[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3660 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 3660

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           November 27, 2018

  Ms. Hirono (for herself, Ms. Duckworth, Mr. Cardin, Ms. Harris, Mr. 
 Booker, Mr. Merkley, Mr. Kaine, Mr. Blumenthal, Mrs. Gillibrand, and 
  Mr. Brown) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 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, gender identity, 
                            and socioeconomic status in collection of 
                            health data.
Sec. 109. Safety and effectiveness of drugs with respect to racial and 
                            ethnic background.
Sec. 110. Improving health data regarding Native Hawaiians and other 
                            Pacific Islanders.
Sec. 111. Clarification of simplified administrative reporting 
                            requirement.
 TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH 
                                  CARE

Sec. 201. Definitions; findings.
Sec. 202. Improving access to services for individuals with limited-
                            English proficiency.
Sec. 203. National standards for culturally and linguistically 
                            appropriate services in health care.
Sec. 204. Culturally and linguistically appropriate health care in the 
                            Public Health Service Act.
Sec. 205. Pilot program for improvement and development of State 
                            medical interpreting services.
Sec. 206. Training tomorrow's doctors for culturally and linguistically 
                            appropriate care: graduate medical 
                            education.
Sec. 207. Federal reimbursement for culturally and linguistically 
                            appropriate services under the Medicare, 
                            Medicaid, and State Children's Health 
                            Insurance Programs.
Sec. 208. Increasing understanding of and improving health literacy.
Sec. 209. Requirements for health programs or activities receiving 
                            Federal funds.
Sec. 210. Report on Federal efforts to provide culturally and 
                            linguistically appropriate health care 
                            services.
Sec. 211. English for speakers of other languages.
Sec. 212. Implementation.
Sec. 213. Language access services.
                 TITLE III--HEALTH WORKFORCE DIVERSITY

Sec. 301. Amendment to the Public Health Service Act.
Sec. 302. Hispanic-serving institutions, historically black colleges 
                            and universities, and tribal colleges.
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 title I of 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 of Secretary.
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 services furnished by certain students, interns, 
                            and residents supervised by certified nurse 
                            midwives within inpatient hospital services 
                            under Medicare.
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. Geoaccess study.
Sec. 607. Asian American, Native Hawaiian, and Pacific Islander 
                            behavioral and mental health outreach and 
                            education strategies.
Sec. 608. Mental health in schools.
          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 EHR 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 United States will face a shortage of 
        health care providers and allied health workers. This shortage 
        will disproportionately affect 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, which are 2 strategic plans that 
        represent the first coordinated roadmap in the United States to 
        reducing health disparities. These comprehensive plans, along 
        with the National Prevention Strategy issued by the National 
        Prevention Council of the Department of Health and Human 
        Services, Healthy People 2020, and the National Quality 
        Strategy of the Agency for Healthcare Research and Quality, as 
        well as critical resources such as the 2012 National Healthcare 
        Quality and Disparities Reports, will work to increase the 
        number of people in the United States who are healthy at every 
        stage of life.
            (9) The Secretary of Health and Human Services has also 
        reviewed and advanced updated clinical guidelines and developed 
        other strategic planning documents to combat health disparities 
        with a high impact on minority populations and to provide high-
        quality family planning services. Such guidelines and documents 
        include the National HIV/AIDS Strategy, the Action Plan for the 
        Prevention, Care, and Treatment of Viral Hepatitis, and 
        recommendations of the Centers for Disease Control and 
        Prevention and the Office of Population Affairs.
            (10) The Patient Protection and Affordable Care Act (Public 
        Law 111-148), as amended by the Health Care and Education 
        Reconciliation Act (Public Law 111-152), represents the biggest 
        advancement for minority health in the 40 years immediately 
        preceding the enactment of this Act.

                 TITLE I--DATA COLLECTION AND REPORTING

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

    (a) Purpose.--It is the purpose of the amendment made by 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 B the following:

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

``SEC. 3431. HEALTH DISPARITY DATA.

    ``(a) Requirements.--
            ``(1) In general.--Each health-related program 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, including--
                            ``(i) using, at a minimum, standards for 
                        data collection on race, ethnicity, sex, 
                        primary language, sexual orientation, gender 
                        identity, socioeconomic status, and disability 
                        status as each are 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) using, where practicable, the 
                        standards developed by the Health and Medicine 
                        Division of the National Academies of Sciences, 
                        Engineering, and Medicine (formerly known as 
                        the `Institute of Medicine') in the 2009 
                        publication, entitled `Race, Ethnicity, and 
                        Language Data: Standardization for Health Care 
                        Quality Improvement'; and
                            ``(iv) where practicable, collecting such 
                        data 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 any requirements, including such 
                requirements in effect on or after the date of 
                enactment of this section, 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 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 and linguistically appropriate 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, sex, 
        primary language, sexual orientation, gender identity, 
        socioeconomic status, and disability 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 Health Information 
        Technology for Economic and Clinical Health Act for the 
        collection and meaningful use of electronic health data on 
        race, ethnicity, sex, primary language, sexual orientation, 
        gender identity, socioeconomic status, and disability 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, sex, sexual orientation, gender 
        identity, socioeconomic status data, and disability status 
        data, subject to all applicable privacy and confidentiality 
        requirements, including HIPAA privacy and security law as 
        defined in section 3009; 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, the 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 programs conducted or supported by such 
agencies 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) Definitions.--In this section--
            ``(1) the term `health-related program' means a program 
        that is operated by the Secretary, or that receives funding or 
        reimbursement, in whole or in part, either directly or 
        indirectly from the Secretary--
                    ``(A) for activities under the Social Security Act 
                for health care services; or
                    ``(B) for providing federal financial assistance 
                for health care, biomedical research, or health 
                services research or for otherwise improving the health 
                of the public;
            ``(2) the term `primary language data' includes spoken and 
        written primary language data; and
            ``(3) the term `primary language data collection 
        activities' includes identifying, collecting, storing, 
        tracking, and analyzing primary language data and information 
        on the methods used to meet the language access needs of 
        individuals with limited-English proficiency.
    ``(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 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.--A grant provided under this section may 
be used to--
            ``(1) enhance or upgrade computer technology that will 
        facilitate collection, analysis, and reporting of racial, 
        ethnic, primary language, sexual orientation, sex, gender 
        identity, socioeconomic status, and disability status data;
            ``(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 any applicable 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, sex, gender identity, 
        disability status, 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, 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 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.--
            ``(1) In general.--The Commissioner of Social Security, in 
        consultation with the Administrator of the Centers for Medicare 
        & Medicaid Services, shall collect 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.
            ``(2) Data collection standards.--In collecting data under 
        paragraph (1), the Commissioner of Social Security shall use 
        standards for data collection on race, ethnicity, primary 
        language, and disability status developed under section 3101 of 
        the Public Health Service Act and, where practicable, the 
        standards developed by the Institute of Medicine in `Race, 
        Ethnicity, and Language Data: Standardization for Health Care 
        Quality Improvement' (released August 31, 2009).
            ``(3) Data for additional population groups.--Where 
        practicable, the information collected by the Commissioner of 
        Social Security under paragraph (1) shall include data for 
        additional population groups if such groups can be aggregated 
        into the race and ethnicity categories outlined by the data 
        collection standards described in paragraph (2).
            ``(4) Collection of data for minors and legally 
        incapacitated individuals.--With respect to the collection of 
        the data described in paragraph (1) of applicants who are under 
        18 years of age or otherwise legally incapacitated, the 
        Commissioner of Social Security shall 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.
            ``(5) Additional requirements.--With respect to data 
        collected under paragraph (1), the Commissioner of Social 
        Security shall--
                    ``(A) require that such data be uniformly analyzed 
                and that such analysis be reported at least annually to 
                the Commissioner;
                    ``(B) be responsible for storing the data reported 
                under subparagraph (A);
                    ``(C) ensure transmission to the Centers for 
                Medicare & Medicaid Services and other agencies within 
                the Department of Health and Human Services, as 
                determined appropriate by the Secretary;
                    ``(D) provide such data to the Secretary on at 
                least an annual basis; and
                    ``(E) ensure that the provision of assistance or 
                benefits 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) is protected--
            ``(1) under the same privacy protections as the Secretary 
        applies to health data under the regulations promulgated under 
        section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (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 entity 
to comply with the requirements of this section or with regulations 
implementing 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, gender identity, and socioeconomic status 
        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 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 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) Repository of Government Data.--The Secretary of Health and 
Human Services, in coordination with the departments, agencies, or 
offices described in subsection (b), shall establish a centralized 
electronic repository of Government data on factors related to the 
health and well-being of the population of the United States.
    (b) 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 the 
repository of Government data established under subsection (a).
    (c) Analysis; Public Availability; Reporting.--Not later than April 
30, 2019, and April 30 of each year 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 datasets are publicly identified on 
        the repository established under subsection (a) 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 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 access and analyze 
racial and ethnic data on disparities in health and health care, and 
where possible other data on disparities in health and health care, 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 an entity that has an accredited public health, health policy, or 
health services research program and is any of the following:
            (1) A part B institution, as defined in section 322 of the 
        Higher Education Act of 1965 (20 U.S.C. 1061).
            (2) A Hispanic-serving institution, as defined in section 
        502 of such Act (20 U.S.C. 1101a).
            (3) A Tribal College or University, as defined in section 
        316 of such Act (20 U.S.C. 1059c).
            (4) An Asian American and Native American Pacific Islander-
        serving institution, as defined in section 371(c) of such Act 
        (20 U.S.C. 1067q(c)).
    (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, GENDER IDENTITY, 
              AND SOCIOECONOMIC STATUS 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, socioeconomic status,'' before ``and 
        disability status'';
            (2) in paragraph (1)(C), by inserting ``sexual orientation, 
        gender identity, socioeconomic status,'' before ``and 
        disability status''; and
            (3) in paragraph (2)(B), by inserting ``sexual orientation, 
        gender identity, socioeconomic status,'' before ``and 
        disability status''.

SEC. 109. 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 or biological product, then--
            ``(1)(A) in the case of a drug, the investigations required 
        under section 505(b)(1)(A) shall include adequate and well-
        controlled investigations of the disparity; or
            ``(B) in the case of a biological product, the evidence 
        required under section 351(a) of the Public Health Service Act 
        for approval of a biologics license application for the 
        biological product shall include adequate and well-controlled 
        investigations of the disparity; and
            ``(2) if the investigations described in subparagraph (A) 
        or (B) of paragraph (1) confirm that there is such a disparity, 
        the labeling of the drug or biological product 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 of this Act or of a 
        biological product for which there is an approved 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, 
        postmarket 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 or biological 
        product shall include appropriate information about the 
        disparity.
            ``(3) Study design.--The Secretary may, in an order under 
        paragraph (1), specify all aspects of the design of the 
        postmarket studies required under such paragraph for a drug or 
        biological product, including the number of studies and study 
        participants, and the other demographic characteristics of the 
        study participants.
            ``(4) Modifications of study design.--The Secretary may, by 
        order and as necessary, modify any aspect of the design of a 
        postmarket study required in an order under paragraph (1) after 
        issuing such order.
            ``(5) Study results.--The results from a study required 
        under paragraph (1) shall be submitted to the Secretary as a 
        supplement to the drug application or biologics license 
        application.
    ``(c) Applications Under Section 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 section 505(j)(5)(F).
            ``(2) Labeling.--Notwithstanding paragraph (1), 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.
    ``(d) Definition.--The term `evidence that there may be a disparity 
on the basis of racial or ethnic background as to the safety or 
effectiveness', with respect to a drug or biological product, 
includes--
            ``(1) evidence that there is a disparity on the basis of 
        racial or ethnic background as to safety or effectiveness of a 
        drug or biological product in the same chemical class as the 
        drug or biological product;
            ``(2) evidence that there is a disparity on the basis of 
        racial or ethnic background in the way the drug or biological 
        product is metabolized; and
            ``(3) other evidence as the Secretary may determine 
        appropriate.''.
    (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(a)(1)(A)(ii)) is amended by inserting 
after ``are not required'' the following: ``, including postmarket 
studies required under section 505G''.

SEC. 110. 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 317T the following:

``SEC. 317U. 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 of nhopi populations.--The 
        term `government representatives of NHOPI populations' 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 Health and Medicine Division.--
            ``(1) In general.--The Secretary shall enter into an 
        agreement with the Health and Medicine Division of the National 
        Academies of Sciences, Engineering, and Medicine to conduct a 
        study, with input from stakeholders in insular areas, on each 
        of 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 
                appropriate.
                    ``(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 
                that are set forth in the 1998 report entitled `Pacific 
                Partnerships for Health: Charting a New Course'.
            ``(2) Report.--An agreement described in paragraph (1) 
        shall require the Health and Medicine Division 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 Health and Medicine 
        Division 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. 111. 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.--
        With respect to any obligation of a State agency to comply with 
        the notification requirement under paragraph (2) of section 
        421(e) of the Personal Responsibility and Work Opportunity 
        Reconciliation Act of 1996 (8 U.S.C. 1631(e)), notwithstanding 
        the requirement to include in that notification the names of 
        the sponsor and the sponsored alien involved, the State agency 
        shall be considered to have complied with the notification 
        requirement if the State agency submits to the Attorney General 
        a report that includes the aggregate number of exceptions 
        granted by the State agency under paragraph (1) of that 
        section.''.

 TITLE II--CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH AND HEALTH 
                                  CARE

SEC. 201. DEFINITIONS; FINDINGS.

    (a) Definitions.--In this title, the definitions in section 3400 of 
the Public Health Service Act, as added by section 204, shall apply.
    (b) 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 individuals with limited-English 
        proficiency 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 
        individuals with limited-English proficiency and individuals 
        with communication disabilities such as hearing, vision, or 
        print impairments is a societal one that cannot fairly be 
        placed solely upon the health care, public health, or social 
        services community.
            (5) Title VI of the Civil Rights Act of 1964 (42 U.S.C. 
        2000d et seq.) 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 Federal Government must take adequate steps 
        to ensure that their policies and procedures do not deny or 
        have the effect of denying individuals with limited-English 
        proficiency with equal access to benefits and services for 
        which such persons qualify.
            (6) Both the Americans with Disabilities Act of 1990 (42 
        U.S.C. 12101 et seq.) and the Rehabilitation Act of 1973 (29 
        U.S.C. 701 et seq.) 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 individuals with limited-
        English proficiency 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.

SEC. 202. IMPROVING ACCESS TO SERVICES FOR INDIVIDUALS WITH LIMITED-
              ENGLISH PROFICIENCY.

    (a) Purpose.--Consistent with the goals provided in Executive Order 
13166 (42 U.S.C. 2000d-1 note; relating to improving access to services 
for persons with limited-English proficiency), 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 with limited-English proficiency;
            (2) to require each Federal agency to examine the services 
        it provides and develop and implement a system by which 
        individuals with limited-English proficiency 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 applicants and 
        beneficiaries that are individuals with limited-English 
        proficiency;
            (4) to ensure that recipients of Federal financial 
        assistance take reasonable steps, consistent with the 
        guidelines set forth in the ``Guidance to Federal Financial 
        Assistance Recipients Regarding Title VI Prohibition Against 
        National Origin Discrimination Affecting Limited English 
        Proficient Persons (67 Fed. Reg. 41455 (June 18, 2002))'', to 
        ensure culturally and linguistically appropriate access to 
        their programs and activities by individuals with limited-
        English proficiency; and
            (5) to ensure compliance with title VI of the Civil Rights 
        Act of 1964 (42 U.S.C. 2000d et seq.) 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 Act, each Federal agency providing financial 
        assistance to, or administering, a health program or activity 
        described in section 203(a) shall prepare a plan to improve 
        culturally and linguistically appropriate access to such 
        program or activity with respect to individuals with limited-
        English proficiency. Not later than 1 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 
                individuals with limited-English proficiency have 
                access to each health program or activity supported or 
                administered by the agency;
                    (B) the policies and procedures for identifying, 
                assessing, and meeting the culturally and 
                linguistically appropriate language needs of its 
                beneficiaries that are individuals with limited-English 
                proficiency served by such program or activity;
                    (C) the steps the agency will take for such program 
                or activity to be culturally and linguistically 
                appropriate by providing a range of language assistance 
                options, notice to individuals with limited-English 
                proficiency 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 
                such program or activity are competently translated 
                into the primary language of a client that is an 
                individual with limited-English proficiency where such 
                materials are needed to improve access of such client 
                to such program or activity;
                    (E) the resources the agency will provide to 
                improve cultural and linguistic appropriateness to 
                assist recipients of Federal funds to improve access to 
                health care related programs and activities for 
                individuals with limited-English proficiency;
                    (F) the resources the agency will provide to ensure 
                that competent language assistance is provided to 
                patients that are individuals with limited-English 
                proficiency 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 
                as permitted under regulations implementing section 
                1557 of the Patient Protection and Affordable Care Act 
                (42 U.S.C. 18116).
            (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 Attorney General, which shall serve as 
        the central repository of all such plans.
            (4) Rule of construction.--Paragraph (2)(G) 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. 203. NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE SERVICES IN HEALTH CARE.

