    [Congressional Bills 116th Congress]
    [From the U.S. Government Publishing Office]
    [H.R. 6637 Introduced in House (IH)]

    <DOC>

    116th CONGRESS
      2d Session
                                    H. R. 6637

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

    _______________________________________________________________________

                        IN THE HOUSE OF REPRESENTATIVES

                                 April 28, 2020

      Mr. Garcia of Illinois (for himself, Ms. Pressley, Ms. Judy Chu of
      California, Mr. Richmond, Mr. Espaillat, Mr. Vela, Mr. Vargas, Ms.
     Barragan, Ms. Roybal-Allard, Mr. Soto, Ms. Tlaib, Mr. Higgins of New
    York, Mr. Huffman, Mr. Green of Texas, Ms. Norton, Ms. Garcia of Texas,
     Mr. Takano, Mr. Serrano, Ms. Jackson Lee, Mrs. Beatty, Mr. Bishop of
    Georgia, Mr. Thompson of Mississippi, Mr. Lewis, Ms. Wilson of Florida,
    Ms. Sewell of Alabama, Mr. Gomez, Ms. Moore, Mr. Carson of Indiana, Ms.
     Lee of California, Mrs. Davis of California, Mr. Sablan, Mrs. Hayes,
      Mrs. Napolitano, Ms. Bonamici, Ms. Clarke of New York, Ms. Kelly of
        Illinois, Mrs. Watson Coleman, Mr. Doggett, Ms. Omar, Ms. Blunt
     Rochester, Mrs. Trahan, Ms. Ocasio-Cortez, Ms. Sanchez, Ms. Escobar,
      Mr. Carbajal, Mr. Castro of Texas, Mr. Cardenas, Mr. Grijalva, Ms.
     Castor of Florida, Mr. McNerney, Mr. Correa, Ms. Meng, Mr. Rush, Ms.
    Velazquez, Ms. Jayapal, Mr. Evans, Mr. Casten of Illinois, Mr. Gallego,
     Mr. Sarbanes, Mr. Meeks, Ms. Johnson of Texas, Mr. Brown of Maryland,
     Ms. Lofgren, Mr. Butterfield, Mr. Nadler, Mr. Engel, Mr. Kennedy, Mr.
       McGovern, Mr. Hastings, Mrs. Carolyn B. Maloney of New York, Mr.
    McEachin, Mr. Sires, Mr. Payne, Mr. Schiff, Mr. Johnson of Georgia, Mr.
    Khanna, Mr. Horsford, Mr. San Nicolas, Ms. Bass, and Mr. Danny K. Davis
     of Illinois) introduced the following bill; which was referred to the
    Committee on Energy and Commerce, and in addition to the Committees on
    Agriculture, Oversight and Reform, Ways and Means, Education and Labor,
    the Judiciary, the Budget, Veterans' Affairs, Natural Resources, Armed
       Services, and Homeland Security, for a period to be subsequently
       determined by the Speaker, in each case for consideration of such
     provisions as fall within the jurisdiction of the committee concerned

    _______________________________________________________________________

                                     A BILL

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

        Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled,

    SECTION 1. SHORT TITLE.

        This Act may be cited as the ``Health Equity and Accountability Act
    of 2020''.

    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 data for the Medicare program.
    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. Ensuring 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.
    Sec. 214. Medically underserved populations.
                     TITLE III--HEALTH WORKFORCE DIVERSITY

    Sec. 301. Amendment to the Public Health Service Act.
    Sec. 302. Hispanic-serving institutions, historically Black colleges
                                and universities, Asian American and Native
                                American Pacific Islander-serving
                                institutions, Tribal Colleges, regional
                                community-based organizations, and national
                                minority medical associations.
    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.
    Sec. 314. Study and report on strategies for increasing diversity.
    Sec. 315. Conrad State 30 and physician retention.
               TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY

                      Subtitle A--Improvement of Coverage

    Sec. 401. Repeal of requirement for documentation evidencing
                                citizenship or nationality under the
                                Medicaid program.
    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. Indian defined in title I of the Patient Protection and
                                Affordable Care Act.
    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.
    Sec. 410. Medicaid coverage for citizens of freely associated states.
    Sec. 411. At-risk youth Medicaid protection.
                        Subtitle B--Expansion of Access

    Sec. 412. Amendment to the Public Health Service Act.
    Sec. 413. Protecting sensitive locations.
    Sec. 414. Grants for racial and ethnic approaches to community health.
    Sec. 415. Border health grants.
    Sec. 416. Critical access hospital improvements.
    Sec. 417. Establishment of Rural Community Hospital (RCH) Program.
    Sec. 418. Medicare remote monitoring pilot projects.
    Sec. 419. Rural Health Quality Advisory Commission and demonstration
                                projects.
    Sec. 420. Rural health care services.
    Sec. 421. Community health center collaborative access expansion.
    Sec. 422. Facilitating the provision of telehealth services across
                                State lines.
    Sec. 423. Scoring of preventive health savings.
    Sec. 424. Sense of Congress on maintenance of effort provisions
                                regarding children's health.
    Sec. 425. Protection of the HHS Offices of Minority Health.
    Sec. 426. Office of Minority Health in Veterans Health Administration
                                of Department of Veterans Affairs.
    Sec. 427. Study of DSH payments to ensure hospital access for low-
                                income patients.
    Sec. 428. Assistant Secretary of the Indian Health Service.
    Sec. 429. Reauthorization of the Native Hawaiian Health Care
                                Improvement Act.
    Sec. 430. Availability of non-English language speaking providers.
    Sec. 431. Access to essential community providers.
    Sec. 432. Provider network adequacy in communities of color.
    Sec. 433. Improving access to dental care.
    Sec. 434. Providing for a special enrollment period for pregnant
                                individuals.
    Sec. 435. Coverage of maternity care for dependent children.
    Sec. 436. Federal employee health benefit plans.
    Sec. 437. Continuation of Medicaid income eligibility standard for
                                pregnant individuals and infants.
    Subtitle C--Advancing Health Equity Through Payment and Delivery Reform

    Sec. 441. Sense of Congress.
    Sec. 442. Centers for Medicare & Medicaid Services reporting and value-
                                based programs.
    Sec. 443. Development and testing of disparity reducing delivery and
                                payment models.
    Sec. 444. Diversity in Centers for Medicare & Medicaid consultation.
    Sec. 445. 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.
      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. MOMMA's Act.
    Sec. 506. Rural maternal and obstetric modernization of services.
    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. Expansion of CDC prevention research centers program to
                                include centers on optimal maternity
                                outcomes.
    Sec. 519. Expanding models allowed to be tested by Center for Medicare
                                & Medicaid Innovation to include maternity
                                care models.
    Sec. 520. Development of interprofessional maternity care educational
                                models and tools.
    Sec. 521. Including services furnished by certain students, interns,
                                and residents supervised by certified nurse
                                midwives within inpatient hospital services
                                under Medicare.
    Sec. 522. Grants to professional organizations to increase diversity in
                                maternal, reproductive, and sexual health
                                professionals.
    Sec. 523. Interagency update to the quality family planning guidelines.
    Sec. 524. 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 mental health disparities
                                research gaps.
    Sec. 605. Health professions competencies to address racial and ethnic
                                mental health disparities.
    Sec. 606. Geoaccess study.
    Sec. 607. Asian American, Native Hawaiian, Pacific Islander, and
                                Hispanic and Latino behavioral and mental
                                health outreach and education strategies.
    Sec. 608. Mental health in schools.
    Sec. 609. Building an effective workforce in mental health.
    Sec. 610. Mental health at the border.
              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. Prostate research, imaging, and men's education (PRIME).
    Sec. 704. Prostate cancer detection research and education.
    Sec. 705. National Prostate Cancer Council.
    Sec. 706. Improved Medicaid coverage for certain breast and cervical
                                cancer patients in the territories.
    Sec. 707. Cancer prevention and treatment demonstration for ethnic and
                                racial minorities.
    Sec. 708. Reducing cancer disparities within Medicare.
    Sec. 709. Cancer clinical trials.
      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, Obesity, 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.
    Sec. 737. Guide on evidence-based strategies for public health
                                department obesity prevention programs.
                              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.
    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 HIV in prison.
    Sec. 759. Support data system review and indicators for monitoring HIV
                                care.
    Sec. 760. Transfer of funds for implementation of ending the HIV
                                epidemic: a plan for America.
                              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--Kidney Disease Research, Surveillance, Prevention, and
                                   Treatment

