008, relating to
jurisdiction under section 404 of the Federal
Water Pollution Control Act.
(B) Forests and land management.--
(i) Healthy Forests Restoration Act of
2003, signed into law on December 3, 2003
(Public Law 108-148; 16 U.S.C. 6501 et seq.).
(ii) National Forest System Land Management
Planning Rule, finalized and published in the
Federal Register on April 21, 2008 (73 Fed.
Reg. 21468), replacing the 2005 final rule (70
Fed. Reg. 1022, Jan. 5, 2005), as amended March
3, 2006 (71 Fed. Reg. 10837), and the 2000
final rule adopted on November 9, 2000 (65 Fed.
Reg. 67514), as amended on September 29, 2004
(69 Fed. Reg. 58055), amending title 36, Code
of Federal Regulations, part 219.
(iii) The application of the Administrative
Procedure Act (5 U.S.C. 551 to 559, 701 to 706,
et seq.), such that States may petition for a
special rule for the roadless areas in all or
part of said State.
(iv) Record of Decision, ``Oil Shale and
Tar Sands Resources Resource Management Plan
Amendments'', issued on November 17, 2008,
along with the Final Rule, Oil Shale
Management-General, published in the Federal
Register on November 18, 2008 (73 Fed. Reg.
223), amending title 43, Code of Federal
Regulations, parts 3900, 3910, 3920, and 3930.
(C) Scientific review.--Final Rule, Interagency
Cooperation Under the Endangered Species Act, published
in the Federal Register on December 16, 2008, amending
title 50, Code of Federal Regulations, part 402.
(2) Method.--In conducting the study under paragraph (1),
the National Academy of Sciences may utilize and compare
existing scientific studies regarding the regulations, laws,
and proposed laws listed in paragraph (1).
(3) Report.--Under the arrangement entered into under
paragraph (1), not later than 270 days after the date on which
such arrangement is entered into, the National Academy of
Sciences shall make publicly available and shall submit to the
Congress and to the head of each department and agency of the
Federal Government that issued, implements, or would implement
a regulation, law, or proposed law listed in paragraph (1), a
report containing--
(A) a description of the impact of all such
regulations, laws, and proposed laws on public health,
air quality, water quality, wildlife, and the
environment, compared to the impact of preexisting
regulations, or laws in effect, including--
(i) any negative impacts to air quality or
water quality;
(ii) any negative impacts to wildlife;
(iii) any delays in hazardous waste cleanup
that are projected to be hazardous to public
health; and
(iv) any other negative impact on public
health or the environment; and
(B) any recommendations that the National Academy
of Sciences considers appropriate to maintain, restore,
or improve in whole or in part protections for public
health, air quality, water quality, wildlife, and the
environment for each of the regulations, laws, and
proposed laws listed in paragraph (1), which may
include recommendations for the adoption of any
regulation or law in place or proposed prior to January
1, 2001.
(d) Department and Agency Revision of Existing Rules, Regulations,
or Laws.--Not later than 180 days after the date on which the report is
submitted pursuant to subsection (c)(3), the head of each department
and agency that has issued or implemented a regulation or law listed in
subsection (c)(1) shall submit to the Congress a plan describing the
steps such department or such agency will take, or has taken, to
restore or improve protections for public health and the environment in
whole or in part that were in existence prior to the issuance of such
regulation or law.
SEC. 1008. GAO REPORT ON HEALTH EFFECTS OF DEEPWATER HORIZON OIL RIG
EXPLOSION IN THE GULF COAST.
(a) Study.--The Comptroller General of the United States shall
conduct a study on the type and scope of health care services
administered through the Department of Health and Human Services
addressing the provision of health care to racial and ethnic
minorities, including residents, cleanup workers, and volunteers,
affected by the explosion of the mobile offshore drilling unit
Deepwater Horizon that occurred on April 20, 2010.
(b) Specific Components; Reporting.--In carrying out subsection
(a), the Comptroller General shall--
(1) assess the type, size, and scope of programs
administered by the Department of Health and Human Services
that focus on provision of health care to communities in the
Gulf Coast;
(2) identify the merits and disadvantages associated with
each the programs;
(3) perform an analysis of the costs and benefits of the
programs;
(4) determine whether there is any duplication of programs;
and
(5) not later than 180 days after the date of the enactment
of this Act, submit to Congress a report containing--
(A) the findings of the study conducted under this
section; and
(B) recommendations for improving access to health
care for racial and ethnic minorities.
Subtitle B--Gun Violence
SEC. 1011. FINDINGS.
Congress finds as follows:
(1) On average, 86 Americans are killed by guns each day.
(2) An estimated 15,549 people were killed by guns in 2017,
not including suicides.
(3) Gun violence disproportionately affects communities of
color, especially African Americans (who comprise around 14
percent of the United States population but account for more
than half the country's gun homicide victims).
(4) On average, there is more than one mass shooting each
day in the United States.
SEC. 1012. REAFFIRMING RESEARCH AUTHORITY OF THE CENTERS FOR DISEASE
CONTROL AND PREVENTION.
(a) In General.--Section 391 of the Public Health Service Act (42
U.S.C. 280b) is amended--
(1) in subsection (a)(1), by striking ``research relating
to the causes, mechanisms, prevention, diagnosis, treatment of
injuries, and rehabilitation from injuries;'' and inserting
``research, including data collection, relating to--
``(A) the causes, mechanisms, prevention,
diagnosis, and treatment of injuries, including with
respect to gun violence; and
``(B) rehabilitation from such injuries;''; and
(2) by adding at the end the following new subsection:
``(c) No Advocacy or Promotion of Gun Control.--Nothing in this
section shall be construed to--
``(1) authorize the Secretary to give assistance, make
grants, or enter into cooperative agreements or contracts for
the purpose of advocating or promoting gun control; or
``(2) permit a recipient of any assistance, grant,
cooperative agreement, or contract under this section to use
such assistance, grant, agreement, or contract for the purpose
of advocating or promoting gun control.''.
SEC. 1013. NATIONAL VIOLENT DEATH REPORTING SYSTEM.
The Secretary of Health and Human Services, acting through the
Director of the Centers for Disease Control and Prevention, shall
improve, particularly through the inclusion of additional States, the
National Violent Death Reporting System, as authorized by title III of
the Public Health Service Act (42 U.S.C. 241 et seq.). Participation in
the system by the States shall be voluntary.
SEC. 1014. REPORT ON EFFECTS OF GUN VIOLENCE ON PUBLIC HEALTH.
Not later than one year after the date of the enactment of this
Act, and annually thereafter, the Surgeon General of the Public Health
Service shall submit to Congress a report on the effects on public
health, including mental health, of gun violence in the United States
during the preceding year, and the status of actions taken to address
such effects.
SEC. 1015. REPORT ON EFFECTS OF GUN VIOLENCE ON MENTAL HEALTH IN
MINORITY COMMUNITIES.
Not later than one year after the date of the enactment of this
Act, the Deputy Assistant Secretary for Minority Health in the Office
of the Secretary of Health and Human Services shall submit to the
Congress a report on the effects of gun violence on public health,
including mental health, in minority communities in the United States,
and the status of actions taken to address such effects.
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