    (a) Applicability.--This section shall apply 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 (42 U.S.C. 18116(a)).
    (b) Standards.--Each program or activity 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 program or activity;
            (2) shall educate and train governance, leadership, and 
        workforce at all levels and across all disciplines of the 
        program or activity 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 with limited-English proficiency or who have other 
        communication needs, at no cost to the individual at all points 
        of contact, and during all hours of operation, to facilitate 
        timely access to health care services and health-care-related 
        services;
            (4) shall for each language group consisting of individuals 
        with limited-English proficiency 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 program or activity, 
        make available--
                    (A) easily understood patient-related materials, 
                including print and multimedia materials, in the 
                language of such language group;
                    (B) information or notices about termination of 
                benefits in such language; and
                    (C) signage;
            (5) 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 planning 
        and operations of the program or activity;
            (6) 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 program or 
        activity and develop ways to standardize the assessments;
            (7) 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 (42 U.S.C. 1320-2 note), 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 management information 
                systems of the program or activity; and
                    (C) periodically updated;
            (8) 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 of such assessments to accurately plan for and 
        implement services that respond to the cultural and linguistic 
        characteristics of the service area of the program or activity;
            (9) 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;
            (10) shall ensure that conflict and grievance resolution 
        processes are culturally and linguistically appropriate and 
        capable of identifying, preventing, and resolving cross-
        cultural conflicts or complaints by patients;
            (11) 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
            (12) shall, if requested, regularly make available to the 
        head of each Federal entity from which Federal funds are 
        provided, information about the progress and successful 
        innovations of the program or activity in implementing the 
        standards under this section as required by the head of such 
        entity.
    (c) Comments Accepted Through Notice and Comment Rulemaking.--An 
agency carrying out a program described in subsection (a) shall ensure 
that comments with respect to such program that are accepted through 
notice and comment rulemaking be accepted in all languages and may not 
require such comments to be submitted only in English.

SEC. 204. CULTURALLY AND LINGUISTICALLY APPROPRIATE HEALTH CARE IN THE 
              PUBLIC HEALTH SERVICE ACT.

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

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

``SEC. 3400. DEFINITIONS.

    ``(a) In General.--In this title:
            ``(1) Bilingual.--The term `bilingual', with respect to an 
        individual, means a person who has sufficient degree of 
        proficiency in 2 languages.
            ``(2) Cultural.--The term `cultural' means relating 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.
            ``(3) Culturally and linguistically appropriate.--The term 
        `culturally and linguistically appropriate' means being 
        respectful of and responsive to the cultural and linguistic 
        needs of all individuals.
            ``(4) Effective communication.--The term `effective 
        communication' means an exchange of information between the 
        provider of health care or health-care-related services and the 
        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 to, understanding of, and benefit from health care or 
        health-care-related services, and full participation in the 
        development of their treatment plan.
            ``(5) Grievance resolution process.--The term `grievance 
        resolution process' means all aspects of dispute resolution 
        including filing complaints, grievance and appeal procedures, 
        and court action.
            ``(6) Health care group.--The term `health care group' 
        means a group of physicians organized, at least in part, for 
        the purposes of providing physician services under the Medicaid 
        program under title XIX of the Social Security Act, the State 
        Children's Health Insurance Program under title XXI of such 
        Act, or the Medicare program under title XVIII of such Act and 
        may include a hospital and any other individual or entity 
        furnishing services covered under any such program that is 
        affiliated with the health care group.
            ``(7) Health care services.--The term `health care 
        services' means services that address physical as well as 
        mental health conditions in all care settings.
            ``(8) Health-care-related services.--The term `health-care-
        related services' means human or social services programs or 
        activities that provide access, referrals, or links to health 
        care.
            ``(9) Health educator.--The term `health educator' includes 
        a professional with a baccalaureate degree who is responsible 
        for designing, implementing, and evaluating individual and 
        population health promotion and chronic disease prevention 
        programs.
            ``(10) Indian; indian tribe.--The terms `Indian' and 
        `Indian Tribe' have the meanings given such terms in section 4 
        of the Indian Self-Determination and Education Assistance Act.
            ``(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.
            ``(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) 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 disorder, and 
        related disciplines to improve the health outcomes of an 
        individual. Such providers may include hospitals, health, 
        mental health, or substance use disorder clinics and providers, 
        home health agencies, ambulatory surgery centers, skilled 
        nursing facilities, rehabilitation centers, and employed, 
        independent, or contracted physicians.
            ``(14) 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.
            ``(15) 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 services or 
        health-care-related services.
            ``(16) 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.
            ``(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) 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 services or health-
        care-related services and the recipient of such services who is 
        limited in English proficiency or has a communication 
        impairment such as an impairment in hearing, vision, or 
        learning.
            ``(20) 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.
            ``(21) 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.
            ``(22) Racial and ethnic minority group.--The term `racial 
        and ethnic minority group' means 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.
            ``(23) 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.
            ``(24) 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.
            ``(25) State.--Notwithstanding section 2, the term `State' 
        means each of the several States, the District of Columbia, the 
        Commonwealth of Puerto Rico, the United States Virgin Islands, 
        Guam, American Samoa, and the Commonwealth of the Northern 
        Mariana Islands.
            ``(26) Telephonic interpretation.--The term `telephonic 
        interpretation' (also known as `over the phone interpretation' 
        or `OPI') means, with respect to interpretation for an 
        individual with limited-English proficiency, a method of 
        interpretation in which the interpreter is not in the physical 
        presence of the provider of health care services or health-
        care-related services and such individual receiving such 
        services, but the interpreter is connected via telephone.
            ``(27) 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.
            ``(28) Video remote interpreting services.--The term `video 
        remote interpreting services' means the provision, in health 
        care services or health-care-related services, through a 
        qualified interpreter for an individual with limited-English 
        proficiency, of video remote interpreting services that are--
                    ``(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.
            ``(29) Vital document.--The term `vital document' includes 
        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 individuals with 
        limited-English proficiency with communication disabilities of 
        the availability of free language services, alternative 
        formats, and other outreach materials.
    ``(b) Reference.--In any reference in this title to a regulatory 
provision applicable to a `handicapped individual', the term 
`handicapped individual' in such provision shall have the same meaning 
as the term `individual with a disability' as defined in subsection 
(a).

       ``Subtitle A--Resources and Innovation for Culturally and 
                 Linguistically Appropriate Health Care

``SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY AND LINGUISTICALLY 
              APPROPRIATE 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 
Culturally and Linguistically Appropriate Health Care' (referred to in 
this section as the `Center') to carry out each of 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) Vital documents.--The Center shall provide, 
                directly or through contract, vital documents from 
                competent translation services for providers of health 
                care services and health-care-related services at no 
                cost to such providers. Such documents may be submitted 
                for translation into non-English languages. Such 
                translation services shall be provided in a timely and 
                reasonable manner. The quality of such translation 
                services shall be monitored and reported publicly.
                    ``(B) Forms.--For each form developed or revised by 
                the Secretary that will be used by individuals with 
                limited-English proficiency 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 shall 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 individuals with limited-English proficiency--
                    ``(A) to obtain information about federally 
                conducted or funded health programs, including the 
                Medicare program under title XVIII of the Social 
                Security Act, the Medicaid program under title XIX of 
                such Act, and the State Children's Health Insurance 
                Program under title XXI of such Act;
                    ``(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 services and health-care-related services to 
                reduce medical errors, improve medical outcomes, 
                improve cultural competence, reduce health care costs 
                caused by miscommunication with individuals with 
                limited-English proficiency, and reduce or eliminate 
                the duplication of efforts to translate materials. The 
                clearinghouse shall include the information described 
                in subparagraphs (B) through (F) and make such 
                information available on the internet and in print.
                    ``(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 templates 
                for each of the following:
                            ``(i) Administrative and legal documents, 
                        including--
                                    ``(I) intake forms;
                                    ``(II) forms related to the 
                                Medicare program under title XVIII of 
                                the Social Security Act, the Medicaid 
                                program under title XIX of such Act, 
                                and the State Children's Health 
                                Insurance Program under title XXI of 
                                such Act, including eligibility 
                                information for such programs;
                                    ``(III) forms informing patients of 
                                the compliance and consent requirements 
                                pursuant to the regulations under 
                                section 264(c) of the Health Insurance 
                                Portability and Accountability Act of 
                                1996 (42 U.S.C. 1320-2 note); 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 and linguistically appropriate;
                            ``(ii) allow public review of the documents 
                        before dissemination in order to ensure that 
                        the documents are understandable and culturally 
                        and linguistically 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 individuals with limited-English proficiency, 
                including case studies using de-identified patient 
                information, program summaries, and program 
                evaluations.
                    ``(E) Culturally and linguistically appropriate 
                materials.--The Center shall provide information 
                relating to culturally and linguistically appropriate 
                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 appropriate care;
                            ``(ii) culturally and linguistically 
                        appropriate self-assessment tools;
                            ``(iii) culturally and linguistically 
                        appropriate training tools;
                            ``(iv) strategic plans to increase cultural 
                        and linguistic appropriateness in different 
                        types of providers of health care services and 
                        health-care-related services, including 
                        regional collaborations among health care 
                        organizations; and
                            ``(v) culturally and linguistically 
                        appropriate 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 3402 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, 
individuals with limited-English proficiency, 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.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2019 through 2023.

``SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUISTICALLY APPROPRIATE 
              HEALTH CARE GRANTS.

    ``(a) In General.--
            ``(1) Grants.--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 culturally and linguistically appropriate access to 
        health care services for individuals with limited-English 
        proficiency.
            ``(2) Coordination.--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 National 
        Institute 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, 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 disorder 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) any other entity designated by the Secretary; 
                and
            ``(2) prepare and submit to the Secretary an application, 
        at such time, in such manner, and containing such additional 
        information as the Secretary may reasonably require.
    ``(c) Use of Funds.--An entity shall use funds received through a 
grant under this section to--
            ``(1) develop, implement, and evaluate models of providing 
        competent interpretation services through onsite 
        interpretation, telephonic interpretation, or video remote 
        interpreting services;
            ``(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 entity;
            ``(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 the service area of 
        the entity;
            ``(4) develop a strategic plan to implement language 
        services;
            ``(5) develop participatory, collaborative partnerships 
        with communities encompassing the patient populations of 
        individuals with limited-English proficiency served by the 
        grant to gain input in designing and implementing language 
        services;
            ``(6) develop and implement grievance resolution processes 
        that are culturally and linguistically appropriate and capable 
        of identifying, preventing, and resolving complaints by 
        individuals with limited-English proficiency;
            ``(7) develop short-term medical and mental health 
        interpretation training courses and incentives for bilingual 
        health care staff who are asked to provide interpretation 
        services 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 and linguistically 
        appropriate 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 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 
        care services 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 Culturally 
        and Linguistically Appropriate Health Care established under 
        section 3401. 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. 3403. 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 services.
    ``(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 
conduct such research.
    ``(c) Use of Funds.--Research conducted 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 individuals with limited-English 
        proficiency.
            ``(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 
        individuals with limited-English proficiency.
            ``(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 
                services 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 
        Secretary can create or coordinate, and subsidize or otherwise 
        fund, telephonic interpretation services 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. 205. PILOT PROGRAM FOR IMPROVEMENT AND DEVELOPMENT OF STATE 
              MEDICAL INTERPRETING SERVICES.

    (a) Grants Authorized.--The Secretary shall award 1 grant in 
accordance with this section to each of 3 States (to be selected by the 
Secretary) to assist each such State in designing, implementing, and 
evaluating a statewide program to provide onsite interpreter services 
under the State Medicaid plan.
    (b) Grant Period.--A grant awarded under this section is authorized 
for the period of 3 fiscal years beginning on October 1, 2019, and 
ending on September 30, 2022.
    (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 
        individuals with limited-English proficiency, 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 Medicaid plan 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 Medicaid plan; 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 individuals with limited-English 
                        proficiency seeking to enroll in the State 
                        Medicaid plan;
                            (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 Medicaid plan.
            (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 Medicaid plan.
            (3) A description of how the program will be evaluated, 
        including a proposal for collaboration with organizations 
        representing interpreters, consumers, and individuals with 
        limited-English proficiency.
    (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 Medicaid plan.
            (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) State medicaid plan.--The term ``State Medicaid plan'' 
        means a State plan under title XIX of the Social Security Act 
        (42 U.S.C. 1396 et seq.) or a waiver of such a plan.
            (4) 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.--Amounts appropriated pursuant 
        to the authorization in paragraph (1) are authorized to remain 
        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)) is amended by inserting ``(or, in the case of a 
        State that was awarded a grant under section 203 of the Health 
        Equity and Accountability Act of 2018, 100 percent for each 
        quarter occurring during the grant period specified in 
        subsection (b) of such section)'' after ``75 percent''.
    (h) Limitation.--No Federal funds awarded under this section may be 
used to provide interpreter services from a location outside the United 
States.

SEC. 206. 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 and linguistically 
                appropriate 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 
                culturally 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. 207. 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 section 1115A(c) of the Social Security Act 
                (42 U.S.C. 1315a(c)).
                    (D) Recommendations, if any, regarding the 
                extension of such project to the entire Medicare 
                Program, subject to the provisions of such section 
                1115A(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 Assistance 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 
        (jjj)(1),''; and
                    (B) by adding at the end the following new 
                subsection:

            ``Language Assistance Services and Related Terms

    ``(jjj)(1) The term `language assistance services' means `language 
access' or `language assistance services' (as those terms are defined 
in section 3400 of the Public Health Service Act) furnished by a 
`qualified interpreter for an individual with limited-English 
proficiency' or a `qualified translator' (as those terms are defined in 
such section 3400) to an `individual with limited English proficiency' 
(as defined in such section 3400) or an `English learner' (as defined 
in paragraph (2)).
    ``(2) The term `English learner' has the meaning given that 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 assistance services (as defined in 
                section 1861(jjj)(1)).''.
            (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 assistance services (as 
        defined in section 1861(jjj)(1)), 100 percent of the reasonable 
        charges for such services, as determined in consultation with 
        the Medicare Payment Advisory Commission.''.
            (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 assistance services (as defined in 
        section 1861(jjj)(1) of such Act).
    (c) Medicare Parts C and D.--
            (1) In general.--Medicare Advantage plans under part C of 
        title XVIII of the Social Security Act and prescription drug 
        plans under part D of such title shall comply with title VI of 
        the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 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 internal 
        policies and procedures of the organization (or sponsor) 
        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 language services programs 
                and services offered by the organization (or sponsor) 
                with respect to the 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 enrollee population.
                    ``(E) The periodic provision of educational 
                information to plan enrollees on the language services 
                and programs offered by the organization (or 
                sponsor).''.
    (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)), as amended by 
        section 203(g)(3), is further amended by--
                    (A) striking ``75'' and inserting ``90'';
                    (B) striking ``translation or interpretation 
                services'' and inserting ``language assistance 
                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 assistance services, as such term is 
        defined in section 1861(jjj)(1), provided in a timely manner to 
        individuals with limited-English proficiency as defined in 
        section 3400 of the Public Health Service Act; and''.
            (4) Use of deductions and cost sharing.--Section 1916(a)(2) 
        of the Social Security Act (42 U.S.C. 1396o(a)(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 assistance 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 assistance services.--The child health 
        assistance provided to a targeted low-income child shall 
        include coverage of language assistance services, as such term 
        is defined in section 1861(jjj)(1), provided in a timely manner 
        to individuals with limited-English proficiency (as defined in 
        section 3400 of the Public Health Service Act).''; 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(a)(27)) is amended by striking ``translation'' and 
        inserting ``language assistance 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 (42 U.S.C. 1397aa et seq.); 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) 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 Assistance 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 (referred to in 
                this subsection as the ``Secretary'') shall make 
                payments (on a quarterly basis) directly to eligible 
                entities to support the provision of language 
                assistance services to English learners in an amount 
                equal to an eligible entity's eligible costs for 
                providing 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 2019 through 
                2023.
                    (C) Relation to medicaid dsh.--Payments under this 
                subsection shall not offset or reduce payments under 
                section 1923 of the Social Security Act (42 U.S.C. 
                1396r-4), nor shall payments under such section be 
                considered when determining uncompensated costs 
                associated with the provision of language assistance 
                services for the purposes of this section.
            (2) Methodology for payment of claims.--
                    (A) In general.--The Secretary shall establish a 
                methodology to determine the average per person cost of 
                language assistance 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 assistance 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 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 assistance services to English learners, the 
                product of--
                            (i) the average per person cost of language 
                        assistance services, determined according to 
                        the methodology devised under paragraph (2); 
                        and
                            (ii) the number of English learners who are 
                        provided language assistance 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) not later than 6 months after the date 
                        of the enactment of this Act, provides language 
                        assistance services to not less than 8 percent 
                        of the entity's total number of patients; and
                            (iii) prepares and submits 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 assistance services.--The term 
                ``language assistance services'' has the meaning given 
                such term in section 1861(jjj)(1) of the Social 
                Security Act, as added by subsection (b).
    (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. 2000d 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, 2019.
            (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. 208. INCREASING UNDERSTANDING OF AND IMPROVING HEALTH LITERACY.