    Sec. 797. Kidney disease, research, surveillance, prevention, and
                                treatment.
    Sec. 798. Kidney disease research in minority populations.
    Sec. 799. Kidney disease action plan.
    Sec. 799A. Home dialysis and increasing end-stage renal disease
                                treatment modalities in minority
                                communities action plan.
    Sec. 799B. Increasing kidney transplants in minority communities.
    Sec. 799C. Environmental and occupational health programs.
    Sec. 799D. Understanding the treatment patterns associated with
                                providing care and treatment of kidney
                                failure in minority populations.
    Sec. 799E. Improving access in underserved areas.
                   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.
    Sec. 803. Nondiscrimination and health equity in health information
                                technology.
    Sec. 804. Language access in health information technology.
        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.
    Sec. 823. Assessment of use and misuse of de-identified health data.
          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 (including sex orientation, gender
                                identity, and pregnancy, including
                                termination of pregnancy), 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.
    Sec. 1009. Establish an interagency counsel and grant programs on
                                social determinants of health.
    Sec. 1010. Correcting hurtful and alienating names in government
                                expression (CHANGE).
                            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) Over the next few decades, the United States will face
            a shortage of health care providers and allied health workers.
                (4) All efforts to reduce health disparities and barriers
            to quality health services require better and more consistent
            data, and better and more consistent collection of and access
            to 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 2030, 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.
                (11) The Health Information Technology for Educational and
            Clinical Health Act of 2009, part of the American Recovery and
            Reinvestment Act of 2009 (Public Law 111-5), provides that the
            nationwide health information exchange infrastructure be
            developed and used to reduce health disparities, among other
            purposes.

                     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, age, 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, age, 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, age, 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,
                    age, 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, age, 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, age,
    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, age,
            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, age, 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, age, 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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.''.

    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 DATA FOR THE MEDICARE PROGRAM.

        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 data for the medicare program

        ``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,
            sex, primary language, sexual orientation, gender identity,
            socioeconomic status, and disability status of all applicants
            for Social Security benefits under title II or Medicare
            benefits under title XVIII.
                ``(2) Data collection standards.--In collecting data under
            paragraph (1), the Commissioner of Social Security shall at
            least use the standards for data collection developed under
            section 3101 of the Public Health Service Act or the standards
            developed by the Office of Management and Budget, whichever is
            more disaggregated. In the event there are no standards for the
            demographic groups listed under paragraph (1), the Commissioner
            shall consult with stakeholder groups representing the various
            identities as well as with the Office of Minority Health within
            the Centers for Medicare & Medicaid Services to develop
            appropriate standards.
                ``(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) Quality of data.--The Commissioner of Social Security
            shall periodically review the quality and completeness of the
            data collected under paragraph (1) and make adjustments as
            necessary to improve both.
                ``(6) Transmission of data.--Upon enrollment in Medicare
            benefits under title XVIII, the Commissioner of Social Security
            shall transmit an individual's demographic data as collected
            under paragraph (1) to the Centers for Medicare & Medicaid
            Services.
                ``(7) Analysis and reporting of data.--With respect to data
            transmitted under paragraph (5), the Administrator of the
            Centers for Medicare & Medicaid Services, in consultation with
            the Commissioner of Social Security shall--
                        ``(A) require that such data be uniformly analyzed
                    and that such analysis be reported at least annually to
                    Congress;
                        ``(B) incorporate such data in other analysis and
                    reporting on health disparities as appropriate;
                        ``(C) make such data available to researchers,
                    under the protections outlined in paragraph (7);
                        ``(D) provide opportunities to individuals enrolled
                    in Medicare to submit updated data; 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 any of the data collected under
                    paragraph (1).
                ``(8) 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--
                        ``(A) 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
                        ``(B) 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.
        ``(b) 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.
        ``(c) 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.
        ``(d) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $500 million for 2020 and $100
    million for each fiscal year thereafter.''.

    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, age, 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, 2021, 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 2021 through 2025.

    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 317U the following:

    ``SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER HEALTH DATA.

        ``(a) Definitions.--In this section:
                ``(1) Community group.--The term `community group' means a
            group of NHOPI who are organized at the community level, and
            may include a church group, social service group, national
            advocacy organization, or cultural group.
                ``(2) Nonprofit, nongovernmental organization.--The term
            `nonprofit, nongovernmental organization' means a group of
            NHOPI with a demonstrated history of addressing NHOPI issues,
            including a NHOPI coalition.
                ``(3) Designated organization.--The term `designated
            organization' means an entity established to represent NHOPI
            populations and which has statutory responsibilities to
            provide, or has community support for providing, health care.
                ``(4) Government representatives 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 2020, 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 2020.
        ``(d) Progress Report.--Not later than 2 years after the date of
    enactment of the Health Equity and Accountability Act of 2020, 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 2020, 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 2021 through 2025.''.

    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 cognitive, 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 cognitive 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. The public accommodation should use
            the person's preferred method of communication whenever
            possible, unless it would be an undue burden to the public
            accommodation and an alternative would provide an equally
            effective means of communication. The ultimate decision as to
            what measures to take rests with the public accommodation,
            provided that the method chosen results in effective
            communication.
                (7) Section 1557 of the Patient Protection and Affordable
            Care Act (42 U.S.C. 18116) builds on Title VI of the Civil
            Rights Act of 1964 (42 U.S.C. 2000d et seq.) and the
            Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.), prohibits
            discrimination on the basis of race, color, national origin,
            disability, sex, and age, requires the provision of language
            services to ensure effective communication with individuals
            with limited English proficiency, and requires the provision of
            appropriate auxiliary aids and services necessary to ensure
            effective communication with individuals with disabilities.
                (8) 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.
                (9) 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 cognitive, hearing, vision, or print
            impairments.
                (10) Access to English as a second language, foreign
            language, and sign language interpreters, translated and
            alternative format documents, readers, and other auxiliary aids
            and services, are essential to ensure effective communication
            and eliminate the language barriers that impede access to
            health care.
                (11) 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
            culturally competence services 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 culturally
            competence services 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 section 1557 of the
            Patient Protection and Affordable Care Act (42 U.S.C. 18116) as
            published in the Federal Register on May 18, 2016, 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 or update
            their current 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 for such program
                    or activity to provide reasonable accommodations
                    necessary for individuals with limited English
                    proficiency and communication disabilities to
                    understand communications from the agency;
                        (E) 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;
                        (F) 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;
                        (G) 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
                        (H) 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) as published in the Federal Register
                    on May 18, 2016.
                (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.

    SEC. 203. ENSURING 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 (42 U.S.C. 18001 et seq.) (or amendments made
    thereby).
        (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 at least
            yearly;
                (3) shall offer and provide language assistance, including
            trained and competent 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 at a fifth grade reading level--
                        (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;
                        (C) signage; and
                        (D) any other documents or types of documents
                    designated by the Secretary;
                (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, and
            such assessments must occur at least yearly;
                (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, may not
    require such comments to be submitted only in English, and must ensure
    these comments are considered equally as comments submitted in English
    during the agency's review of comments submitted.