    (a) In General.--The Secretary, acting through the Director of the 
Agency for Healthcare Research and Quality with respect to grants under 
subsection (c)(1) and through the Administrator of the Health Resources 
and Services Administration with respect to grants under subsection 
(c)(2), 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 reasonably require.
    (c) Use of Funds.--
            (1) Agency for healthcare research and quality.--A grant 
        awarded under subsection (a) through the Director of 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.
            (2) Health resources and services administration.--A grant 
        awarded under subsection (a) through the Administrator of 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 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.
    (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. 209. REQUIREMENTS FOR HEALTH PROGRAMS OR ACTIVITIES RECEIVING 
              FEDERAL FUNDS.

    (a) Covered Entity; Covered Program or Activity.--In this section--
            (1) the term ``covered entity'' means an entity carrying 
        out a covered program or activity; and
            (2) the term ``covered program or activity'' means 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(a)).
    (b) Requirements.--A covered entity, in order to ensure the right 
of individuals with limited-English proficiency to receive access to 
quality health care through the covered program or activity, shall--
            (1) ensure that appropriate clinical and support staff 
        receive ongoing education and training in culturally and 
        linguistically appropriate service delivery;
            (2) offer and provide appropriate language assistance 
        services at no additional charge to each patient that is an 
        individual 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, 
        except as provided in subsection (c).
    (c) Exemptions.--The requirements of subsection (b)(4) shall not 
apply as follows:
            (1) When a patient requests the use of family, friends, or 
        other persons untrained in interpretation or translation if 
        each of the following conditions are met:
                    (A) The interpreter requested by the patient is 
                over the age of 18.
                    (B) The covered entity informs the patient in the 
                primary language of the patient that he or she has the 
                option of having the entity provide to the patient an 
                interpreter and translation services without charge.
                    (C) The covered entity informs the patient that the 
                entity may not require an individual with a limited-
                English proficiency to use a family member or friend as 
                an interpreter.
                    (D) The covered entity evaluates whether the person 
                the patient wishes to use as an interpreter is 
                competent. If the covered entity has reason to believe 
                that such person is not competent as an interpreter, 
                the entity provides its own interpreter to protect the 
                covered entity from liability if the patient's 
                interpreter is later found not competent.
                    (E) If the covered entity has reason to believe 
                that there is a conflict of interest between the 
                interpreter and patient, the covered entity may not use 
                the patient's interpreter.
                    (F) The covered entity 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 primary 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.
    (d) Rule of Construction.--Subsection (c)(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. 210. 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 to health care services and health-
care-related services that are culturally and linguistically 
appropriate. 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 services 
        and health-care-related services for individuals with limited-
        English proficiency;
            (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. 211. 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.--In 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 of 
Education 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 individuals 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 funds 
        available under this section 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 for ESL 
                instruction, 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. 212. IMPLEMENTATION.

    (a) General Provisions.--
            (1) Immunity.--A State shall not be immune under the 11th 
        Amendment to the Constitution of the United States from suit in 
        Federal court for a violation of this title (including an 
        amendment made by this title).
            (2) Remedies.--In a suit against a State for a violation of 
        this title (including an amendment made by this title), 
        remedies (including remedies 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 a 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. 2000d et seq.) or any other Federal statute.

SEC. 213. 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 
54.9815-2719(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 the requirements for providing relevant 
        notices in a culturally and linguistically appropriate manner 
        in the applicable non-English languages, to apply a threshold 
        that 5 percent of the population, or not less than 500 
        individuals, in the county is literate only in the same non-
        English language in order for the language to be considered an 
        applicable non-English language.
    (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 individuals assisting with enrollment to collect and 
        report requests for language assistance; and
            (3) require the toll-free telephone hotlines 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 hotline, and any entity contracting with the 
        Secretary to provide language services, have taken to actively 
        address some of the consumer complaints.
    (f) Effective Date.--The amendments made by this section shall not 
apply to plans beginning prior to 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 
204, is amended by adding at the end the following:

          ``Subtitle B--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 of 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 each 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 National Institute on Minority Health and 
                Health Disparities.
                    ``(G) The Agency for Healthcare Research and 
                Quality.
                    ``(H) The Institute of Medicine Study Committee for 
                the 2004 workforce diversity report.
                    ``(I) The Indian Health Service.
                    ``(J) The Department of Education.
                    ``(K) Minority-serving academic institutions.
                    ``(L) Consumer organizations.
                    ``(M) Health professional associations, including 
                those that represent underrepresented minority 
                populations.
                    ``(N) Researchers in the area of health workforce.
                    ``(O) Health workforce accreditation entities.
                    ``(P) Private (including nonprofit) foundations 
                that have sponsored workforce diversity initiatives.
                    ``(Q) Local and State health departments.
                    ``(R) Representatives of community members to be 
                included on admissions committees for health profession 
                schools pursuant to subsection (c)(9).
                    ``(S) National community-based organizations that 
                serve as a national intermediary to their urban 
                affiliate members and have demonstrated capacity to 
                train health care professionals.
                    ``(T) The Veterans Health Administration.
                    ``(U) Other entities determined appropriate by the 
                Secretary.
            ``(2) The grantee shall ensure that, in addition to the 
        representatives under paragraph (1), the working 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 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) Help 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 and 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 related to health workforce 
diversity.
    ``(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) part B institutions, as defined in section 
                322 of the Higher Education Act of 1965;
                    ``(B) Hispanic-serving health professions schools;
                    ``(C) Hispanic-serving institutions, as defined in 
                section 502 of such Act;
                    ``(D) Tribal colleges or universities, as defined 
                in section 316 of such Act;
                    ``(E) Asian American and Native American Pacific 
                Islander-serving institutions, as defined in section 
                371(c) of such Act;
                    ``(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) supporting workforce diversity in 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) 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 agency listed in 
subsection (a) 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 agency listed in 
subsection (a) 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 Assistant Secretary 
for Mental Health and Substance Use, 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 Office of 
Minority Health, in collaboration with the National Institute on 
Minority Health and Health Disparities, 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 individuals 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 INSTITUTIONS, HISTORICALLY BLACK COLLEGES 
              AND UNIVERSITIES, AND TRIBAL COLLEGES.

    (a) In General.--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 
              AND UNIVERSITIES, AND TRIBAL COLLEGES.

    ``(a) In General.--The Secretary, acting through the Administrator 
of the Health Resources and Services Administration and in consultation 
with the Secretary of Education, shall award grants to hispanic-serving 
institutions, historically black colleges and universities, Tribal 
Colleges or Universities, 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 underrepresented minority students including--
            ``(1) mentoring with underrepresented health professionals; 
        and
            ``(2) providing financial assistance information for 
        continued education and applications to health professional 
        schools.
    ``(b) Definitions.--In this section:
            ``(1) Hispanic serving institution.--The term `hispanic-
        serving institution' means an entity that--
                    ``(A) is a school or program for which there is a 
                definition under 799B;
                    ``(B) has an enrollment of full-time equivalent 
                students that is made up of at least 9 percent Hispanic 
                students;
                    ``(C) has been effective in carrying out programs 
                to recruit Hispanic individuals to enroll in and 
                graduate from the school;
                    ``(D) has been effective in recruiting and 
                retaining Hispanic faculty members;
                    ``(E) has a significant number of graduates who are 
                providing health services to medically underserved 
                populations or to individuals in health professional 
                shortage areas; and
                    ``(F) is a Hispanic Center of Excellence in Health 
                Professions Education designated under section 
                736(d)(2) of the Public Health Service Act (42 U.S.C. 
                293(d)(2)).
            ``(2) Historically black colleges and university.--The term 
        `historically black college and university' has the meaning 
        given the term `part B institution' as defined in section 322 
        of the Higher Education Act of 1965.
            ``(3) Tribal college or university.--The term `Tribal 
        College or University' has the meaning given such term in 
        section 316(b) of such Act.
    ``(c) Certain Loan Repayment Programs.--In carrying out the 
National Health Service Corps Loan Repayment Program established under 
subpart III of part D of title III and the loan repayment program under 
section 317F, the Secretary shall ensure, notwithstanding such subpart 
or section, that loan repayments of not less than $50,000 per year per 
person are awarded for repayment of loans incurred for enrollment or 
participation of underrepresented minority individuals in health 
professional schools and other health 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 
enter into cooperative agreements with schools of public health and 
schools of allied health to design and implement online degree 
programs.
    ``(b) Priority.--In entering into 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.--As a condition of entering into a cooperative 
agreement with the Secretary under this section, a school of public 
health or school of allied health shall agree to 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 B 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 Director of the Centers for Disease Control 
and Prevention, in collaboration with the Administrator of the Health 
Resources and Services Administration and the Deputy Assistant 
Secretary for Minority Health, shall award grants to eligible entities 
to increase awareness among secondary 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 determined 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.--
            ``(1) In general.--Subject to paragraph (2), an entity 
        receiving a grant under this section may use the funds made 
        available through such grant to award stipends for educational 
        and living expenses to students participating in the internship 
        supported by the grant.
            ``(2) Limitations.--A stipend awarded under paragraph (1) 
        to an individual--
                    ``(A) may not be provided for a period that exceeds 
                6 months; and
                    ``(B) may not exceed $20 per day for an individual 
                (notwithstanding any other provision of law regarding 
                the amount of a stipend).
    ``(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 eligible individuals 
under subsection (b) 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; and
            ``(5) 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 a scholarship may not exceed $10,000 per academic year for an 
individual (notwithstanding any other provision of law regarding the 
amount of a 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 Assistant Secretary for Mental Health and 
Substance Use, and the Director of the Indian Health Services, shall 
award research fellowships to eligible individuals under subsection (b) 
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 
        designated by the Secretary under section 332;
            ``(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; 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.--A fellowship awarded under subsection (a) to 
an eligible individual shall be used to support an opportunity for the 
individual to become a researcher and advance the research base on the 
intersection between gender and health.
    ``(d) Priority.--In awarding fellowships 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 for an individual (notwithstanding any 
other provision of law regarding the amount of a 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 
eligible individuals under subsection (b) 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 4-year 
        institution of higher education; and
            ``(5) 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.--A fellowship awarded under subsection (a) to 
an eligible individual shall be used to support an opportunity for the 
individual to become a health professional and to advance the knowledge 
of the individual about international issues relating to health care 
access and quality.
    ``(d) Priority.--In awarding fellowships under subsection (a), the 
Director shall give priority to eligible individuals 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.--A fellowship awarded under this section may 
not--
            ``(1) be provided to an eligible individual for more than a 
        period of 6 months;
            ``(2) be awarded to a graduate of a 4-year institution of 
        higher education that has not been enrolled in such institution 
        for more than 1 year; and
            ``(3) exceed $4,000 per academic year (notwithstanding any 
        other provision of law regarding the amount of a 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 & 
Medicaid Services, and the Administrator of the 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 
        designated by the Secretary under section 332;
            ``(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 & Medicaid Services, or 
        the Administrator of the Health Resources and Services 
        Administration.
    ``(d) Priority.--In awarding grants under subsection (a), the 
Director of the Agency for Healthcare Research and Quality, the 
Director of the Centers for Medicare & Medicaid Services, and the 
Administrator of the Health Resources and Services Administration, in 
collaboration with the Deputy Assistant for Secretary for Minority 
Health, 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 students in successfully completing their education at 
        the postsecondary level.
    ``(e) Stipends.--
            ``(1) In general.--Subject to paragraph (2), an entity 
        receiving a grant under this section may use the funds made 
        available through such grant to award stipends for educational 
        and living expenses to students participating in the 
        opportunities supported by the grant.
            ``(2) Limitations.--A stipend awarded under paragraph (1) 
        to an individual--
                    ``(A) may not be provided for a period that exceeds 
                2 months; and
                    ``(B) may not exceed $100 per day (notwithstanding 
                any other provision of law regarding the amount of a 
                stipend).
    ``(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. 3420C. LEADERSHIP FELLOWSHIP PROGRAMS.

    ``(a) In General.--The Secretary shall award grants to national 
minority medical or health professional associations to develop 
leadership fellowship programs for underrepresented health 
professionals in order to--
            ``(1) assist such professionals in becoming future leaders 
        in public health and health care delivery institutions; and
            ``(2) increase diversity in decision-making positions that 
        can improve the health of underserved communities.
    ``(b) Use of Funds.--A leadership fellowship program supported 
under this section shall--
            ``(1) focus on training mid-career physicians and health 
        care executives who have documented leadership experience and a 
        commitment to public health services in underserved 
        communities; and
            ``(2) support Federal public health policy and budget 
        programs, and priorities that impact health equity, through 
        activities such as didactic lectures and leader site visits.
    ``(c) Period of Grants.--The period during which payments are made 
under a grant awarded under subsection (a) may not exceed 1 year.''.

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, 2019, 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)(xi) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(B)(xi)), as redesignated by 
section 204(b), 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) For purposes of cost-reporting periods 
                beginning on or after October 1, 2019, the provisions 
                of subparagraph (M) 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 Secretary of Health and Human Services, acting 
jointly with the Secretary of Education and the Secretary of Labor, 
shall make grants to institutions of higher education 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 
        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 institution of 
higher education 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 institution-wide health workforce goals 
        that can serve as models for increasing health equity in 
        communities across the United States;
            (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 institution of higher education 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 schools 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:
    ``(r) Repayment Plan for Mental and Behavioral Health Social 
Workers.--
            ``(1) In general.--The Secretary shall cancel the balance 
        of interest and principal due, in accordance with paragraph 
        (2), 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) Establishment.--There is established in the Health Resources 
and Services Administration of the Department of Health and Human 
Services a Health Professions Workforce Fund 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 (42 U.S.C. 292 et seq; 42 U.S.C. 296 et seq).
    (b) Funding.--
            (1) In general.--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--
                    (A) $355,000,000 for fiscal year 2019;
                    (B) $375,000,000 for fiscal year 2020;
                    (C) $392,000,000 for fiscal year 2021;
                    (D) $412,000,000 for fiscal year 2022;
                    (E) $432,000,000 for fiscal year 2023;
                    (F) $454,000,000 for fiscal year 2024;
                    (G) $476,000,000 for fiscal year 2025;
                    (H) $500,000,000 for fiscal year 2026;
                    (I) $525,000,000 for fiscal year 2027; and
                    (J) $552,000,000 for fiscal year 2028.
            (2) Health professions education programs.--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.
            (3) Nursing workforce development programs.--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 and other expert entities, such as the Health 
        Resources and Services Administration, 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 47,800,000 in 2015 
        to approximately 66,000,000 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 
        people in the United States 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 and 
        ethnic minorities and the approximately 20 percent of people in 
        the United States who live in rural or inner-city locations 
        designated as health professional shortage areas.
            (8) The health care utilization equity model of the 
        Association of American Medical Colleges 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 health care in the United States, 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 United 
        States.
            (10) United States medical school enrollment will grow by 
        30 percent from 2018 to 2019 to help reduce the shortage of 
        quality physicians in the United States.
            (11) An increase in United States medical school graduates 
        must be accompanied by an increase of 4,000 graduate medical 
        education 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 (42 U.S.C. 1395 et seq.) (having more 
        beneficiaries than any other health care program), supports its 
        ``fair share'' of the costs associated with graduate medical 
        education.
            (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 health care needs in the United States;
            (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 and Programs 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, more than 
        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 the 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 health workforce of the United States 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 D the following:

 ``Subtitle E--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 plan under title XIX 
                of the Social Security Act (or under a waiver of such 
                plan), 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 minority groups; or
                    ``(ii) that--
                            ``(I) serves a disproportionate percentage 
                        of local patients that are from a racial and 
                        ethnic minority group, or that has a patient 
                        population, at least 50 percent of which is 
                        composed of individuals with limited-English 
                        proficiency; 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 minority 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 title XVIII of the Social Security Act, or a State plan 
        under title XIX of such Act (or under a waiver of such plan), 
        or who are members of a vulnerable population, as determined by 
        the Secretary; or
            ``(B) serves a disproportionate percentage of local 
        patients that are from a racial and ethnic minority group.
    ``(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 receiving direct 
        financial assistance under subsection (a);
            ``(2) include all amounts of Federal assistance received by 
        each such entity in the preceding fiscal year;
            ``(3) review the total unmet needs of health care 
        facilities serving American Samoa, Guam, the Commonwealth of 
        the Northern Mariana Islands, the United States Virgin Islands, 
        Puerto Rico, and Hawaii, including needs for renovation and 
        expansion of existing facilities;
            ``(4) include a strategic plan for addressing the needs of 
        each such population 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 (Public Law 111-148) 
        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, including the amendments made by 
                such title; 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''.

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.''.
    (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) Definitions.--In this section:
            (1) Border area.--The term ``border area'' means the United 
        States-Mexico Border Area, as defined in section 8 of the 
        United States-Mexico Border Health Commission Act (22 U.S.C. 
        290n-6).
            (2) Eligible entity.--The term ``eligible entity'' means an 
        entity that is located in the border area and is any of the 
        following:
                    (A) A State, local government, or Tribal 
                government.
                    (B) Public institution of higher education.
                    (C) Nonprofit health organization.
                    (D) Community health center.
                    (E) Community clinic that is a health center 
                receiving assistance under section 330 of the Public 
                Health Service Act (42 U.S.C. 254b).
    (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 use disorders;
                    (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 et seq.; 42 U.S.C. 1397aa et seq.)); 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 408(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--
            (1) by striking ``Service'' each place such term appears 
        and inserting ``Department of Homeland Security'';
            (2) by striking ``Attorney General'' each place such term 
        appears and inserting ``Secretary of Homeland Security'';
            (3) in subsection (f)(1), by striking ``Commissioner'' and 
        inserting ``Director of U.S. Citizenship and Immigration 
        Services'';
            (4) in subsection (h)--
                    (A) by striking ``of the Immigration and 
                Nationality Act''; and
                    (B) by striking ``of such Act''; and
            (5) 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, 
                        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 award 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 (referred to in this section as the 
``Secretary''), 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) Indian tribes or tribal 
                                organizations (as such terms are 
                                defined in section 4 of the Indian 
                                Self-Determination and Education 
                                Assistance Act (25 U.S.C. 5304)), the 
                                Indian Health Service, or any other 
                                organization that serves Alaska 
                                Natives; and
                                    (V) interested public or private 
                                health care providers or organizations 
                                as determined 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.--Any funds provided to an eligible entity 
through a grant under this section shall--
            (1) supplement, not supplant, any other Federal funds made 
        available to the entity for the purposes of this section; and
            (2) not be used to duplicate the activities of any other 
        health disparity grant program under this Act, including an 
        amendment made by 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 
eligible entities receiving grants under this section to share best 
practices, evaluation results, and reports with communities not 
affiliated with such entities, by using the Internet, conferences, and 
other pertinent information regarding the projects funded by this 
section, including through using outreach efforts of the Office of 
Minority Health 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 
eligible entities receiving grants under this section.
    (i) 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, 2019.
    (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

    ``(kkk)(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(kkk)(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:
    ``(w) 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(kkk)(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(w) 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 ``(w)''; 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 furnished 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 of services 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 of 
        services, 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(w).''.
            (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), and 
                (kkk)(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(w)(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, 2019.

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 recommendations 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 recommend to the 
                Secretary 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 a total of 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 
                        Academy of Sciences 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 United States.
            (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 
        (referred to in this section as the `Director') 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) Definition of Delta Region.--In this section, 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).
    ``(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(r)(4) of the Public Health Service Act (42 U.S.C. 
254b(r)(4)) is amended--
            (1) in subparagraph (A), by striking ``primary health care 
        services'' each place it appears and inserting ``primary health 
        care and other mental, dental, and physical health services''; 
        and
            (2) in subparagraph (B)--
                    (A) in clause (i), by striking ``; and'' and 
                inserting ``;'';
                    (B) in clause (ii), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
                            ``(iii) in the case of a rural health 
                        clinic described in such subparagraph--
                                    ``(I) that such clinic provides, to 
                                the extent possible, enabling services, 
                                such as transportation and language 
                                assistance (including translation and 
                                interpretation); and
                                    ``(II) that the primary health care 
                                and other services described in such 
                                subparagraph are subject to full 
                                reimbursement according to the 
                                prospective payment system for 
                                Federally qualified health center 
                                services under section 1834(o) of the 
                                Social Security Act.''.

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:
    ``(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 `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; and
                    ``(B) 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.''.

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 intended 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, 2027;
            (3) waiving the maintenance of effort provisions should not 
        be permitted;
            (4) the maintenance of effort provisions ensure the 
        continued success of the Medicaid program and Children's Health 
        Insurance Program and were intended to specifically protect 
        vulnerable and disabled adults, 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 section 1707A of the Public Health 
Service Act (42 U.S.C. 300u-6a), 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 for 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 for 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 TITLE I OF 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) Inclusions.--An individual is described in this 
        paragraph if the individual is any of the following:
                    ``(A) A member of a federally recognized Indian 
                Tribe.
                    ``(B) A resident of an urban center who meets any 
                of the following 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 ``(as defined 
        in section 4 of the Indian Health Care Improvement Act)''.
            (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 ``(as defined in section 
                4(d) of the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450b(d))''; and
                    (B) in paragraph (2), in the matter preceding 
                subparagraph (A), by striking ``(as so defined)''.
            (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 amendments 
made by the Patient Protection and Affordable Care Act (Public Law 111-
148) and the Health Care and Education Reconciliation Act of 2010 
(Public Law 111-152) to titles XVIII and XIX of the Social Security Act 
(42 U.S.C. 1395 et seq., 1396 et seq.) relating to disproportionate 
share hospital adjustment payments under Medicare and Medicaid (and 
subsequent amendments made with respect to such payments) 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 mitigate 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 such disproportionate share 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 such disproportionate share 
        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 Finance 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 payment 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 under 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 the ability of such 
provider to provide care in a language other than English either 
through the provider speaking such language or by the provider having a 
qualified interpreter for an individual with limited-English 
proficiency (as defined in section 3400 of such Act) who speaks such 
language available during office hours''.
    (b) Effective Date.--The amendment made by subsection (a) shall not 
apply to any plan beginning on or prior to the date that is 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 January 1, 2020, increase the 
                percentage of essential community providers as 
                described in clause (i) 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 such 
                essential community providers in the contract service 
                area are in-network; and
                    ``(iii) include at least one essential community 
                provider in each of the essential community provider 
                categories described in section 156.235(a)(2)(ii)(B) of 
                title 45, Code of Federal Regulations (as in effect on 
                the date of enactment of the Health Equity and 
                Accountability Act of 2018) in each county in the 
                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)) 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 as described in clause 
                (ii) of subsection (c)(1)(C), by county, that contract 
                with each qualified health plan offered in that county 
                and the percentage of such essential community 
                providers, by category as described in clause (iii) of 
                such subsection, that contract with each qualified 
                health plan offered in that county. Such data 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) 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)), as amended by 
section 428(a), is further 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 individuals with 
                                limited-English proficiency as defined 
                                in section 3400 of such Act; 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 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 
not apply to plans beginning on or prior to the date that is 1 year 
after the date of the enactment of this Act.''.

SEC. 431. IMPROVING ACCESS TO DENTAL CARE.

    (a) Reports to Congress.--
            (1) GAO reports.--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) a report on the Alaska Dental Health Aide 
                Therapists program and the Dental Therapist and 
                Advanced Dental Therapist programs in Minnesota, to 
                assess the effectiveness of dental therapists in--
                            (i) improving access to timely dental care 
                        among communities of color;
                            (ii) providing high quality care; and
                            (iii) providing culturally competent care; 
                        and
                    (B) a report on State variations in the use of 
                dental hygienists and the effectiveness of expanding 
                the scope of practice for dental hygienists in--
                            (i) improving access to timely dental care 
                        among communities of color;
                            (ii) providing high quality care; and
                            (iii) providing culturally competent care.
            (2) HRSA report on dental shortage areas.--Not later than 1 
        year after the date of the enactment of this Act, the Secretary 
        of Health and Human Services, acting through the Administrator 
        of the Health Resources and Services 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 
(25 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 (FF), by striking ``and'' at 
                the end;
                    (B) in subparagraph (GG), by adding ``and'' after 
                the semicolon at the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(HH) 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 413(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 ``(BB)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (CC) 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)(HH),'' 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)(84)(C) 
                for the State in which the services are provided.
    ``(3) For purposes of paragraph (1), such term shall not include 
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 (82), by striking ``and'' 
                        at the end;
                            (iii) in paragraph (83), by striking the 
                        period at the end and inserting ``; and''; and
                            (iv) by inserting after paragraph (83) the 
                        following:
            ``(84) 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 any 
        oral disease and promote oral health, restore oral structures 
        to health and function, and treat emergency oral 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 subsection 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 subsection, 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 subsection 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 subsection, 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 other dental care providers who are licensed 
        to provide clinical care, dental services provided under the 
        demonstration program under this subsection 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 subsection and subsection (i), 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 the preceding 
        3 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 other dental care providers who are licensed 
        to provide clinical care, dental services provided under the 
        demonstration program under this subsection may be administered 
        by such providers through telehealth-enabled collaboration and 
        supervision when appropriate and feasible.
            (3) 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--
            (1) the sustainability of the health care system in the 
        United States 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;
            (2) 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);
            (3) a high value health care system must deliver timely, 
        accessible, well-coordinated, high-quality, culturally 
        centered, and language-appropriate care to everyone;
            (4) eliminating health disparities and achieving health 
        equity must be central to efforts to achieve a high value 
        health care system;
            (5) eliminating such disparities and achieving such equity 
        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; and
            (6) 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) Integrating Achieving Health Equity Across Measures and 
Activities.--
            (1) In general.--The Centers for Medicare & Medicaid 
        Services Quality Payment Program (in this section referred to 
        as the ``Quality Payment Program''), developed through 
        implementation of the provisions of and amendments made by the 
        Medicare Access and CHIP Reauthorization Act of 2015 (Public 
        Law 114-10) relating to improving quality and payment under 
        title XVIII of the Social Security Act, shall explicitly 
        integrate ``achieving health equity'' across all measures and 
        activities under the Quality Payment Program, including under 
        the Merit-based Incentive Payment System under section 1848(q) 
        of such Act (42 U.S.C. 1395w-4(q)) or alternative payment 
        models in accordance with this section.
            (2) Identification of limited-english proficient 
        individuals as underserved group.--The Administrator of the 
        Centers for Medicare & Medicaid Services (in this section 
        referred to as the ``Administrator'') shall identify 
        individuals with limited-English proficiency as a specific 
        underserved group within the Quality Payment Program and give 
        high weight under the Quality Payment Program to measures and 
        activities relating to providing language services for non-
        English speakers. A clinician or other professional may 
        demonstrate performance on measures and activities with respect 
        to 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.--
            (1) In general.--The Administrator shall include an 
        explicit reference under the Quality Payment Program indicating 
        that data stratification and reporting is one way of working to 
        achieve health equity.
            (2) Stratification of data.--The Administrator shall 
        require that a clinician or other professional, in reporting 
        measures relating to achieving health quality under this the 
        Quality Payment Program, stratify clinical quality measures by 
        disparity variables, including race, ethnicity, preferred 
        language, disability status, sexual orientation, gender 
        identity, and psychological and behavioral status. A clinician 
        or other professional may use existing demographic data 
        collection fields in certified electronic health record 
        technology (as defined in section 1848(o)(4) of the Social 
        Security Act (42 U.S.C. 1395w-4(o)(4))) to carry out such data 
        stratification under the preceding sentence. Such stratified 
        data may assist clinicians and other professionals in the 
        identification of disparities and distinguish efforts to 
        improve quality from efforts to reduce disparities, which may 
        not correlate without dedicated work.
            (3) Requirement of adoption of cert.--All entities, 
        clinicians, or other professionals participating in the Quality 
        Payment Program shall be required to adopt 2015 certified 
        electronic health record technology (as so defined) as a 
        condition of participating in the Quality Payment Program.
    (c) Quality Improvement Activities.--The Administrator, upon yearly 
review of the Quality Payment Program, shall add quality improvement 
activities that implement the Culturally and Linguistically Accessible 
Standards (CLAS) standards as Improvement Activities under the Quality 
Payment Program.

SEC. 443. DEVELOPMENT AND TESTING OF DISPARITY REDUCING DELIVERY AND 
              PAYMENT MODELS.

    (a) In General.--The Center for Medicare and Medicaid Innovation 
established under section 1115A of the Social Security Act (42 U.S.C. 
1315a) (in this section referred to as the ``CMI'') shall establish a 
dedicated fund to identify, test, evaluate, and scale delivery and 
payment models under the applicable titles (as defined in subsection 
(a)(4)(B) of such section) 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 status, low health literacy, and case 
management, transportation, and enrollment assistance needs, which will 
help to reduce disparities and impact the overall cost of care.
    (b) Pilot Programs.--The CMI shall prioritize the testing of models 
under such section 1115A 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.
    (c) Alternatives.--Any model tested by the CMI under such 1115A 
shall include measures to assess and track the impact of the model on 
health disparities, using existing measures such as the Healthcare 
Disparities and Cultural Competency Measures endorsed by the entity 
with a contract under section 1890(a) of the Social Security Act (42 
U.S.C. 1395aaa(a)), 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.--Any pay-for-performance or alternative payment 
model that is developed and tested by the Center for Medicare and 
Medicaid Innovation established under section 1115A of the Social 
Security Act (42 U.S.C. 1315a), or any other agency of the Department 
of Health and Human Services with respect to the programs under titles 
XVIII, XIX, or XXI of such Act, shall 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 any such models shall include 
training and additional up front resources for community based and 
safety net providers to enable those providers to participate in the 
model.

                  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.