    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
                    and competent 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 individual with a disability.--The term
            `qualified individual with a disability' means, with respect to
            a health program or activity, an individual with a disability
            who, with or without reasonable modifications to policies,
            practices, or procedures, the removal of architectural,
            communication, or transportation barriers, or the provision of
            auxiliary aids and services, meets the essential eligibility
            requirements for the receipt of aids, benefits, or services
            offered or provided by the health program or activity.
                ``(21) Qualified interpreter for an individual with a
            disability.--The term `qualified interpreter for an individual
            with a disability', for an individual with a disability--
                        ``(A) means an interpreter who by means of a remote
                    interpreting service or an onsite appearance--
                                ``(i) adheres to generally accepted
                            interpreter ethics principles, including client
                            confidentiality; and
                                ``(ii) is able to interpret effectively,
                            accurately, and impartially, both receptively
                            and expressively, using any necessary
                            specialized vocabulary, terminology, and
                            phraseology; and
                        ``(B) may include sign language interpreters, oral
                    transliterators (individuals who represent or spell in
                    the characters of another alphabet), and cued language
                    transliterators (individuals who represent or spell by
                    using a small number of handshapes).
                ``(22) 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 onsite
            appearance--
                        ``(A) adheres to generally accepted interpreter
                    ethics principles, including client confidentiality;
                        ``(B) has demonstrated proficiency in speaking and
                    understanding both spoken English and 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.
                ``(23) 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.
                ``(24) 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.
                ``(25) 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.
                ``(26) 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.
                ``(27) 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.
                ``(28) 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.
                ``(29) 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.
                ``(30) 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.
                ``(31) 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
                    by covered entities (as defined in section 92.4 of
                    title 42, Code of Federal Regulations, as in effect on
                    May 16, 2016) for translation into non-English
                    languages or alternative formats at a fifth-grade
                    reading level. 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 calendar days of the Secretary receiving final
                    approval of the form from the Office of Management and
                    Budget. The Center shall post all translated forms on
                    its website so that other entities may use the same
                    translations.
                ``(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, marketplace
                    coverage available pursuant to title XXVII of this Act
                    and the Patient Protection and Affordable Care Act, and
                    other sources of free or reduced care including
                    federally qualified health centers, title X clinics,
                    and public health departments;
                        ``(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) Translation glossaries.--The Center shall--
                                ``(i) develop and publish on its website
                            translation glossaries that provide
                            standardized translations of commonly used
                            terms and phrases utilized in documents
                            translated by the Center; and
                                ``(ii) make these glossaries available--
                                        ``(I) free of charge;
                                        ``(II) in the 15 languages in which
                                    the Center translates materials; and
                                        ``(III) in alternative formats in
                                    accordance with the Americans with
                                    Disabilities Act of 1990 (42 U.S.C.
                                    12101 et seq.).
                        ``(G) 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, individuals with hearing
    or vision impairments, 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 and competent 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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.''.

    SEC. 205. PILOT PROGRAM FOR IMPROVEMENT AND DEVELOPMENT OF STATE
                  MEDICAL INTERPRETING SERVICES.

        (a) Grants Authorized.--The Secretary of Health and Human Services
    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, 2021, and
    ending on September 30, 2024.
        (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 (42
            U.S.C. 1396 et seq.).
                (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 (42 U.S.C. 1396 et seq.).
        (g) Continuation Past Demonstration.--Any State receiving a grant
    under this section must agree to directly pay for language services in
    Medicaid for all Medicaid providers by the end of the grant period.
        (h) 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 2020, 100 percent for each
            quarter occurring during the grant period specified in
            subsection (b) of such section)'' after ``75 percent''.
        (i) 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, which shall include all diverse populations
                    including people with disabilities and the Lesbian,
                    gay, bisexual, transgender, queer, questioning,
                    questioning and intersex (LGBTQIA) community, 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
                    (as referred to in section 1115A of the Social Security
                    Act (42 U.S.C. 1315a)), 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 limited English proficient,
                    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 (42
                            U.S.C. 1395c et seq.);
                                (ii) a provider of services under part B of
                            such title (42 U.S.C. 1395j et seq.);
                                (iii) a Medicare Advantage organization
                            offering a Medicare Advantage plan under part C
                            of such title (42 U.S.C. 1395w-21 et seq.); or
                                (iv) a PDP sponsor offering a prescription
                            drug plan under part D of such title (42 U.S.C.
                            1395w-101 et seq.).
                        (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 comply with the
                                            requirements of section 1557 of
                                            the Patient Protection and
                                            Affordable Care Act (42 U.S.C.
                                            18116) as published in the
                                            Federal Register on May 18,
                                            2016; 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 (42
                    U.S.C. 1395w-21 et seq.) or a PDP sponsor offering a
                    prescription drug plan under part D of such title (42
                    U.S.C. 1395w-101 et seq.), 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

        ``(kkk)(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(kkk)(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 (42 U.S.C. 1395w-21 et
            seq.) and prescription drug plans under part D of such title
            (42 U.S.C. 1395q-101) 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 2020, 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 ``95'';
                        (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 (29)'' and inserting ``(29), and (30)''.
                (3) Definition of medical assistance.--Section 1905(a) of
            the Social Security Act (42 U.S.C. 1396d(a)) is amended--
                        (A) in paragraph (29), by striking ``and'' at the
                    end;
                        (B) by redesignating paragraph (30) as paragraph
                    (31); and
                        (C) by inserting after paragraph (29) the following
                    new paragraph:
                ``(30) language assistance services, as such term is
            defined in section 1861(kkk)(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--
                        (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 (10)'';
                        (B) in subsection (c), by adding at the end the
                    following new paragraph:
                ``(10) 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)(10)''
                            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)(10)''.
                (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 2021 through
                    2025.
                        (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 subsection (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 (20
                    U.S.C. 7801(20)), 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(kkk)(1) of the Social
                    Security Act, as added by subsection (b).
        (f) Application of Civil Rights Act of 1964, Section 1557 of the
    Affordable Care Act, 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.), section 1557 of the Affordable Care
    Act, 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, 2021.
                (2) Exception if state legislation required.--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 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;
                        (F) the conduct of educational campaigns concerning
                    health directed specifically at patients with mental
                    disabilities, including those with cognitive and
                    intellectual disabilities, designed to reduce the
                    incidence of low health literacy among these
                    populations, which shall have instructional materials
                    in the plain language standards promulgated under the
                    Plain Writing Act of 2010 (5 U.S.C. 301 note) for
                    Federal agencies; and
                        (G) 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 2021 through 2025.

    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'' has the meaning given such
            term in section 92.4 of title 42, Code of Federal Regulations,
            as in effect on May 16, 2016; and
                (2) the term ``covered program or activity'' has the
            meaning given such term in section 92.4 of title 42, Code of
            Federal Regulations, as in effect on May 16, 2016.
        (b) Requirements.--A covered entity, in order to ensure the right
    of individuals with limited English proficiency to receive access to
    high-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, including people with cognitive, hearing,
            vision, or print impairments;
                (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 2021 through 2025.

    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 as ``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, 2020.
        (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 2021 through 2024 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 such Act (42 U.S.C. 18001 et seq.);
                (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.

    SEC. 214. MEDICALLY UNDERSERVED POPULATIONS.

        Section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a))
    is amended by adding at the end the following new paragraph:
                ``(3) Medically underserved.--The term `medically
            underserved', with respect to a population, means--
                        ``(A) the population of an urban or rural area
                    designated by the Secretary as--
                                ``(i) an area with a shortage of personal
                            health services; or
                                ``(ii) a population group having a shortage
                            of such services; or
                        ``(B) a population of individuals, not confined to
                    a particular urban or rural area, who are designated by
                    the Secretary as having a shortage of personal health
                    services due to a specific demographic trait.''.

                     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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.

    ``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 2021 through 2025.''.

    SEC. 302. HISPANIC-SERVING INSTITUTIONS, HISTORICALLY BLACK COLLEGES
                  AND UNIVERSITIES, ASIAN AMERICAN AND NATIVE AMERICAN
                  PACIFIC ISLANDER-SERVING INSTITUTIONS, TRIBAL COLLEGES,
                  REGIONAL COMMUNITY-BASED ORGANIZATIONS, AND NATIONAL
                  MINORITY MEDICAL ASSOCIATIONS.

        (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, ASIAN AMERICAN AND NATIVE AMERICAN
                  PACIFIC ISLANDER-SERVING INSTITUTIONS, 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, Asian
    American and Native American Pacific Islander-serving institutions,
    Tribal Colleges or Universities, regional community-based
    organizations, and national minority medical associations, for
    counseling, mentoring and providing information on financial assistance
    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) Asian american and native american pacific islander-
            serving institution.--The term `Asian American and Native
            American Pacific Islander-serving institution' has the meaning
            given such term in section 320(b) of the Higher Education Act
            of 1965.
                ``(2) 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 section 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)).
                ``(3) Historically black college 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.
                ``(4) Tribal college or university.--The term `Tribal
            College or University' has the meaning given such term in
            section 316(b) of the Higher Education Act of 1965.
        ``(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.
        ``(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 2021 through 2026.''.

    SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR DISEASE CONTROL AND
                  PREVENTION.

        Section 317F(c)(1) of the Public Health Service Act (42 U.S.C.
    247b-7(c)(1)) 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 2020, and such sums as
            may be necessary for each of the fiscal years 2021 through
            2025''.

    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 2021 through 2025.
        ``(e) Period of Grants.--The period during which payments are made
    under a grant awarded may not exceed 3 years.''.

    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 2021 through 2026.

    ``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 2021 through 2025.

    ``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 2021 through 2025.

    ``SEC. 3421. 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 2021 through 2025.

    ``SEC. 3422. 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 2021 through 2025.

    ``SEC. 3423. 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 3 years.
        ``(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 2021 through 2026.''.

    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 2021
    through 2026.''.

    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, 2021, 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, 2021, 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.
        (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 2021 through 2026.

    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, 2020, 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 2021;
                        (B) $375,000,000 for fiscal year 2022;
                        (C) $392,000,000 for fiscal year 2023;
                        (D) $412,000,000 for fiscal year 2024;
                        (E) $432,000,000 for fiscal year 2025;
                        (F) $454,000,000 for fiscal year 2026;
                        (G) $476,000,000 for fiscal year 2027;
                        (H) $500,000,000 for fiscal year 2028;
                        (I) $525,000,000 for fiscal year 2029; and
                        (J) $552,000,000 for fiscal year 2030.
                (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 2021.
                        (B) $253,000,000 for fiscal year 2022.
                        (C) $265,000,000 for fiscal year 2023.
                        (D) $278,000,000 for fiscal year 2024.
                        (E) $292,000,000 for fiscal year 2025.
                        (F) $307,000,000 for fiscal year 2026.
                        (G) $322,000,000 for fiscal year 2027.
                        (H) $338,000,000 for fiscal year 2028.
                        (I) $355,000,000 for fiscal year 2029.
                        (J) $373,000,000 for fiscal year 2030.
                (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 2021.
                        (B) $122,000,000 for fiscal year 2022.
                        (C) $127,000,000 for fiscal year 2023.
                        (D) $134,000,000 for fiscal year 2024.
                        (E) $140,000,000 for fiscal year 2025.
                        (F) $147,000,000 for fiscal year 2026.
                        (G) $154,000,000 for fiscal year 2027.
                        (H) $162,000,000 for fiscal year 2028.
                        (I) $170,000,000 for fiscal year 2029.
                        (J) $179,000,000 for fiscal year 2030.

    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 121,900 physicians, split evenly
            between primary care and specialists, by 2032.
                (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 in rural and
            medically underserved areas, medical education and training
            need to be accessible to underrepresented minorities (African
            American, Hispanic, Native American, and Native Hawaiian), and
            need to increase pathway programs for underrepresented
            minorities who make up less than 12 percent as well as for
            international medical graduates who make up 25 percent of
            graduate medical education. 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.

    SEC. 314. STUDY AND REPORT ON STRATEGIES FOR INCREASING DIVERSITY.

        (a) Study.--The Comptroller General of the United States shall
    conduct a study on strategies for increasing the diversity of the
    health professional workforce. Such study shall include an analysis of
    strategies for increasing the number of health professionals from
    rural, lower income, and underrepresented minority communities,
    including which strategies are most effective for achieving such goal.
        (b) Report.--Not later than 2 years after the date of enactment of
    this Act, the Comptroller General shall submit to Congress a report on
    the study conducted under subsection (a), together with recommendations
    for such legislation and administrative action as the Comptroller
    General determines appropriate.

    SEC. 315. CONRAD STATE 30 AND PHYSICIAN RETENTION.