    Congress finds the following:
            (1) Numerous studies and reports, including the 2015 
        National Healthcare Quality and Disparities Report of the 
        Agency for Healthcare Research and Quality and the 2002 report 
        of the Institute of Medicine entitled ``Unequal Treatment: 
        Confronting Racial and Ethnic Disparities in Health Care'', 
        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 
        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.--The Secretary may, at the request of an eligible 
community partnership described in subsection (b)(1), designate an 
eligible area described in subsection (b)(2) as a health empowerment 
zone for the purpose of eligibility for a grant under section 455.
    (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 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 use disorder 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 community, the historical and 
                persistent presence of conditions that have been found 
                to contribute to health disparities including any such 
                conditions respecting any of 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 reservations of Indian 
                        tribes).
                            (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 a grant under subsection (b), 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 OF SECRETARY.

    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 on 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 described 
                in paragraph (3)(C), 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 
                Governors of Puerto Rico, the Virgin Islands, Guam, the 
                Northern Mariana Islands, or American Samoa, 
                respectively, 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 described 
        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 described in section 
        402(b)(3)(C) (relating to the Medicaid program).''.
    (d) Effective Date.--The amendments made by this section take 
effect on October 1, 2018.

SEC. 462. AT-RISK YOUTH MEDICAID PROTECTION.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a), as amended by section 431(d)(2), is further amended--
            (1) in subsection (a)--
                    (A) by striking ``and'' at the end of paragraph 
                (83);
                    (B) by striking the period at the end of paragraph 
                (84) and inserting ``; and''; and
                    (C) by inserting after paragraph (84) the following 
                new paragraph:
            ``(85) 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 
        (30) 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 (30) 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 
        for medical assistance under a State plan under title XIX of 
        the Social Security Act 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 these programs 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.
    ``(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 (N) of section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read as follows:
                    ``(N) 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 ``for--'' and all that 
        follows and inserting ``for assistance under any State program 
        funded under part A of title IV of the Social Security Act (42 
        U.S.C. 601 et seq.).'';
            (2) in subsection (b)--
                    (A) by striking ``(1) Program of temporary 
                assistance for needy families.--''; and
                    (B) by striking paragraph (2); and
            (3) in subsection (e), by striking ``it--'' and all that 
        follows and inserting ``the term in section 419(5) of the 
        Social Security Act (42 U.S.C. 619(5)) when referring to 
        assistance provided under a State program funded under 
        paragraph A of title IV of the Social Security Act (42 U.S.C. 
        601 et seq.).''.

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) Maternal.--The term ``maternal'' refers to persons who 
        are pregnant or breastfeeding of all gender identities.
            (2) Pregnancy and breastfeeding information services.--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, 
                Websites, fact sheets, telephonic or electronic 
                communication, community outreach efforts, or other 
                appropriate means.
            (3) Secretary.--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, acting 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) Pregnancy-associated death.--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) Pregnancy-related death.--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) Severe maternal morbidity.--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) State.--The term ``State'' means each of the 50 States, 
        the District of Columbia, and each of the territories.
            (5) Vital statistics unit.--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 (as added by section 110), the following:

``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:

            ``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 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 part, 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 part) are hereby transferred and made available to the Secretary 
to carry out this section. The amounts transferred and made available 
to carry out this section 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) 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 section 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. 3253), 
                        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 subsection 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 111-117; 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, as 
        described in paragraph (5)(B).
            (2) Duration.--Grants awarded under this subsection shall 
        be for a period of 5 years.
            (3) Applications.--An institution of higher education or 
        consortium of such institutions desiring a grant under this 
        subsection shall submit an application to the Secretary at such 
        time, in such manner, and containing such information as the 
        Secretary may require, including an assurance to participate in 
        the evaluation described in subsection (e).
            (4) Priority.--In awarding grants under this subsection, 
        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, or a consortium, receiving a grant under 
                this subsection shall use grant funds to integrate 
                issues relating to comprehensive sex education into the 
                institution of higher education, or consortium, in 
                order to reach a large number of students, by carrying 
                out 1 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 contents required under subsection (b)(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 subsection 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 subsection 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 section. 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 section 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 section 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 section 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 subsection 
        (f), 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 
        (f), 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 
        section.
    (j) Funding.--
            (1) Appropriation.--For the purpose of carrying out this 
        section, 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 paragraph 
        (1) 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 section. The amounts transferred 
        and made available to carry out this section 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) by moving the indentation of subparagraph (W) 2 
                ems to the left;
                    (B) in subparagraph (X)--
                            (i) by moving the indentation 2 ems to the 
                        left; and
                            (ii) by striking ``and'' at the end;
                    (C) in subparagraph (Y), by striking the period at 
                the end and inserting ``; and''; and
                    (D) by inserting after subparagraph (Y) the 
                following new subparagraph:
            ``(Z) 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)(Z), 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 
                        emergency contraception--
                                    ``(I) 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) is more effective the sooner 
                                it is taken; and
                                    ``(III) 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, 2019, 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) Contraception.--The term `contraception' or 
        `contraceptive' means any drug or device approved by the Food 
        and Drug Administration to prevent pregnancy.
            ``(2) Employee.--The term `employee' means a person hired, 
        by contract or any other form of an agreement, by a pharmacy.
            ``(3) Pharmacy.--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) Product.--The term `product' means a Food and Drug 
        Administration-approved drug or device.
            ``(5) Professional clinical judgment.--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) Without delay.--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:

``SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON THE PROMOTION OF 
              OPTIMAL MATERNITY OUTCOMES.

    ``(a) In General.--The Secretary, 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 section 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 Administration, 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 by sections 514 and 515, is further amended by 
adding at the end the following:
            ``(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 Websites 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:
    ``(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 the United States. 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 SERVICES FURNISHED BY CERTAIN STUDENTS, INTERNS, 
              AND RESIDENTS SUPERVISED BY CERTIFIED NURSE MIDWIVES 
              WITHIN INPATIENT HOSPITAL SERVICES UNDER MEDICARE.

    (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'' at the end 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:

``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 431(c), is 
        amended--
                    (A) in subparagraph (GG), by striking ``and'' at 
                the end;
                    (B) in subparagraph (HH), by inserting ``and'' at 
                the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(II) 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 the Social Security Act 
        (42 U.S.C. 1395x), as amended by sections 205(b)(a), 413(a), 
        and 431(c), 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; 
     Substance Abuse Counselor Services; Substance Abuse 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 that 
        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 that 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 that 
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 the Social Security 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 the Social 
        Security Act (42 U.S.C. 1395l(a)(1)), as amended by section 
        431(c)(3), is amended--
                    (A) by striking ``and'' before ``(CC)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (DD) with respect to marriage 
                and family therapist services, mental health counselor 
                services, and substance abuse counselor services under 
                section 1861(s)(2)(II), 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 the 
        Social Security 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 the Social Security 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 
        the Social Security 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.

    (a) In General.--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 to carry out the activities under 
subsection (b), or, if the National Academy of Sciences declines to 
enter into such an arrangement, the Director of the National Institute 
on Minority Health and Health Disparities, in cooperation with the 
Agency for Healthcare Research and Quality, shall carry out the 
activities under subsection (b).
    (b) Activities.--The applicable entity under subsection (a) shall--
            (1) 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) submit to 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. GEOACCESS STUDY.

    The Assistant Secretary for Mental Health and Substance Use 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 Congress on the results of such 
        study.

SEC. 607. 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.), as amended by section 603, is further amended by adding at 
the end the following new section:

``SEC. 551. BEHAVIORAL AND MENTAL HEALTH OUTREACH AND EDUCATION 
              STRATEGIES.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, 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 such communities and stakeholders serving such 
        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. 608. 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 interventions that 
                        are evidence-based, 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 (20 U.S.C. 1400 et seq.).
                    ``(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 (42 U.S.C. 1320d-2 note) 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 Assistant Secretary 
        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 Assistant Secretary shall 
                develop measures of outcomes to be applied by 
                recipients of assistance under this section, and the 
                Assistant Secretary, 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 Assistant Secretary 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 assistant secretary.--Based on the data 
        submitted under paragraph (3), the Assistant Secretary 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''.

          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 25 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 90 
        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 
        18 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 in 
        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, despite their smoking rate being 
        similar to other racial groups.
            (8) Members of the Baby Boomer Generation are entering 
        their 60s, 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 scan reduced 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 the Health Equity and Accountability Act of 2018, 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 those 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 529B 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:

``SEC. 529B. DRUGS RELATING TO LUNG CANCER.

    ``(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; or
            ``(3) a drug to curtail or prevent nicotine addiction.
    ``(c) Board.--The Board established under section 701 of 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 529B, 
        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, each in 
coordination with the Secretary of Health and Human Services, shall 
engage--
            (1) 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
            (2) 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 comprised of--
                    (A) the Secretary of Health and Human Services;
                    (B) the Secretary of Defense;
                    (C) the Secretary of Veterans Affairs; and
                    (D) 2 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 $75,000,0000 for fiscal year 2019 and such sums as 
        may be necessary for each of fiscal years 2020 through 2023.
            (2) Lung cancer mortality reduction program.--The amounts 
        appropriated under paragraph (1) shall be allocated as follows:
                    (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);
                    (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 the Public Health Service 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 the Public Health Service 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 the Public Health Service 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 2018, an estimated 164,690 men will be diagnosed 
        with prostate cancer and more than 29,000 will die from this 
        disease.
            (3) Roughly 2,000,000 to 3,000,000 people in the United 
        States 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; 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, such as the extent to which 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 (about 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 under title XVIII of the Social Security Act (42 U.S.C. 
        1395 et seq.) as one of 8 high-volume, high-cost areas in the 
        Resource Utilization Report Program established under the 
        Medicare Improvements for Patients and Providers Act of 2008 
        (Public Law 110-275).
            (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 
                        individuals who are 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 comprised of representatives from such Federal agencies, as 
        each head of such applicable agencies 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 each 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 such task 
        force determines 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 
        of Veterans Affairs 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 on September 30, 2021.
    (d) Prostate Cancer Research.--
            (1) Research coordination.--The Secretary of Veterans 
        Affairs, in coordination with the Secretary of Defense and the 
        Secretary of Health and Human Services, shall establish and 
        carry out a program to coordinate and intensify prostate cancer 
        research. 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) develop better understanding of 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 
                subsection.
            (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) outreach and educational efforts to 
                        raise awareness among the populations described 
                        in clause (ii); and
                            (iv) appropriate access and utilization of 
                        imaging modalities.
    (e) Telehealth and Rural Access Pilot Projects.--
            (1) In general.--The Secretary of Veterans Affairs, in 
        cooperation with the Secretary of Defense and the Secretary of 
        Health and Human Services (referred to in this section 
        collectively 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 1 year 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 
        (referred to in this subsection as the ``Secretary'') 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 savings described in this 
        paragraph is 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, 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 Puerto 
        Rico, the Virgin Islands, Guam, the Northern Mariana Islands, 
        or American Samoa 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 Virgin Islands, 
Guam, 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, 2018.

SEC. 704. CANCER PREVENTION AND TREATMENT DEMONSTRATION FOR ETHNIC AND 
              RACIAL MINORITIES.

    (a) Demonstration.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this section as the ``Secretary'') shall 
        conduct 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 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 9 demonstration projects, including the 
        following:
                    (A) Two projects, each of which shall target 
                different ethnic subpopulations, for each of the 4 
                following major racial and ethnic minority groups:
                            (i) American Indians and Alaska Natives, 
                        Eskimos, and Aleuts.
                            (ii) Asian Americans.
                            (iii) Blacks and African Americans.
                            (iv) Latinos and 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 in a rural area.
                    (D) At least one project in an inner-city area.
            (3) Expansion of projects; implementation of demonstration 
        project results.--The Secretary shall continue the existing 
        demonstration projects and may expand the number of 
        demonstration projects 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 such 
                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.
    (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) Content 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, approximately 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 causes of liver cancer, one of the most lethal and 
        fastest growing cancers in this country. Such viruses are the 
        most common cause of chronic liver disease, liver cirrhosis, 
        and the most common indications for liver transplantation. At 
        least 18,000 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 (such as puncture 
        through the skin).
            (5) The CDC estimates that in 2016, more than 41,000 people 
        in the United States were newly infected with HCV and nearly 
        21,000 people in the United States 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 102,000,000 (1,600,000 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 (referred to in this section as the ``USPSTF'') issued a 
        Grade B rating for screening for 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 HBV in 
        persons at high-risk of hepatitis B infection. In 2009, the 
        USPSTF issued a Grade A for screening pregnant women for 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 health care-
        associated infection of HBV and HCV, 56 of which occurred in 
        non-hospital 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 6 percent of the population, Asian Americans and Pacific 
        Islanders account for 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 HCV 
        cases. In addition, African Americans, Latinos, and American 
        Indian and Native Alaskans are among the groups which have 
        disproportionately high rates of HBV 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'' (referred to in this section as the ``HHS Action 
        Plan''). In March 2017, the National Academies of Sciences, 
        Engineering, and Medicine released a report entitled, ``A 
        National Strategy for the Elimination of Hepatitis B and C: 
        Phase Two Report'' (referred to in this section as the ``NAS 
        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 NAS 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 goal of Healthy People 2020 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 subtitle (including the amendments 
        made by this subtitle) 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 233 percent increase in hepatitis C cases from 2010 
        to 2016, stemming from the opioid, heroin, and overdose 
        epidemics affecting communities nationwide. From 2014 to 2015, 
        the number of reported cases of acute hepatitis B infection in 
        the United States rose for the first time since 2006, 
        increasing by 20.7 percent, which is also largely attributable 
        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.), as 
amended by title V, is further amended--
            (1) by striking section 317N (42 U.S.C. 247b-15); and
            (2) by adding after part W, as added by section 508, 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) 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 Nation 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 of the Centers for Disease Control 
                        and Prevention 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 of 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 CDC 
        Director, 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 Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Energy and Commerce 
        of the House of Representatives.
            ``(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 people in the United States 
        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.--Title 
III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended 
by inserting after section 317W, as added by section 506, 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 shall--
                    ``(A) identify the incidence and prevalence of 
                acquired bone marrow failure diseases in the United 
                States;
                    ``(B) 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) 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; or
                            ``(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;
            ``(2) aplastic anemia;
            ``(3) paroxysmal nocturnal hemoglobinuria;
            ``(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 Director 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. 274k) 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:

``SEC. 1707B. MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE MARROW FAILURE 
              DISEASE.

    ``(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 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--
                    ``(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.
    ``(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'' has the meaning given such term in section 317X(d) of 
the Public Health Service Act, as added by subsection (c).