        (a) Conrad State 30 Program Extension.--Section 220(c) of the
    Immigration and Nationality Technical Corrections Act of 1994 (Public
    Law 103-416; 8 U.S.C. 1182 note) is amended by striking ``September 30,
    2015'' and inserting ``September 30, 2021''.
        (b) Retaining Physicians Who Have Practiced in Medically
    Underserved Communities.--Section 201(b)(1) of the Immigration and
    Nationality Act (8 U.S.C. 1151(b)(1)) is amended by adding at the end
    the following:
                        ``(F)(i) Alien physicians who have completed
                    service requirements of a waiver requested under
                    section 203(b)(2)(B)(ii), including--
                                ``(I) alien physicians who completed such
                            service before the date of the enactment of the
                            Conrad State 30 and Physician Access Act; and
                                ``(II) the spouse or children of an alien
                            physician described in subclause (I).
                        ``(ii) Nothing in this subparagraph may be
                    construed--
                                ``(I) to prevent the filing of a petition
                            with the Secretary of Homeland Security for
                            classification under section 204(a) or the
                            filing of an application for adjustment of
                            status under section 245 by an alien physician
                            described in this subparagraph before the date
                            by which such alien physician has completed the
                            service described in section 214(l) or worked
                            full-time as a physician for an aggregate of 5
                            years at the location identified in the section
                            214(l) waiver or in an area or areas designated
                            by the Secretary of Health and Human Services
                            as having a shortage of health care
                            professionals; or
                                ``(II) to permit the Secretary of Homeland
                            Security to grant a petition or application
                            described in subclause (I) until the alien has
                            satisfied all of the requirements of the waiver
                            received under section 214(l).''.
        (c) Employment Protections for Physicians.--
                (1) Exceptions to 2-year foreign residency requirement.--
            Section 214(l)(1) of the Immigration and Nationality Act (8
            U.S.C. 1184(l)(1)) is amended--
                        (A) in the matter preceding subparagraph (A), by
                    striking ``Attorney General'' and inserting ``Secretary
                    of Homeland Security'';
                        (B) in subparagraph (A), by striking ``Director of
                    the United States Information Agency'' and inserting
                    ``Secretary of State'';
                        (C) in subparagraph (B), by inserting ``, except as
                    provided in paragraphs (7) and (8)'' before the
                    semicolon at the end;
                        (D) in subparagraph (C), by striking clauses (i)
                    and (ii) and inserting the following:
                                ``(i) the alien demonstrates a bona fide
                            offer of full-time employment at a health
                            facility or health care organization, which
                            employment has been determined by the Secretary
                            of Homeland Security to be in the public
                            interest;
                                ``(ii) the alien--
                                        ``(I) has accepted employment with
                                    the health facility or health care
                                    organization in a geographic area or
                                    areas which are designated by the
                                    Secretary of Health and Human Services
                                    as having a shortage of health care
                                    professionals;
                                        ``(II) begins employment by the
                                    later of the date that is--
                                                ``(aa) 120 days after
                                            receiving such waiver;
                                                ``(bb) 120 days after
                                            completing graduate medical
                                            education or training under a
                                            program approved pursuant to
                                            section 212(j)(1); or
                                                ``(cc) 120 days after
                                            receiving nonimmigrant status
                                            or employment authorization, if
                                            the alien or the alien's
                                            employer petitions for such
                                            nonimmigrant status or
                                            employment authorization not
                                            later than 120 days after the
                                            date on which the alien
                                            completes his or her graduate
                                            medical education or training
                                            under a program approved
                                            pursuant to section 212(j)(1);
                                            and
                                        ``(III) agrees to continue to work
                                    for a total of not less than 3 years in
                                    the status authorized for such
                                    employment under this subsection,
                                    except as provided in paragraph (8).'';
                                    and
                        (E) in subparagraph (D), in the matter preceding
                    clause (i), by inserting ``(except as provided in
                    paragraph (8)).
                (2) Allowable visa status for physicians fulfilling waiver
            requirements in medically underserved areas.--Section
            214(l)(2)(A) of such Act (8 U.S.C. 1184(l)(2)(A)) is amended to
            read as follows:
                        ``(A) Upon the request of an interested Federal
                    agency or an interested State agency for recommendation
                    of a waiver under this section by a physician who is
                    maintaining valid nonimmigrant status under section
                    101(a)(15)(J) and a favorable recommendation by the
                    Secretary of State, the Secretary of Homeland Security
                    may change the status of such physician to any status
                    authorized for employment under this Act. The numerical
                    limitations contained in subsection (g)(1)(A) shall not
                    apply to any alien whose status is changed under this
                    subparagraph.''.
                (3) Violation of agreements.--Section 214(l)(3)(A) of such
            Act (8 U.S.C. 1184(l)(3)(A)) is amended by inserting
            ``substantial requirement of an'' before ``agreement entered
            into''.
                (4) Physician employment in underserved areas.--Section
            214(l) of such Act (8 U.S.C. 1184(l)), as amended by this
            section, is further amended by adding at the end the following:
                ``(4)(A) If an interested State agency denies the
            application for a waiver under paragraph (1)(B) from a
            physician pursuing graduate medical education or training
            pursuant to section 101(a)(15)(J) because the State has
            requested the maximum number of waivers permitted for that
            fiscal year, the physician's nonimmigrant status shall be
            extended for up to 6 months if the physician agrees to seek a
            waiver under this subsection (except for paragraph (1)(D)(ii))
            to work for an employer described in paragraph (1)(C) in a
            State that has not yet requested the maximum number of waivers.
                ``(B) Such physician shall be authorized to work only for
            the employer referred to in subparagraph (A) from the date on
            which a new waiver application is filed with such State until
            the earlier of--
                        ``(i) the date on which the Secretary of Homeland
                    Security denies such waiver; or
                        ``(ii) the date on which the Secretary approves an
                    application for change of status under paragraph (2)(A)
                    pursuant to the approval of such waiver.''.
                (5) Contract requirements.--Section 214(l) of such Act, as
            amended by this section, is further amended by adding at the
            end the following:
                ``(5) An alien granted a waiver under paragraph (1)(C)
            shall enter into an employment agreement with the contracting
            health facility or health care organization that--
                        ``(A) specifies the maximum number of on-call hours
                    per week (which may be a monthly average) that the
                    alien will be expected to be available and the
                    compensation the alien will receive for on-call time;
                        ``(B) specifies--
                                ``(i) whether the contracting facility or
                            organization will pay the alien's malpractice
                            insurance premiums;
                                ``(ii) whether the employer will provide
                            malpractice insurance; and
                                ``(iii) the amount of such insurance that
                            will be provided;
                        ``(C) describes all of the work locations that the
                    alien will work and includes a statement that the
                    contracting facility or organization will not add
                    additional work locations without the approval of the
                    Federal agency or State agency that requested the
                    waiver; and
                        ``(D) does not include a non-compete provision.
                ``(6) An alien granted a waiver under this subsection whose
            employment relationship with a health facility or health care
            organization terminates under paragraph (1)(C)(ii) during the
            3-year service period required under paragraph (1) shall be
            considered to be maintaining lawful status in an authorized
            period of stay during the 120-day period referred to in items
            (aa) and (bb) of subclause (III) of paragraph (1)(C)(ii) or the
            45-day period referred to in subclause (III)(cc) of such
            paragraph.''.
                (6) Recapturing waiver slots lost to other states.--Section
            214(l) of such Act, as amended by this section, is further
            amended by adding at the end the following:
                ``(7) If a recipient of a waiver under this subsection
            terminates the recipient's employment with a health facility or
            health care organization pursuant to paragraph (1)(C)(ii),
            including termination of employment because of circumstances
            described in paragraph (1)(C)(ii)(III), and accepts new
            employment with such a facility or organization in a different
            State, the State from which the alien is departing may be
            accorded an additional waiver by the Secretary of State for use
            in the fiscal year in which the alien's employment was
            terminated.''.
                (7) Exception to 3-year work requirement.--Section 214(l)
            of such Act, as amended by this section, is further amended by
            adding at the end the following:
                ``(8) The 3-year work requirement set forth in
            subparagraphs (C) and (D) of paragraph (1) shall not apply if--
                        ``(A)(i) the Secretary of Homeland Security
                    determines that extenuating circumstances, including
                    violations by the employer of the employment agreement
                    with the alien or of labor and employment laws, exist
                    that justify a lesser period of employment at such
                    facility or organization; and
                        ``(ii) the alien demonstrates, not later than 120
                    days after the employment termination date (unless the
                    Secretary determines that extenuating circumstances
                    would justify an extension), another bona fide offer of
                    employment at a health facility or health care
                    organization in a geographic area or areas which are
                    designated by the Secretary of Health and Human
                    Services as having a shortage of health care
                    professionals, for the remainder of such 3-year period;
                        ``(B)(i) the interested State agency that requested
                    the waiver attests that extenuating circumstances,
                    including violations by the employer of the employment
                    agreement with the alien or of labor and employment
                    laws, exist that justify a lesser period of employment
                    at such facility or organization; and
                        ``(ii) the alien demonstrates, not later than 120
                    days after the employment termination date (unless the
                    Secretary determines that extenuating circumstances
                    would justify an extension), another bona fide offer of
                    employment at a health facility or health care
                    organization in a geographic area or areas which are
                    designated by the Secretary of Health and Human
                    Services as having a shortage of health care
                    professionals, for the remainder of such 3-year period;
                    or
                        ``(C) the alien--
                                ``(i) elects not to pursue a determination
                            of extenuating circumstances pursuant to
                            subclause (A) or (B);
                                ``(ii) terminates the alien's employment
                            relationship with the health facility or health
                            care organization at which the alien was
                            employed;
                                ``(iii) demonstrates, not later than 45
                            days after the employment termination date,
                            another bona fide offer of employment at a
                            health facility or health care organization in
                            a geographic area or areas, in the State that
                            requested the alien's waiver, which are
                            designated by the Secretary of Health and Human
                            Services as having a shortage of health care
                            professionals; and
                                ``(iv) agrees to be employed for the
                            remainder of such 3-year period, and 1
                            additional year for each termination under
                            clause (ii).''.
        (d) Allotment of CONRAD 30 Waivers.--
                (1) In general.--Section 214(l) of the Immigration and
            Nationality Act (8 U.S.C. 1184(l)), as amended by subsection
            (d), is further amended by adding at the end the following:
        ``(8)(A)(i) All States shall be allotted a total of 35 waivers
    under paragraph (1)(B) for a fiscal year if 90 percent of the waivers
    available to the States receiving at least 5 waivers were used in the
    previous fiscal year.
        ``(ii) When an allotment occurs under clause (i), all States shall
    be allotted an additional 5 waivers under paragraph (1)(B) for each
    subsequent fiscal year if 90 percent of the waivers available to the
    States receiving at least 5 waivers were used in the previous fiscal
    year. If the States are allotted 45 or more waivers for a fiscal year,
    the States will only receive an additional increase of 5 waivers the
    following fiscal year if 95 percent of the waivers available to the
    States receiving at least 1 waiver were used in the previous fiscal
    year.
        ``(B) Any increase in allotments under subparagraph (A) shall be
    maintained indefinitely, unless in a fiscal year, the total number of
    such waivers granted is 5 percent lower than in the last year in which
    there was an increase in the number of waivers allotted pursuant to
    this paragraph, in which case--
                ``(i) the number of waivers allotted shall be decreased by
            five for all States beginning in the next fiscal year; and
                ``(ii) each additional 5 percent decrease in such waivers
            granted from the last year in which there was an increase in
            the allotment, shall result in an additional decrease of 5
            waivers allotted for all States, provided that the number of
            waivers allotted for all States shall not drop below 30.''.
                (2) Academic medical centers.--Section 214(l)(1)(D) of such
            Act is amended--
                        (A) in clause (ii), by striking ``and'' at the end;
                        (B) in clause (iii), by striking the period at the
                    end and inserting ``; and''; and
                        (C) by adding at the end the following:
                        ``(iv) in the case of a request by an interested
                    State agency--
                                ``(I) the head of such agency determines
                            that the alien is to practice medicine in, or
                            be on the faculty of a residency program at, an
                            academic medical center (as that term is
                            defined in section 411.355(e)(2) of title 42,
                            Code of Federal Regulations, or similar
                            successor regulation), without regard to
                            whether such facility is located within an area
                            designated by the Secretary of Health and Human
                            Services as having a shortage of health care
                            professionals; and
                                ``(II) the head of such agency determines
                            that--
                                        ``(aa) the alien physician's work
                                    is in the public interest; and
                                        ``(bb) the grant of such waiver
                                    would not cause the number of the
                                    waivers granted on behalf of aliens for
                                    such State for a fiscal year (within
                                    the limitation in subparagraph (B) and
                                    subject to paragraph (6)) in accordance
                                    with the conditions of this clause to
                                    exceed 3.''.
        (e) Amendments to the Procedures, Definitions, and Other Provisions
    Related to Physician Immigration.--
                (1) Dual intent for physicians seeking graduate medical
            training.--Section 214(b) of the Immigration and Nationality
            Act (8 U.S.C. 1184(b)) is amended by striking ``(other than a
            nonimmigrant described in subparagraph (L) or (V) of section
            101(a)(15), and other than a nonimmigrant described in any
            provision of section 101(a)(15)(H)(i) except subclause (b1) of
            such section)'' and inserting ``(other than a nonimmigrant
            described in subparagraph (L) or (V) of section 101(a)(15), a
            nonimmigrant described in any provision of section
            101(a)(15)(H)(i) (except subclause (b1) of such section), and
            an alien coming to the United States to receive graduate
            medical education or training as described in section 212(j) or
            to take examinations required to receive graduate medical
            education or training as described in section 212(j))''.
                (2) Physician national interest waiver clarifications.--
                        (A) Practice and geographic area.--Section
                    203(b)(2)(B)(ii)(I) of the Immigration and Nationality
                    Act (8 U.S.C. 1153(b)(2)(B)(ii)(I)) is amended by
                    striking items (aa) and (bb) and inserting the
                    following:
                                ``(aa) the alien physician agrees to work
                            on a full-time basis practicing primary care,
                            specialty medicine, or a combination thereof,
                            in an area or areas designated by the Secretary
                            of Health and Human Services as having a
                            shortage of health care professionals, or at a
                            health care facility under the jurisdiction of
                            the Secretary of Veterans Affairs; or
                                ``(bb) the alien physician is pursuing such
                            waiver based upon service at a facility or
                            facilities that serve patients who reside in a
                            geographic area or areas designated by the
                            Secretary of Health and Human Services as
                            having a shortage of health care professionals
                            (without regard to whether such facility or
                            facilities are located within such an area) and
                            a Federal agency, or a local, county, regional,
                            or State department of public health determines
                            the alien physician's work was or will be in
                            the public interest.''.
                        (B) Five-year service requirement.--Section
                    203(b)(2)(B)(ii) of the Immigration and Nationality Act
                    (8 U.S.C. 1153(B)(ii)) is amended--
                                (i) by moving subclauses (II), (III), and
                            (IV) 4 ems to the left; and
                                (ii) in subclause (II)--
                                        (I) by inserting ``(aa)'' after
                                    ``(II)''; and
                                        (II) by adding at the end the
                                    following:
                                ``(bb) The 5-year service requirement under
                            item (aa) shall begin on the date on which the
                            alien physician begins work in the shortage
                            area in any legal status and not on the date on
                            which an immigrant visa petition is filed or
                            approved. Such service shall be aggregated
                            without regard to when such service began and
                            without regard to whether such service began
                            during or in conjunction with a course of
                            graduate medical education.
                                ``(cc) An alien physician shall not be
                            required to submit an employment contract with
                            a term exceeding the balance of the 5-year
                            commitment yet to be served or an employment
                            contract dated within a minimum time period
                            before filing a visa petition under this
                            subsection.
                                ``(dd) An alien physician shall not be
                            required to file additional immigrant visa
                            petitions upon a change of work location from
                            the location approved in the original national
                            interest immigrant petition.''.
                (3) Technical clarification regarding advanced degree for
            physicians.--Section 203(b)(2)(A) of the Immigration and
            Nationality Act (8 U.S.C. 1153(b)(2)(A)) is amended by adding
            at the end the following: ``An alien physician holding a
            foreign medical degree that has been deemed sufficient for
            acceptance by an accredited United States medical residency or
            fellowship program is a member of the professions holding an
            advanced degree or its equivalent.''.
                (4) Short-term work authorization for physicians completing
            their residencies.--
                        (A) In general.--A physician completing graduate
                    medical education or training described in section
                    212(j) of the Immigration and Nationality Act (8 U.S.C.
                    1182(j)) as a nonimmigrant described in section
                    101(a)(15)(H)(i) of such Act (8 U.S.C.
                    1101(a)(15)(H)(i))--
                                (i) shall have such nonimmigrant status
                            automatically extended until October 1 of the
                            fiscal year for which a petition for a
                            continuation of such nonimmigrant status has
                            been submitted in a timely manner and the
                            employment start date for the beneficiary of
                            such petition is October 1 of that fiscal year;
                            and
                                (ii) shall be authorized to be employed
                            incident to status during the period between
                            the filing of such petition and October 1 of
                            such fiscal year.
                        (B) Termination.--The physician's status and
                    employment authorization shall terminate on the date
                    that is 30 days after the date on which a petition
                    described in clause (i)(I) is rejected, denied or
                    revoked.
                        (C) Automatic extension.--A physician's status and
                    employment authorization will automatically extend to
                    October 1 of the next fiscal year if all of the visas
                    described in section 101(a)(15)(H)(i) of such Act that
                    were authorized to be issued for the fiscal year have
                    been issued.
                (5) Applicability of section 212(e) to spouses and children
            of j-1 exchange visitors.--A spouse or child of an exchange
            visitor described in section 101(a)(15)(J) of the Immigration
            and Nationality Act (8 U.S.C. 1101(a)(15)(J)) shall not be
            subject to the requirements under section 212(e) of such Act (8
            U.S.C. 1182(e)).