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 that 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 as the Secretary determines appropriate.
    (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 2 years after the date of 
enactment of this Act, 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 by section 531, 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 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 462(a), is 
amended--
            (1) by striking ``and'' at the end of paragraph (84);
            (2) by striking the period at the end of paragraph (85) and 
        inserting ``; and''; and
            (3) by inserting after paragraph (85) the following new 
        paragraph:
            ``(86) 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 1905(bb) of this title) and covered 
                outpatient drugs (as defined in subsection (k)(2) of 
                section 1927 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 
                1905(bb)(2)(A)'' each place it appears; and
                    (B) in each of subsections (a)(2)(B) and (b)(2)(B) 
                by inserting ``and counseling and pharmacotherapy for 
                cessation of tobacco use (as defined in section 
                1905d(bb) of this title) and covered outpatient drugs 
                (as defined in subsection (k)(2) of section 1927 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 1905(bb)(2)(A)'' 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 1905(bb))''; 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 1927 
                        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 redesignating paragraphs (6) and (7) as paragraphs 
        (7) and (8), respectively; and
            (3) by inserting after paragraph (5) the following:
            ``(6) No prior authorization programs for tobacco cessation 
        drugs.--A State plan under this title 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.''.
    (g) Comprehensive Coverage of Tobacco Cessation Coverage in Private 
Health Insurance.--Section 2713 of the Public Health Service Act (42 
U.S.C. 300gg-3) is amended by adding at the end the following:
    ``(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.''.
    (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 subsection (d) 
of the section 2709 of the Public Health Service Act that relates to 
coverage for individuals participating in approved clinical trials.''.
    (b) Conforming Amendment.--Section 1902(a) of the Social Security 
Act (42 U.S.C. 1396a(a)), as amended by section 734(c), is amended--
            (1) by striking ``and'' at the end of paragraph (85);
            (2) by striking the period at the end of paragraph (86) and 
        inserting ``; and''; and
            (3) by inserting after paragraph (86) the following new 
        paragraph:
            ``(87) 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 1,000,000 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 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 and Hispanics; in 2015, 
        Latinos and Hispanics made up 18 percent of the United States 
        population and 24 percent of new infections.
            (6) Though the rate of new infections among American 
        Indians and Alaska Natives (referred to in this section as 
        ``AI/AN'') is proportional to their population size, from 2005 
        to 2014, the annual number of HIV diagnoses increased 19 
        percent among AI/AN 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 or ethnicity.
            (8) The latest data from the Centers for Disease Control 
        and Prevention in 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 such 
        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 (referred to in this section as 
        ``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 (referred to in this section as ``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 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 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 antiretroviral therapy 
        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 of 
                coverage) for medical treatment (including coverage 
                through the Medicaid program, the Medicare program, 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 Assistant Secretary for Mental Health and Substance 
Use, 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 1 year 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 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 (referred to in this section as 
        ``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 and 
        untransmittable a person living with HIV who is on 
        antiretroviral therapy 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 of Health and Human 
Services, 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 of Health and Human Services, 
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 Assistant Secretary for Mental Health and Substance Use, 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.--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 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 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.--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 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 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 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 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 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.--Not 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 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 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) 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--
                    (A) that includes information about abstinence and 
                about the proper use and disposal of sexual barrier 
                protection devices; and
                    (B) which is--
                            (i) evidence-based;
                            (ii) medically accurate;
                            (iii) age and developmentally appropriate;
                            (iv) gender and identity sensitive;
                            (v) culturally and linguistically 
                        appropriate; and
                            (vi) 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.
    (b) 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 Director of the Bureau of Prisons to allow 
        community organizations to, in accordance with all relevant 
        Federal laws and regulations which govern visitation in 
        correctional facilities--
                    (A) distribute sexual barrier protection devices in 
                Federal correctional facilities; and
                    (B) engage in STI counseling and STI prevention 
                education in Federal 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.--A Federal correctional 
        facility may not, 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.
    (c) 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.
    (d) Survey of and Report on Correctional Facility Programs Aimed at 
Reducing the Spread of STIs.--
            (1) Survey.--Not later than 180 days after the date of 
        enactment of this Act, and annually thereafter for 5 years, 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, to determine the following:
                    (A) Counseling, treatment, and supportive 
                services.--Whether the correctional facility--
                            (i) requires incarcerated persons to 
                        participate in counseling, treatment, and 
                        supportive services related to STIs or
                            (ii) 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; or
                            (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 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 HIV, 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 under paragraph (1), 
        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.--
                    (A) In general.--The Attorney General shall 
                transmit to Congress and make publicly available the 
                results of the survey required under paragraph (1), 
                both for the United States as a whole and disaggregated 
                as to each State and each correctional facility.
                    (B) Deadlines.--To the maximum extent possible, the 
                Attorney General shall--
                            (i) issue the first report under 
                        subparagraph (A) not later than 1 year after 
                        the date of enactment of this Act; and
                            (ii) issue reports under subparagraph (A) 
                        annually thereafter for 5 years.
    (e) 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 (d)(3).
            (2) Contents of strategy.--The strategy developed under 
        paragraph (1) 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--
                            (i) incarcerated persons who were enrolled 
                        in their State Medicaid program prior to 
                        incarceration in a correctional facility are 
                        automatically reenrolled in such program upon 
                        their release; and
                            (ii) incarcerated persons who were not 
                        enrolled in their State Medicaid program prior 
                        to incarceration, and who are diagnosed with 
                        HIV 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).
    (f) 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.

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:
            ``(16) 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 
                        all services for which medical assistance is 
                        provided under the State plan 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 
                        subdivision (A) following paragraph (29) of 
                        section 1905(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 paragraphs (3), with respect to 
        a State, for each of the first 4 calendar quarters in which the 
        State plan meets the requirements of paragraph (16) of section 
        1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as 
        added by subsection (a)), 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) for the State expenditures 
        described in paragraph (2) shall be increased by 5 percentage 
        points.
            (2) Expenditures.--The expenditures described in this 
        paragraph are the following:
                    (A) Expenditures for which payment is available 
                under section 1903 of the Social Security Act (42 
                U.S.C. 1396b) and which are attributable to 
                strengthening 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 (16) of section 1902(e) of the Social 
                Security Act (42 U.S.C. 1396a(e)) (as amended by 
                subsection (a)).
                    (B) Expenditures for medical assistance (as such 
                term is defined in section 1905(a) of the Social 
                Security Act (42 U.S.C. 1396d(a))) provided to such 
                eligible individuals.
            (3) Requirements; limitation.--
                    (A) Report.--A State is not eligible for an 
                increase in its Federal matching payments under 
                paragraph (1) unless the State agrees to submit to the 
                Secretary of Health and Human Services, and make 
                publicly available, a report that contains the 
                information required under paragraph (4) by the end of 
                the 1-year period during which the State receives 
                increased Federal matching payments in accordance with 
                that paragraph.
                    (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) 
                        if eligibility standards, methodologies, or 
                        procedures under its State plan under title XIX 
                        of the Social Security Act (42 U.S.C. 1396 et 
                        seq.), or waiver of such a plan, 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 (42 U.S.C. 1396 et 
                        seq.), or a waiver of such plan, after the date 
                        of enactment of this Act, is no longer 
                        ineligible under clause (i) 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) Limitation of matching payments to 100 
                percent.--In no case shall an increase in Federal 
                matching payments under paragraph (1) result in Federal 
                matching payments that exceed 100 percent of State 
                expenditures.
            (4) Required report information.--The information that is 
        required in the report under paragraph (3)(A) shall include--
                    (A) the results of an evaluation of the impact of 
                the implementation of the requirements of paragraph 
                (16) of section 1902(e) of the Social Security Act (42 
                U.S.C. 1396a(e)) on improving the State's processes for 
                enrolling individuals who are released from public 
                institutions under the State Medicaid plan;
                    (B) the number of individuals who were 
                automatically enrolled (or whose enrollment was 
                reinstated) under such paragraph during the 1-year 
                period during which the State received increased 
                payments under this subsection; and
                    (C) any other information that is required by the 
                Secretary of Health and Human Services.
    (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.
            (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 (42 U.S.C. 1396 et seq.) 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 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 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 Director of the Bureau of Prisons (referred to 
in this section as the ``Director'') 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 the policy required to be developed 
under subsection (b) 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 Director 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 the policy required under subsection (b).
    (e) Time Limit.--Not later than 1 year after the date of enactment 
of this Act, the Director shall draft appropriate regulations to 
implement the policy required to be developed under subsection (b).
    (f) Requirements for Policy.--The policy required to be developed 
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 not earlier 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 enactment of this Act, the 
        Director shall provide a report to the Congress on the policies 
        and procedures of the Bureau of Prisons 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 Director 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 enactment of this Act, and then annually 
                thereafter, the Director 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.--Each 
                report 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 the testing, treatment, and 
                        prevention education programs for these 
                        diseases conducted by the Bureau of Prisons.
                    (C) Matters pertaining to hiv/aids only.--Each 
                report 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 Director 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 each report 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 Assistant Secretary for Mental 
Health and Substance Use, 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 National Academy 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 (Public Law 111-148) 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 a State Medicaid program, the 
                Medicare program, 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, 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 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 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 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 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.), as amended by section 721, is further amended by inserting 
after section 317X 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 by section 733, 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 by section 773, 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 National Academy of Medicine under which the 
National Academy will--
            (1) not later than 1 year after the date of enactment of 
        this Act, submit to Congress an updated version of the 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.--Congress finds as follows:
            (1) The prevalence of asthma has increased since 1980 and 
        affects more than 26,000,000 people in the United States.
            (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 2016, almost 4,500,000 non-Hispanic African 
        Americans reported having asthma. African Americans with asthma 
        are 3 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) The majority 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 Healthy People 2020; 
                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.--Congress finds as follows:
            (1) Chronic obstructive pulmonary disease (referred to in 
        this subsection as ``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) It is estimated that over 13,500,000 adults in the 
        United States have COPD.
            (5) COPD is the third-leading cause of death in the United 
        States, 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 National Academy 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 (c).
    (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 may be cited as the ``End 
Tuberculosis Act''.
    (b) Findings.--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 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 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(h) of the Public Health Act (42 U.S.C. 247b-6(h)) 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 section 317 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 (referred to in this 
section 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.

    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 46,000,000 people in the United 
        States, and that number will rise to 67,000,000 by the year 
        2030.
            (3) Twenty-seven million people in the United States 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 non-obese adults will have end-stage disease 
        over the same time period.
            (5) Arthritis affects 1 in 5 people in the United States 
        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 $128,000,000,000 a year, including 
        $81,000,000,000 in direct costs (medical) and $47,000,000,000 
        in indirect costs (lost earnings). Each year, $309,000,000,000 
        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 43,000,000 annual 
        visits to physicians' offices and outpatient clinics where 
        arthritis was the primary diagnosis. Women also represented 60 
        percent of approximately 1,000,000 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 
        (referred to in this section as ``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 (referred to in this section as ``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 National Academy 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 and Blacks;
                    (D) Hispanic and 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.--Congress finds the following:
            (1) Decrements in sleep health such as sleep apnea, 
        insufficient sleep time, and insomnia, affect 50,000,000 to 
        70,000,000 adults in the United States. 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 people in 
        the United States 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.--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 and Blacks;
                    (D) Hispanic and 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 
(referred to in this section 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 
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 by section 774, 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.''.

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) 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'';
            (2) by striking ``Sickle Cell Disease'' each place such 
        term appears and inserting ``sickle cell disease'';
            (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 shall 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 EHR technology'' has the meaning given such 
        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 EHR 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 (referred to in this section as the 
        ``National Coordinator'') shall--
                    (A) 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 such communities have providers who use 
                electronic health records, and indicating whether such 
                providers--
                            (i) are participating in the Medicare 
                        program under title XVIII of the Social 
                        Security Act (42 U.S.C. 1395 et seq.) or a 
                        State plan under title XIX of such Act (42 
                        U.S.C. 1396 et seq.) (or a waiver of such 
                        plan);
                            (ii) have received incentive payments or 
                        incentive payment adjustments under Medicare 
                        and Medicaid Electronic Health Records 
                        Incentive Programs (as defined in subsection 
                        (c)(2));
                            (iii) are MIPS eligible professionals, as 
                        defined in paragraph (1)(C) of section 1848(q) 
                        of the Social Security Act (42 U.S.C. 1395w-
                        4(q)), for purposes of the Merit-Based 
                        Incentive Payment System under such section; or
                            (iv) have been recruited by any of the 
                        Health Information Technology Regional 
                        Extension Centers established under section 
                        3012 of the Public Health Service Act (42 
                        U.S.C. 300jj-32); and
            (2) publish the results of such evaluation including the 
        race and ethnicity of such providers and the populations served 
        by such providers.
    (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 National Center for Health Statistics 
data brief entitled ``Adoption of Certified Electronic Health Record 
Systems and Electronic Information Sharing in Physician Offices: United 
States, 2013 and 2014'' (NCHS Data Brief No. 236).
    (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 Medicare and Medicaid Electronic 
        Health Records Incentive Programs (as defined in paragraph (2)) 
        or the Merit-Based Incentive Payment System under section 
        1848(q) of the Social Security Act (42 U.S.C. 1395w-4(q)), 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'';
            (3) by striking ``The National Coordinator'' and inserting 
        the following:
                            ``(i) In general.--The National 
                        Coordinator''; and
            (4) by adding at the end the following:
                            ``(ii) Criteria.--In any publication under 
                        clause (i), 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 of 
                        1973 to encourage patient involvement in 
                        patient health care. The National Coordinator 
                        shall--
                                    ``(I) not later than 6 months after 
                                the submission of the report required 
                                under 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 1 year after 
                                the submission of such report, 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), in the matter preceding paragraph 
        (1), by inserting ``, including with respect to communities 
        with a high proportion of individuals from racial and ethnic 
        minority groups (as defined in section 1707(g))'' before the 
        colon; and
            (2) by adding at the end the following new subsection:
    ``(e) Annual Report on Expenditures.--The National Coordinator 
shall report annually to Congress on activities and expenditures under 
this section.''.

SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DEVELOPMENT OF LOAN 
              PROGRAMS TO FACILITATE ADOPTION OF CERTIFIED EHR 
              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, in the matter preceding paragraph (1), by inserting 
``, including with respect to communities with a high proportion of 
individuals from racial and ethnic minority groups (as defined in 
section 1707(g))'' after ``health care provider to''.

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-, or 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 2 years 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 defined in section 3000 of the 
        Public Health Service Act (42 U.S.C. 300jj)) is effective in 
        reducing health disparities, including analysis of clinical 
        quality measures reported by providers who are participating in 
        the Medicare program under title XVIII of the Social Security 
        Act (42 U.S.C. 1395 et seq.) or a State plan under title XIX of 
        such Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan), 
        pursuant to programs to encourage the adoption and use of 
        certified EHR 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 of the 
        Public Health Service Act (42 U.S.C. 295p); or
            (4) another area or population that--
                    (A) experiences significant barriers to accessing 
                quality health services; and
                    (B) has a high prevalence of diseases or conditions 
                described in title VII, 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.

    (a) In General.--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)).''.
    (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.

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 C the following:

               ``Subtitle D--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 that 
receive Federal financial assistance are in compliance with title VI of 
the Civil Rights Act, including through the following activities:
            ``(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 
        National Academy of Sciences (formerly known as 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 
        National Academy of Sciences. 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 most recent 
                version of the Office of Management and Budget 
                statistical policy directive entitled `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.
    ``(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 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 the applicable 
        agency, 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 
        most recent version of the Office of Management and Budget 
        statistical policy directive entitled `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.
            ``(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 of 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 described in subsection (a), subject to 
        paragraph (2).
            ``(2) Department of justice.--The Office for Civil Rights 
        of the Department of Justice may, as appropriate, institute 
        formal proceedings when a civil rights compliance office 
        established under subsection (a) determines that a recipient of 
        Federal financial assistance is not in compliance with the 
        disparity reduction standards of the applicable 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 minority groups based on race or color, promote 
        coordination of such activities of--
                    ``(A) the Office for Civil Rights within the Office 
                of Justice Programs of 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 population of the United 
        States 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 to 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 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 should be 
        accountable for their role in causing disparities and inequity;
            (3) funding 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 should be doubled 
        by fiscal year 2020;
            (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 Initiative at the Centers for 
        Disease Control and Prevention, the Minority HIV/AIDS 
        Initiative, and the Excellence Centers to Eliminate Ethnic/
        Racial Disparities Program at the Agency for Healthcare 
        Research and Quality;
            (5) funding should be fully restored to the Racial and 
        Ethnic Approaches to Community Health 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 Racial and 
        Ethnic Approaches to Community Health 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 during such period.
                    (C) All members of the peer review panels of such 
                applicants and recipients, respectively.
            (2) Report.--Not later than 6 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 6 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)) 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 Patient Protection and Affordable Care 
        Act (Public Law 111-148) (including the amendments made by such 
        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 such 
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.

    In this title:
            (1) Determinants of health.--The term ``determinants of 
        health''--
                    (A) means the range of personal, social, economic, 
                and environmental factors that influence health status; 
                and
                    (B) 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.
            (2) Environmental determinants of health.--The term 
        ``environmental determinants of health'' means the broad 
        physical, psychological, social, and aesthetic environment.
            (3) Personal determinants of health.--The term ``personal 
        determinants of health'' means an individual's behavior, 
        biology, and genetics.
            (4) Social determinants of health.--The term ``social 
        determinants of health'' means a subset of determinants of the 
        health of individuals and environments (such as communities, 
        neighborhoods, and societies) that describe an individual's or 
        group of people's social identity, describe the social and 
        economic resources to which such individual or group has 
        access, and describe the conditions in which an individual or 
        group of people works, lives, and plays.

SEC. 1002. FINDINGS.