               TITLE IV--IMPROVING HEALTH CARE ACCESS AND QUALITY

                      Subtitle A--Improvement of Coverage

    SEC. 401. 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) State payments for medical assistance.--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) Payment to states.--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) Repeal.--Subsection (c) of section 6036 of the Deficit
            Reduction Act of 2005 (42 U.S.C. 1396b note) is repealed.
        (c) Effective Date.--The amendments made by this section shall take
    effect as if included in the enactment of the Deficit Reduction Act of
    2005.

    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 preceding
                    paragraph (1), by striking ``subsection (g)'' and
                    inserting ``subsections (g) and (h)'';
                        (B) in subsection (g)(2), in the matter preceding
                    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
    2020.''.
                (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 2021.
        (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 2020'' after ``American
    Samoa''.
        (c) Application of Medicaid Waiver Authority to All of the
    Territories.--
                (1) In general.--Section 1902(j) of the Social Security Act
            (42 U.S.C. 1396a(j)) is amended--
                        (A) by striking ``American Samoa and the Northern
                    Mariana Islands'' and inserting ``Puerto Rico, the
                    Virgin Islands of the United States, Guam, the Northern
                    Mariana Islands, and American Samoa'';
                        (B) by striking ``American Samoa or the Northern
                    Mariana Islands'' and inserting ``Puerto Rico, the
                    Virgin Islands of the United States, Guam, the Northern
                    Mariana Islands, or American Samoa'';
                        (C) by inserting ``(1)'' after ``(j)'';
                        (D) by inserting ``except as otherwise provided in
                    this subsection,'' after ``Notwithstanding any other
                    requirement of this title''; and
                        (E) by adding at the end the following:
                ``(2) The Secretary may not waive under this subsection the
            requirement of subsection (a)(10)(A)(i)(IX) (relating to
            coverage of adults formerly under foster care) with respect to
            any territory.''.
                (2) Effective date.--The amendments made by this section
            shall apply beginning October 1, 2021.
        (d) Permitting Medicaid DSH Allotments for Territories.--Section
    1923(f) of the Social Security Act (42 U.S.C. 1396r-4) is amended--
                (1) in paragraph (6), by adding at the end the following
            new subparagraph:
                        ``(C) Territories.--
                                ``(i) Fiscal year 2020.--For fiscal year
                            2020, the DSH allotment for Puerto Rico, the
                            Virgin Islands of the United States, Guam, the
                            Northern Mariana Islands, and American Samoa
                            shall bear the same ratio to $300,000,000 as
                            the ratio of the number of individuals who are
                            low-income or uninsured and residing in such
                            respective territory (as estimated from time to
                            time by the Secretary) bears to the sums of the
                            number of such individuals residing in all of
                            the territories.
                                ``(ii) Subsequent fiscal year.--For each
                            subsequent fiscal year, the DSH allotment for
                            each such territory is subject to an increase
                            in accordance with paragraph (2).''; and
                (2) in paragraph (9), by inserting before the period at the
            end the following: ``, and includes, beginning with fiscal year
            2021, Puerto Rico, the Virgin Islands of the United States,
            Guam, the Northern Mariana Islands, and American Samoa''.

    SEC. 405. EXTENSION OF MEDICARE SECONDARY PAYER.

        (a) In General.--Section 1862(b)(1)(C) of the Social Security Act
    (42 U.S.C. 1395y(b)(1)(C)) is amended--
                (1) in the last sentence, by inserting ``, and before
            January 1, 2021'' 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, 2021 (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. INDIAN DEFINED IN TITLE I OF THE PATIENT PROTECTION AND
                  AFFORDABLE CARE ACT.

        (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. 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.

    SEC. 410. 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 the
    Personal Responsibility and Work Opportunity Reconciliation Act of 1996
    (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 the Personal
    Responsibility and Work Opportunity Reconciliation Act of 1996 (8
    U.S.C. 1641(b)) is amended--
                (1) in paragraph (6), by striking ``; or'' at the end 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, 2021.

    SEC. 411. AT-RISK YOUTH MEDICAID PROTECTION.

        (a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
    1396a) is amended--
                (1) in subsection (a)--
                        (A) by striking ``and'' at the end of paragraph
                    (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.

                        Subtitle B--Expansion of Access

    SEC. 412. 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 2021 through 2026.

    ``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 2021 through 2026.

    ``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. 413. 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 or subdivision of government
                    that--
                                ``(I) assists children, pregnant women,
                            victims of crime or abuse, or individuals with
                            significant mental or physical disabilities; or
                                ``(II) provides social services and
                            assistance, including emergency and disaster
                            services or assistance with food and nutrition,
                            housing affordability and income or other
                            services funded by State or local government,
                            charitable giving, the Special Supplemental
                            Nutrition Program for Women, Infants, and
                            Children (WIC), Supplemental Nutrition
                            Assistance Program (SNAP), Temporary Assistance
                            for Needy Families (TANF), or the United States
                            Housing Act;
                        ``(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. 414. 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. 415. 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) A public institution of higher education.
                        (C) A nonprofit health organization.
                        (D) A community health center.
                        (E) A 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 promotores;
                        (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
    2021 and such sums as may be necessary for each succeeding fiscal year.

    SEC. 416. 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, 2021.
        (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. 417. 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:
        ``(j) 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(j) 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 ``(j)''; 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
                    (8);
                        (C) by striking the period at the end of paragraph
                    (9) and inserting ``; and''; and
                        (D) by adding at the end the following:
                ``(10) in the case of outpatient services furnished by a
            rural community hospital, the amounts described in section
            1834(j).''.
                (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(j)(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, 2021.

    SEC. 418. 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 (42 U.S.C. 1395 et seq.) 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 (42 U.S.C. 1395 et seq.) 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 (42 U.S.C. 1395 et seq.) 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 (42 U.S.C. 1395 et seq.) (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 (42 U.S.C. 1301 et seq.;
    42 U.S.C. 1395 et seq.) 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 (42 U.S.C. 1395 et seq.), 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. 419. 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 Research and Quality, 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.; 42 U.S.C.
                    1396 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
            2021 through 2025.
                (2) Availability.--
                        (A) In general.--Funds appropriated under paragraph
                    (1) shall remain available for expenditure through
                    fiscal year 2025.
                        (B) Report.--For purposes of carrying out
                    subsection (b)(8), funds appropriated under paragraph
                    (1) shall remain available for expenditure through
                    fiscal year 2026.
                (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. 420. 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, 2022, 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 2021
    and such sums as may be necessary for each of fiscal years 2022 through
    2025.''.

    SEC. 421. 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'' at the end;
                        (B) in clause (ii), by striking the period at the
                    end 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. 422. 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. 423. 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. 424. 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 (42 U.S.C. 1396a;
            42 U.S.C. 1397ee(d)) 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 (42 U.S.C. 1396 et
            seq.) and Children's Health Insurance Program under title XXI
            of such Act (42 U.S.C. 1397aa et seq.) 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. 425. 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. 426. 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. 427. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL ACCESS FOR LOW-
                  INCOME PATIENTS.

        (a) In General.--Not later than January 1, 2021, 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.; 42 U.S.C. 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. 428. 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. 429. 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. 430. 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. 431. 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 2020) 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. 432. 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 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 the Health Equity and Accountability
    Act of 2020.''.

    SEC. 433. 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
                                (iv) providing accessible care to people
                            with disabilities;
                        (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;
                                (iii) providing culturally competent care;
                            and
                                (iv) providing accessible care to people
                            with disabilities; and
                        (C) the reports shall also explain how telehealth
                    service is used to enhance services provided by dental
                    hygienists and therapists and shall recommend any
                    modifications in Medicare and Medicaid to better
                    provide for telehealth consultations in conjunction
                    with therapists' and hygienists' 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 (GG), by striking ``and'' at
                    the end;
                        (B) in subparagraph (HH), by adding ``and'' after
                    the semicolon at the end; and
                        (C) by adding at the end the following new
                    subparagraph:
                ``(II) 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 ``(CC)''; and
                        (B) by inserting before the semicolon at the end
                    the following: ``, and (DD) 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)(II),'' 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, 2021.
        (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 (ff)(1))''; and
                        (B) by adding at the end the following new
                    subsection:
        ``(ff)(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(ff));
                        ``(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
                    (ff)(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.

    SEC. 434. PROVIDING FOR A SPECIAL ENROLLMENT PERIOD FOR PREGNANT
                  INDIVIDUALS.