    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, in the air we breathe, and in 
        the water we drink.
            (2) The social determinants of health are the largest 
        predictors of health outcomes.
            (3)(A) 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.
            (B) The following examples illustrate the nexus between the 
        unequal distribution of the social determinants of health and 
        health disparities:
                    (i) 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.
                    (ii) 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.
                    (iii) 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 Vietnamese 
                women who constitute 48 percent of nail salon 
                technicians, 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.
                    (iv) 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 health and social services, and experiences with the 
                criminal justice system are all highly patterned by 
                race, with non-White racial groups 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.
                    (v) 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 of 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.
                    (vi) 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 harmful health 
                behaviors such as tobacco use, drug use, and violence.
                    (vii) Educational attainment is the strongest 
                predictor of adult mortality. It is a basic component 
                of socioeconomic status that shapes 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.
                    (viii) Similarly, reading ability is a strong 
                predictor of adult health status and greater reading 
                ability is negatively correlated with other child 
                health issues, such as developmental problems, vision 
                and hearing impairments, and frequent school absence 
                due to illness.
                    (ix) 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.
                    (x) 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.
                    (xi) 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.
                    (xii) 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 3,600,000 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 $50,000,000,000 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 adopted by the World Health Organisation 
        in October 2011 that ``[c]ollaboration in coordinated and 
        intersectoral policy actions has proven to be effective. Health 
        in All Policies, an initiative of the American Public Health 
        Association, 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 by section 
796A, is further amended by adding at the end the following:

``SEC. 399V-12. HEALTH IMPACT ASSESSMENTS.

    ``(a) Definitions.--In this section:
            ``(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) 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.
            ``(5) Health disparity.--The term `health disparity' means 
        a particular type of health difference that is closely linked 
        with social, economic, or environmental disadvantage and that 
        adversely affects 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.
    ``(b) Establishment.--The Secretary, acting through the Director 
and in collaboration with the Administrator, shall--
            ``(1) in consultation with 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, 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 that includes--
                    ``(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) develop guidance and guidelines to conduct health 
        impact assessments in accordance with subsection (c); and
            ``(3) establish a grant program to allow States to fund 
        eligible entities to conduct health impact assessments.
    ``(c) Guidance.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Health Equity and Accountability Act of 2018, 
        the Secretary, acting through the Director, shall issue final 
        guidance for conducting the health impact assessments. In 
        developing such guidance the Secretary shall--
                    ``(A) consult 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; and
                    ``(B) consider available international health 
                impact assessment guidance, North American health 
                impact assessment practice standards, and 
                recommendations from the National Academy of Science.
            ``(2) Content.--The guidance under this subsection shall 
        include--
                    ``(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.
    ``(d) Grant Program.--
            ``(1) In general.--The Secretary, acting through the 
        Director and in collaboration with the Administrator, shall--
                    ``(A) award grants to States to fund eligible 
                entities for capacity building or to prepare health 
                impact assessments; and
                    ``(B) 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, institution of higher education, or nonprofit 
                health impact assessment experts to provide such 
                technical assistance.
            ``(2) Applications.--
                    ``(A) In general.--To be eligible to receive a 
                grant under this section, an eligible entity shall--
                            ``(i) be a State, Indian tribe, or tribal 
                        organization that includes individuals or 
                        populations the health of which are, or will 
                        be, affected by an activity or a proposed 
                        activity; and
                            ``(ii) 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.
                    ``(B) 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.
                    ``(C) 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.
            ``(3) Use of funds.--
                    ``(A) In general.--An entity receiving a grant 
                under this section shall use such grant funds to 
                conduct health impact assessment capacity building or 
                to fund subgrantees in conducting a health impact 
                assessment for a proposed activity in accordance with 
                this subsection.
                    ``(B) Purposes.--The purposes of a health impact 
                assessment under this subsection are--
                            ``(i) 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;
                            ``(ii) 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;
                            ``(iii) 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;
                            ``(iv) 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;
                            ``(v) to ensure that the disproportionate 
                        distribution of negative impacts among 
                        vulnerable populations is minimized as much as 
                        possible;
                            ``(vi) to engage affected community members 
                        and ensure adequate opportunity for public 
                        comment on all stages of the health impact 
                        assessment;
                            ``(vii) 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
                            ``(viii) 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.
            ``(4) Assessments.--Health impact assessments carried out 
        using grant funds under this section shall--
                    ``(A) take appropriate health factors into 
                consideration as early as practicable during the 
                planning, review, or decisionmaking processes;
                    ``(B) 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
                    ``(C) assess the distribution of health effects 
                across various factors, such as race, income, 
                ethnicity, age, disability status, gender, and 
                geography.
            ``(5) 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.
            ``(6) 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.
            ``(7) 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.
            ``(8) 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.
            ``(9) 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.
            ``(10) 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.
            ``(11) Methodology.--In preparing a health impact 
        assessment under this subsection, an eligible entity or partner 
        shall follow the guidance published under subsection (c).
    ``(e) 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).
    ``(f) 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.
    ``(g) Report to Congress.--Not later than 1 year after the date of 
enactment of the Health Equity and Accountability Act of 2018, 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.
    ``(h) 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.--The Secretary, in collaboration with 
the Administrator of the Environmental Protection Agency (referred to 
in this section as the `Administrator'), shall award grants to public 
agencies or private nonprofit institutions to implement evidence-based 
programming to improve human health through improvements to the built 
environment and subsequently human health, by addressing--
            ``(1) levels of physical activity;
            ``(2) consumption of nutritional foods;
            ``(3) rates of crime;
            ``(4) air, water, and soil quality;
            ``(5) risk or rate of injury;
            ``(6) accessibility to health-promoting goods and services;
            ``(7) chronic disease rates;
            ``(8) community design;
            ``(9) housing; or
            ``(10) other factors, as the Secretary determines 
        appropriate.
    ``(b) Applications.--A public agency or private nonprofit 
institution desiring a grant under this section shall submit to the 
Secretary an application at such time, in such manner, and containing 
such agreements, assurances, and information as the Secretary, in 
consultation with the Administrator, may require.
    ``(c) Research.--The Secretary, in consultation with the 
Administrator, shall support, through grants awarded under this 
section, research that--
            ``(1) uses evidence-based research to improve the built 
        environment and human health;
            ``(2) examines--
                    ``(A) 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
                    ``(B) the distribution of such impacts by--
                            ``(i) location; and
                            ``(ii) population subgroup;
            ``(3) is used to develop--
                    ``(A) measures and indicators to address health 
                impacts and the connection of health to the built 
                environment;
                    ``(B) efforts to link the measures to 
                transportation, land use, and health databases; and
                    ``(C) efforts to enhance the collection of built 
                environment surveillance data;
            ``(4) 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
            ``(5)(A) 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
            ``(B) in developing the intervention strategies under 
        subparagraph (A), 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.
    ``(d) Surveys.--The Secretary may allow recipients of grants under 
this section to use such grant funds 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.
    ``(e) Priority.--In awarding grants under this section, the 
Secretary and the Administrator shall give priority to entities with 
programming that incorporates--
            ``(1) interdisciplinary approaches; or
            ``(2) the expertise of the public health, physical 
        activity, urban planning, land use, and transportation research 
        communities in the United States and abroad.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section. 
The Secretary may allocate not more than 20 percent of the amount so 
appropriated for a fiscal year for purposes of conducting research 
under subsection (c).''.

SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY ENVIRONMENTAL 
              PROTECTION AGENCY.

    (a) Inspector General Recommendations.--The Administrator of the 
Environmental Protection Agency (referred to in this section as the 
``Administrator'') shall, as promptly as practicable, carry out each of 
the following recommendations of the Inspector General of the 
Environmental Protection Agency as described in the report entitled 
``EPA needs to conduct environmental justice reviews of its programs, 
policies and activities'' (Report No. 2006-P-00034):
            (1) The recommendation that the program and regional 
        offices of the Environmental Protection Agency identify which 
        programs, policies, and activities need environmental justice 
        reviews and the Administrator require those offices to 
        establish a plan to complete the necessary reviews.
            (2) The recommendation that the Administrator ensure that 
        the reviews described in paragraph (1) 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 of the Environmental Protection Agency 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 promulgating regulations of the 
Environmental Protection Agency, the Administrator shall, as promptly 
as practicable, carry out each of the following recommendations of the 
Comptroller General of the United States as described in the report 
entitled ``EPA Should Devote More Attention to Environmental Justice 
when Developing Clean Air Rules'' (GAO-05-289):
            (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 the workgroups described in paragraph (1) to 
        identify potential environmental justice issues through steps 
        such as--
                    (A) providing workgroup members with guidance and 
                training to help those members identify potential 
                environmental justice problems; and
                    (B) involving environmental justice coordinators in 
                the workgroups if 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 those impacts.
            (4) The recommendation that the Administrator direct 
        appropriate officers and employees of the Environmental 
        Protection Agency, if feasible, to respond fully to public 
        comments on environmental justice, including by--
                    (A) improving the explanation by the Administrator 
                of the basis for any conclusions relating to 
                environmental justice; and
                    (B) including in an explanation under subparagraph 
                (A) supporting data.
    (c) 2004 Inspector General Report.--
            (1) In general.--The Administrator shall, as promptly as 
        practicable, carry out each of the following recommendations of 
        the Inspector General of the Environmental Protection Agency as 
        described in the report entitled ``EPA Needs to Consistently 
        Implement the Intent of the Executive Order on Environmental 
        Justice'' (Report No. 2004-P-00007):
                    (A) The recommendation that the Administrator 
                clearly define the mission of the Office of 
                Environmental Justice and provide Environmental 
                Protection Agency staff with an understanding of the 
                roles and responsibilities of that Office.
                    (B) The recommendation that the Administrator--
                            (i) establish, through the issuance of 
                        guidance or a policy statement, specific 
                        timeframes for the development of definitions, 
                        goals, and measurements regarding environmental 
                        justice; and
                            (ii) provide the regions and program 
                        offices a standard and consistent definition 
                        for a minority and low-income community, with 
                        instructions on how the Environmental 
                        Protection Agency will implement and put into 
                        operation environmental justice in the daily 
                        activities of the Environmental Protection 
                        Agency.
                    (C) The recommendation that the Administrator 
                ensure that the comprehensive training program under 
                development (as of the date of enactment of this Act) 
                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.
            (2) Reports.--
                    (A) Initial report.--Not later than 180 days after 
                the date of enactment of this Act, the Administrator 
                shall submit to Congress an initial report on the 
                strategy of the Administrator for implementing the 
                recommendations described in subparagraphs (A), (B), 
                and (C) of paragraph (1).
                    (B) Subsequent reports.--After submitting the 
                initial report under subparagraph (A), the 
                Administrator shall submit to Congress semiannual 
                reports on the progress of the Administrator in--
                            (i) implementing the recommendations 
                        referred to in subparagraph (A); and
                            (ii) modifying the emergency management 
                        procedures of the Administrator to incorporate 
                        environmental justice in the Incident Command 
                        Structure of the Environmental Protection 
                        Agency, in accordance with the December 18, 
                        2006, letter from the Deputy Administrator to 
                        the Acting Inspector General of the 
                        Environmental Protection Agency.
    (d) Federal Action Plan for Saving Lives, Protecting People and 
Their Families From Radon.--
            (1) Findings.--Congress finds that radon is a naturally 
        occurring radioactive gas that is--
                    (A) recognized as the leading cause of lung cancer 
                among nonsmokers; and
                    (B) a particular environmental threat for low-
                income and minority individuals because of the lack of 
                information about radon levels in the homes of those 
                individuals.
            (2) Implementation.--Not later than 180 days after the date 
        of the enactment of this Act, the Administrator shall implement 
        the action plan entitled ``Protecting People and Families from 
        Radon: A Federal Action Plan for Saving Lives'' (June 20, 
        2011), in consultation with the Director of the Centers for 
        Disease Control and Prevention and any other Federal agencies 
        referred to in the action plan.
            (3) Specific steps.--In carrying out paragraph (2), the 
        Administrator shall ensure that--
                    (A) the workgroup comprised of the Federal agencies 
                participating in the development of the action plan 
                referred to in paragraph (2) implements specific steps 
                within the existing authority and activities of each 
                Federal agency to reduce exposure to radon; and
                    (B) not later than the date that is 1 year after 
                the date on which the Administrator begins 
                implementation of the action plan described in 
                paragraph (2), the workgroup described in subparagraph 
                (A) meets to assess and recognize achievements of the 
                plan.
            (4) Report.--After the progress meeting of the workgroup 
        under paragraph (3)(B), the Administrator shall submit to 
        Congress a report on the implementation of the action plan 
        described in paragraph (2), including the challenges remaining 
        and the progress in reducing radon exposure, particularly for 
        low-income and minority families.
    (e) Federal Action Plan for Preventing Childhood Lead Poisoning.--
            (1) Findings.--Congress finds that--
                    (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 children 
                exposed to lead result in a lifetime of health and 
                behavioral problems, which makes prevention efforts 
                more critical; and
                    (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.--Not later than 180 days after the date of 
        enactment of this Act, the Administrator, in consultation with 
        the Director of the Centers for Disease Control and Prevention 
        and other relevant Federal agencies, shall develop an action 
        plan to reduce exposure to lead.
            (3) Specific steps.--In carrying out paragraph (2), the 
        Administrator shall--
                    (A) establish a working group, comprised of 
                representatives of the Federal agencies participating 
                in the development of the action plan described in 
                paragraph (2), to make recommendations for the 
                implementation of specific steps within the existing 
                authority and activities of each Federal agency to 
                reduce exposure to lead; and
                    (B) assist other Federal agencies in the 
                development of materials on the hazards of lead-based 
                paint for the purpose of educating tenants and 
                landlords, how to recognize potential sources of 
                exposure, and how to remediate those sources.

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, 
                disproportionately high 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, or 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) Use of Grant Funds.--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.--The Director shall award 
grants to eligible entities at the following 3 funding levels:
            (1) 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.
            (2) 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 (1)).
                    (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 
                        (1)(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 the conditions described 
                                in subclause (I) 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.
            (3) 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 eligible entities awarded a grant 
                        under this paragraph to report any other 
                        information the Director determines appropriate 
                        to be shared by or developed by such entity, 
                        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.--Congress finds that--
                    (A) humans share an environment with a wide variety 
                of habitats and ecosystems that nurture and sustain a 
                diversity of species;
                    (B) the abundance of natural resources in the 
                environment forms the basis for the 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--
                            (i) the natural environment and its 
                        resources;
                            (ii) the health and diversity of plant and 
                        animal life;
                            (iii) the availability of critical 
                        habitats;
                            (iv) the quality of the air and water; and
                            (v) the global climate;
                    (D) the intervention of the Federal Government is 
                necessary to minimize and mitigate human impact on the 
                environment--
                            (i) for the benefit of public health;
                            (ii) to maintain air quality and water 
                        quality;
                            (iii) to sustain the diversity of plants 
                        and animals;
                            (iv) to combat global climate change; and
                            (v) to protect the environment;
                    (E) laws and regulations in the United States have 
                been enacted 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, including--
                            (i) chapter 3203 of title 54, United States 
                        Code (commonly known as the ``Antiquities Act 
                        of 1906''), which was initiated by President 
                        Theodore Roosevelt to create the National Park 
                        System;
                            (ii) the National Environmental Policy Act 
                        of 1969 (42 U.S.C. 4321 et seq.);
                            (iii) the Clean Air Act (42 U.S.C. 7401 et 
                        seq.);
                            (iv) the Federal Water Pollution Control 
                        Act (33 U.S.C. 1251 et seq.);
                            (v) the Comprehensive Environmental 
                        Response, Compensation, and Liability Act of 
                        1980 (42 U.S.C. 9601 et seq.);
                            (vi) the Endangered Species Act of 1973 (16 
                        U.S.C. 1531 et seq.); and
                            (vii) the National Forest Management Act of 
                        1976 (Public Law 94-588; 90 Stat. 2949) and the 
                        amendments made by that Act; and
                    (F) 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.--
        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) Fill material.--
                                    (I) On May 9, 2002, the 
                                Environmental Protection Agency and the 
                                Corps of Engineers issued a final rule, 
                                entitled ``Final Revisions to the Clean 
                                Water Act Regulatory Definitions of 
                                `Fill Material' and `Discharge of Fill 
                                Material''' (67 Fed. Reg. 31129), that 
                                reconciled regulations implementing 
                                section 404 of the Federal Water 
                                Pollution Control Act (33 U.S.C. 1344) 
                                by redefining the term ``fill 
                                material'' and amending the definition 
                                of the term ``discharge of fill 
                                material'', reversing a 25-year-old 
                                regulation.
                                    (II) The rule described in 
                                subclause (I)--
                                            (aa) fails to restrict the 
                                        dumping of hardrock mining 
                                        waste, construction debris, and 
                                        other industrial wastes into 
                                        rivers, streams, lakes, and 
                                        wetlands; and
                                            (bb) 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) Livestock waste regulations.--
                                    (I) On February 12, 2003, the 
                                Environmental Protection Agency 
                                published the rule entitled ``National 
                                Pollutant Discharge Elimination System 
                                Permit Regulation and Effluent 
                                Limitation Guidelines and Standards for 
                                Concentrated Animal Feeding Operations 
                                (CAFOs)'' (68 Fed. Reg. 7176), new 
                                livestock waste regulations that aimed 
                                to control factory farm pollution but 
                                which would severely undermine then-
                                existing protections under the Federal 
                                Water Pollution Control Act (33 U.S.C. 
                                1251 et seq.).
                                    (II) The regulation described in 
                                subclause (I) allows large-scale animal 
                                factories to foul waters in the United 
                                States 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.
                                    (III) 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 Environmental Protection Agency.
                                    (IV) On November 20, 2008, the 
                                Environmental Protection Agency 
                                published a revised final rule, 
                                entitled ``Revised National Pollutant 
                                Discharge Elimination System Permit 
                                Regulation and Effluent Limitations 
                                Guidelines for Concentrated Animal 
                                Feeding Operations in Response to the 
                                Waterkeeper Decision'' (73 Fed. Reg. 
                                70418), that undermines environmental 
                                protection provisions by removing 
                                mandatory permitting requirements and 
                                allowing large animal farms to self-
                                certify the absence of pollutant 
                                discharge activity.
                            (iii) Total maximum daily load.--
                                    (I) On March 19, 2003, the 
                                Environmental Protection Agency 
                                published a new rule regarding the 
                                total maximum daily load program under 
                                section 303(d) of the Federal Water 
                                Pollution Control Act (33 U.S.C. 
                                1313(d)), entitled ``Withdrawal of 
                                Revisions to the Water Quality Planning 
                                and Management Regulation and Revisions 
                                to the National Pollutant Discharge 
                                Elimination System Program in Support 
                                of Revisions to the Water Quality 
                                Planning and Management Regulation'' 
                                (68 Fed. Reg. 13608), that regulates 
                                the maximum amount of a particular 
                                pollutant that can be present in a body 
                                of water and still meet water quality 
                                standards.
                                    (II) The new rule described in 
                                subclause (I) withdrew the then-
                                existing regulation issued on July 13, 
                                2000, and entitled ``Revisions to the 
                                Water Quality Planning and Management 
                                Regulation and Revisions to the 
                                National Pollutant Discharge 
                                Elimination System Program in Support 
                                of Revisions to the Water Quality 
                                Planning and Management Regulation'' 
                                (65 Fed. Reg. 43586) and halted 
                                momentum in cleaning up polluted 
                                waterways throughout the United States.
                                    (III) By abandoning the then-
                                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.
                                    (IV) 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.
                                    (V) The result of dropping the rule 
                                described in subclause (II) 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) Waters of the united states.--
                                    (I) On December 2, 2008, the 
                                Environmental Protection Agency and the 
                                Corps of Engineers jointly issued a 
                                guidance document, entitled ``Clean 
                                Water Act Jurisdiction Following the 
                                U.S. Supreme Court's Decision in 
                                Rapanos v. United States & Carabell v. 
                                United States''.
                                    (II) The guidance described in 
                                subclause (I) dictates enforcement 
                                actions under the Federal Water 
                                Pollution Control Act (33 U.S.C. 1251 
                                et seq.) and calls for a complicated 
                                ``case-by-case'' analysis to determine 
                                jurisdiction for waterways that do not 
                                flow all year.
                                    (III) Enforcement actions described 
                                in subclause (II) 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.
                                    (IV) The definition provided in the 
                                guidance described in subclause (I) for 
                                ``waters of the United States'' is 
                                applicable to the Federal Water 
                                Pollution Control Act (33 U.S.C. 1251 
                                et seq.) 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 that Act.
                    (B) Forests and land management.--
                            (i) Healthy forests restoration act of 
                        2003.--
                                    (I) On December 3, 2003, the 
                                President signed into law the Healthy 
                                Forests Restoration Act of 2003 (16 
                                U.S.C. 6501 et seq.) (referred to in 
                                this clause as the ``law'').
                                    (II) Although the law attempts to 
                                reduce the risk of catastrophic forest 
                                fires, the law provides a boon to 
                                timber companies by accelerating the 
                                aggressive thinning of backcountry 
                                forests that are located far from at-
                                risk communities.
                                    (III) The law allows for increased 
                                logging of large, fire-resistant trees 
                                that are not in close proximity to 
                                homes and communities.
                                    (IV) The law 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.
                                    (V) The law limits public 
                                participation by reducing the number of 
                                environmental reviews for projects 
                                carried out under the law.
                            (ii) NFS land management planning final 
                        planning rule and record of decision.--
                                    (I) On April 21, 2008, the 
                                Secretary of Agriculture issued a final 
                                rule entitled ``National Forest System 
                                Land Management Planning'' (73 Fed. 
                                Reg. 21486 (April 21, 2008)) (referred 
                                to in this clause as the ``revised 
                                rule'').
                                    (II) The revised rule is a revision 
                                of a similar final rule entitled 
                                ``National Forest System Land 
                                Management Planning'' (70 Fed Reg. 1022 
                                (January 5, 2005)), which the United 
                                States District Court for the Northern 
                                District of California remanded to the 
                                Secretary of Agriculture in the case 
                                styled Citizens for Better Forestry v. 
                                United States Department of Agriculture 
                                (481 F. Supp. 2d 1059 (N.D. Cal. 2007)) 
                                for violating--
                                            (aa) the National 
                                        Environmental Policy Act of 
                                        1969 (42 U.S.C. 4321 et seq.);
                                            (bb) the Endangered Species 
                                        Act of 1973 (16 U.S.C. 1531 et 
                                        seq.); and
                                            (cc) subchapter II of 
                                        chapter 5, and chapter 7, of 
                                        title 5, United States Code 
                                        (commonly known as the 
                                        ``Administrative Procedure 
                                        Act'').
                                    (III) The revised rule eliminates 
                                strict forest planning standards 
                                established in 1982.
                                    (IV) The revised rule opens 
                                millions of acres of public land to 
                                damaging and invasive logging, mining, 
                                and drilling operations.
                                    (V) The revised rule would reverse 
                                more than 20 years of protections for 
                                wildlife and national forests by--
                                            (aa) removing the overall 
                                        goal of ensuring ecological 
                                        sustainability in managing the 
                                        National Forest System;
                                            (bb) weakening the effect 
                                        of the National Forest 
                                        Management Act of 1976 (Public 
                                        Law 94-588; 90 Stat. 2949) and 
                                        the amendments made by that 
                                        Act; and
                                            (cc) effectively ending the 
                                        review of forest management 
                                        plans under the National 
                                        Environmental Policy Act of 
                                        1969 (42 U.S.C. 4321 et seq.).
                            (iii) Inventoried roadless area rules.--
                                    (I) On September 20, 2006, the 
                                United States District Court for the 
                                Northern District of California vacated 
                                the final rule entitled ``Special 
                                Areas; State Petitions for Inventoried 
                                Roadless Area Management'' (70 Fed. 
                                Reg. 25654 (May 13, 2005)) (referred to 
                                in this clause as the ``2005 rule''), 
                                which gave each Governor of a State 18 
                                months to petition the Federal 
                                Government--
                                            (aa) to restore the 
                                        inventoried roadless area rules 
                                        applicable to the State of the 
                                        Governor before the effective 
                                        date of the final rule entitled 
                                        ``Special Areas; Roadless Area 
                                        Conservation'' (66 Fed. Reg. 
                                        3244 (January 12, 2001)) 
                                        (referred to in this clause as 
                                        the ``2001 rule''); or
                                            (bb) to submit a new 
                                        management and development plan 
                                        for National Forest System 
                                        inventoried roadless areas 
                                        within the State.
                                    (II) Despite the enjoinment of the 
                                2005 rule and the subsequent 
                                restoration of the 2001 rule, the 
                                Forest Service has continued to allow 
                                States to petition for a special rule 
                                under the authority of section 553(e) 
                                of title 5, United States Code, and has 
                                issued a final rule entitled ``Special 
                                Areas; Roadless Area Conservation; 
                                Applicability to the National Forests 
                                in Idaho'' (73 Fed. Reg. 61456 (October 
                                16, 2008)).
                                    (III) As a result, 58,500,000 acres 
                                of wild National Forest System land are 
                                still vulnerable to logging, road 
                                building, and other developments that 
                                may fragment natural habitats and 
                                negatively impact fish and wildlife.
                            (iv) BLM resource management plans.--
                                    (I) On November 28, 2008, the 
                                Bureau of Land Management announced the 
                                record of decision entitled ``Record of 
                                Decision for Oil Shale and Tar Sands 
                                Resources to Address Land Use 
                                Allocations in Colorado, Utah, and 
                                Wyoming'' (73 Fed. Reg. 72519 (November 
                                28, 2008)), which amended 12 resource 
                                management plans in the States of 
                                Colorado, Utah, and Wyoming, opening 
                                2,000,000 acres of public land to 
                                commercial tar sands and oil shale 
                                exploration and development.
                                    (II) On November 18, 2008, the 
                                Bureau of Land Management issued the 
                                final rule entitled ``Oil Shale 
                                Management--General'' (73 Fed. Reg. 
                                69414 (November 18, 2008)), setting the 
                                policies and procedures for a 
                                commercial leasing program for the 
                                management of federally owned oil shale 
                                in the States referred to in subclause 
                                (I).
                                    (III) 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 land 
                                poses a serious threat to land 
                                conservation, endangered and threatened 
                                species, and critical habitat.
                                    (IV) Domestic shale oil production 
                                authorized by the final rules described 
                                in subclauses (I) and (II)--
                                            (aa) is water- and energy-
                                        intensive; and
                                            (bb) will intensify 
                                        existing water scarcity in the 
                                        arid Western United States and 
                                        potentially degrade air and 
                                        water quality for surrounding 
                                        populations.
                    (C) Scientific review.--
                            (i) On December 16, 2008, the United States 
                        Fish and Wildlife Service and the National 
                        Marine Fisheries Service jointly issued a new 
                        rule, entitled ``Interagency Cooperation Under 
                        the Endangered Species Act'' (73 Fed. Reg. 
                        76272) amending regulations governing 
                        interagency cooperation under section 7 of the 
                        Endangered Species Act of 1973 (16 U.S.C. 
                        1536).
                            (ii) The rule described in clause (i) 
                        undermines the intention of the Endangered 
                        Species Act (16 U.S.C. 1531 et seq.) to protect 
                        species and the ecosystems on which those 
                        species 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.
                            (iii) Under the rule described in clause 
                        (i), Federal agencies can unilaterally 
                        circumvent the formal review process, 
                        eliminating longstanding and scientifically 
                        grounded safeguards that serve to protect the 
                        biodiversity of ecosystems in the United States 
                        and avert harm to thousands of endangered and 
                        threatened species.
    (b) Statement of Policy.--It is the policy of the Federal 
Government to work in conjunction with States, territories, Tribal 
governments, international organizations, and foreign governments 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.
    (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 shall 
        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) The final rule of the Environmental 
                        Protection Agency and the Corps of Engineers 
                        entitled ``Final Revisions to the Clean Water 
                        Act Regulatory Definitions of `Fill Material' 
                        and `Discharge of Fill Material''' (67 Fed. 
                        Reg. 31129 (May 9, 2002)).
                            (ii) The final rule of the Environmental 
                        Protection Agency entitled ``Revised National 
                        Pollutant Discharge Elimination System Permit 
                        Regulation and Effluent Limitations Guidelines 
                        for Concentrated Animal Feeding Operations in 
                        Response to the Waterkeeper Decision'' (73 Fed. 
                        Reg. 70418 (November 20, 2008)).
                            (iii) The final rule entitled ``Withdrawal 
                        of Revisions to the Water Quality Planning and 
                        Management Regulation and Revisions to the 
                        National Pollutant Discharge Elimination System 
                        Program in Support of Revisions to the Water 
                        Quality Planning and Management Regulation'' 
                        (68 Fed. Reg. 13608 (March 19, 2003)).
                            (iv) The guidance document of the 
                        Environmental Protection Agency and the Corps 
                        of Engineers entitled ``Clean Water Act 
                        Jurisdiction Following the U.S. Supreme Court's 
                        Decision in Rapanos v. United States & Carabell 
                        v. United States'' (December 2, 2008).
                    (B) Forests and land management.--
                            (i) The Healthy Forests Restoration Act of 
                        2003 (16 U.S.C. 6501 et seq.).
                            (ii) The application of section 553(e) of 
                        title 5, United States Code, such that a State 
                        may petition for a special rule for the 
                        National Forest System inventoried roadless 
                        areas within the State.
                            (iii) The final rule entitled ``National 
                        Forest System Land Management Planning'' (73 
                        Fed. Reg. 21486 (April 21, 2008)).
                            (iv) The final rule entitled ``Oil Shale 
                        Management--General'' (73 Fed. Reg. 69414 
                        (November 18, 2008)).
                            (v) The record of decision entitled 
                        ``Record of Decision for Oil Shale and Tar 
                        Sands Resources To Address Land Use Allocations 
                        in Colorado, Utah, and Wyoming'' (73 Fed. Reg. 
                        72519 (November 28, 2008)).
                    (C) Scientific review.--The final rule of the 
                United States Fish and Wildlife Service and the 
                National Marine Fisheries Service entitled 
                ``Interagency Cooperation Under the Endangered Species 
                Act'' (73 Fed. Reg. 76272 (December 16, 2008)).
            (2) Method.--In conducting the study under paragraph (1), 
        the National Academy of Sciences may use and compare existing 
        scientific studies regarding the regulations, laws, and 
        proposed laws described in paragraph (1).
            (3) Report.--Not later than 270 days after the date on 
        which the President enters into the arrangement under paragraph 
        (1), 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 described in paragraph (1), a report that 
        includes--
                    (A) a description of the impact of each regulation, 
                law, or proposed law described in paragraph (1) on 
                public health, air quality, water quality, wildlife, 
                and the environment, compared to the impact of 
                preexisting regulations, or laws in effect, as 
                applicable, 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 described 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 or 
agency that has issued or implemented a regulation or law described in 
subsection (c)(1) shall submit to Congress a plan describing the steps 
the department or 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 the applicable 
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 (referred 
to in this section as the ``Comptroller General'') 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 blowout and 
explosion of the mobile offshore drilling unit Deepwater Horizon that 
occurred on April 20, 2010, and resulting hydrocarbon releases into the 
environment.
    (b) Specific Components.--In carrying out subsection (a), the 
Comptroller General shall--
            (1) assess the type, size, and scope of programs 
        administered by the Secretary of Health and Human Services that 
        focus on the provision of health care to communities on the 
        Gulf Coast;
            (2) identify the merits and disadvantages associated with 
        each of the programs;
            (3) perform an analysis of the costs and benefits of the 
        programs; and
            (4) determine whether there is any duplication of programs.
    (c) Report.--Not later than 180 days after the date of enactment of 
this Act, the Comptroller General shall submit to Congress a report 
that includes--
            (1) the findings of the study conducted under subsection 
        (a); and
            (2) 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 sections 
301(a) and 391(a) of the Public Service Health Act (42 U.S.C. 241(a), 
280(b)). 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 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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