        (a) Public Health Service Act.--Section 2702(b)(2) of the Public
    Health Service Act (42 U.S.C. 300gg-1(b)(2)) is amended by inserting
    ``including a special enrollment period for pregnant individuals,
    beginning on the date on which the pregnancy is reported to the health
    insurance issuer'' before the period at the end.
        (b) Patient Protection and Affordable Care Act.--Section 1311(c)(6)
    of the Patient Protection and Affordable Care Act (42 U.S.C.
    18031(c)(6)) is amended--
                (1) in subparagraph (C), by striking ``and'' at the end;
                (2) by redesignating subparagraph (D) as subparagraph (E);
            and
                (3) by inserting after subparagraph (C) the following new
            subparagraph:
                        ``(D) a special enrollment period for pregnant
                    individuals, beginning on the date on which the
                    pregnancy is reported to the Exchange; and''.
        (c) Special Enrollment Periods.--
                (1) Internal revenue code.--Section 9801(f) of the Internal
            Revenue Code of 1986 (26 U.S.C. 9801(f)) is amended by adding
            at the end the following new paragraph:
                ``(4) For pregnant individuals.--
                        ``(A) A group health plan shall permit an employee
                    who is eligible, but not enrolled, for coverage under
                    the terms of the plan (or a dependent of such an
                    employee if the dependent is eligible, but not
                    enrolled, for coverage under such terms) to enroll for
                    coverage under the terms of the plan upon pregnancy,
                    with the special enrollment period beginning on the
                    date on which the pregnancy is reported to the group
                    health plan or the pregnancy is confirmed by a health
                    care provider.
                        ``(B) The Secretary shall promulgate regulations
                    with respect to the special enrollment period under
                    subparagraph (A), including establishing a time period
                    for pregnant individuals to enroll in coverage and
                    effective date of such coverage.''.
                (2) ERISA.--Section 701(f) of the Employee Retirement
            Income Security Act of 1974 (29 U.S.C. 1181(f)) is amended by
            adding at the end the following:
                ``(4) For pregnant individuals.--
                        ``(A) A group health plan or health insurance
                    issuer in connection with a group health plan shall
                    permit an employee who is eligible, but not enrolled,
                    for coverage under the terms of the plan (or a
                    dependent of such an employee if the dependent is
                    eligible, but not enrolled, for coverage under such
                    terms) to enroll for coverage under the terms of the
                    plan upon pregnancy, with the special enrollment period
                    beginning on the date on which the pregnancy is
                    reported to the group health plan or health insurance
                    issuer or the pregnancy is confirmed by a health care
                    provider.
                        ``(B) The Secretary shall promulgate regulations
                    with respect to the special enrollment period under
                    subparagraph (A), including establishing a time period
                    for pregnant individuals to enroll in coverage and
                    effective date of such coverage.''.
        (d) Effective Date.--The amendments made by this section shall
    apply with respect to plan years beginning after the 2021 plan year.

    SEC. 435. COVERAGE OF MATERNITY CARE FOR DEPENDENT CHILDREN.

        Section 2719A of the Public Health Service Act (42 U.S.C. 300gg-
    19a) is amended by adding at the end the following:
        ``(e) Coverage of Maternity Care.--A group health plan, or health
    insurance issuer offering group or individual health insurance
    coverage, that provides coverage for dependants shall ensure that such
    plan or coverage includes coverage for maternity care associated with
    pregnancy, childbirth, and postpartum care for all participants,
    beneficiaries, or enrollees, including dependants, including coverage
    of labor and delivery. Such coverage shall be provided to all pregnant
    dependents regardless of age.''.

    SEC. 436. FEDERAL EMPLOYEE HEALTH BENEFIT PLANS.

        (a) Coverage of Pregnancy.--
                (1) In general.--The Director of the Office of Personnel
            Management shall issue such regulations as are necessary to
            ensure that pregnancy is considered a change in family status
            and a qualifying life event for an individual who is eligible
            to enroll, but is not enrolled, in a health benefit plan under
            chapter 89 title 5, United States Code.
                (2) Effective date.--The requirement in paragraph (1) shall
            apply with respect to any contract entered into under section
            8902 of such title beginning 12 months after the date of
            enactment of this Act.
        (b) Designating Certain FEHBP-Related Services as Excepted Services
    Under the Anti-Deficiency Act.--
                (1) In general.--Section 8905 of title 5, United States
            Code, is amended by adding at the end the following:
                                ``(i) Any services by an officer or
                            employee under this chapter relating to
                            enrolling individuals in a health benefits plan
                            under this chapter, or changing the enrollment
                            of an individual already so enrolled due to an
                            event described in section 5(a)(1) of the
                            Healthy MOM Act, shall be deemed, for purposes
                            of section 1342 of title 31, services for
                            emergencies involving the safety of human life
                            or the protection of property.''.
                (2) Application.--The amendment made by paragraph (1) shall
            apply to any lapse in appropriations beginning on or after the
            date of enactment of this Act.

    SEC. 437. CONTINUATION OF MEDICAID INCOME ELIGIBILITY STANDARD FOR
                  PREGNANT INDIVIDUALS AND INFANTS.

        Section 1902(l)(2)(A) of the Social Security Act (42 U.S.C.
    1396a(l)(2)(A)) is amended--
                (1) in clause (i), by striking ``and not more than 185
            percent'';
                (2) in clause (ii)--
                        (A) in subclause (I), by striking ``and'' after the
                    comma;
                        (B) in subclause (II), by striking the period at
                    the end and inserting ``, and''; and
                        (C) by adding at the end the following:
                                        ``(III) January 1, 2020, is the
                                    percentage provided under clause
                                    (v).''; and
                (3) by adding at the end the following new clause:
                                ``(v) The percentage provided under clause
                            (ii) for medical assistance provided on or
                            after January 1, 2020, with respect to
                            individuals described in subparagraph (A) or
                            (B) of paragraph (1) shall not be less than--
                                        ``(I) the percentage specified for
                                    such individuals by the State in an
                                    amendment to its State plan (whether
                                    approved or not) as of January 1, 2014;
                                    or
                                        ``(II) if no such percentage is
                                    specified as of January 1, 2014, the
                                    percentage established for such
                                    individuals under the State's
                                    authorizing legislation or provided for
                                    under the State's appropriations as of
                                    that date.''.

    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
            and behavioral health, oral health, their history of adverse
            childhood experiences and adverse community environments,
            social determinants of health, social risk factors, unmet
            social needs, and the burden of intergenerational racial and
            other inequities.

    SEC. 442. CENTERS FOR MEDICARE & MEDICAID SERVICES REPORTING AND VALUE-
                  BASED PROGRAMS.

        (a) Advancing Health Equity in Reporting and Value-Based Payment
    Programs.--
                (1) In general.--The Administrator shall require that a
            clinician or other professional participating in any pay-for-
            reporting or value-based payment program stratify clinical
            quality measures by disparity variables, including race,
            ethnicity, sex, primary language, disability status, sexual
            orientation, gender identity, and socioeconomic 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 will assist clinicians and other professionals in the
            identification of disparities obscured in aggregated data and
            assist with the provision of interventions that target reducing
            those disparities.
                (2) Clinician.--In assessing performance in any value-based
            payment program, the Administrator shall incorporate a
            clinician or other professional's performance in reducing
            disparities across race, ethnicity, sex, primary language,
            disability status, sexual orientation, gender identity, and
            socioeconomic status. Linking performance payments to the
            reduction of health care disparities across such variables will
            assist in holding clinicians and other professionals
            accountable for providing quality care that can lead to
            decreased health inequities.
                (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.
        (b) 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, case
    management, transportation, enrollment assistance needs, stable and
    affordable housing, utility assistance, employment and career
    development, and nutrition and food security which will help to reduce
    disparities and impact the overall cost of care.
        (b) Amendment to Social Security Act.--Section 1115A(a)(1) of the
    Social Security Act (42 U.S.C. 1315a(a)(1)) is amended as follows:
                ``(1) The purpose of the CMI is to test innovative payment
            and service delivery models to reduce program expenditures and
            improve health equity under the applicable titles while
            preserving or enhancing the quality of care furnished to
            individuals under such titles.''.
        (c) 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 nonprofit entities, to
    help address socially determined barriers to health and health care.
        (d) 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. DIVERSITY IN CENTERS FOR MEDICARE & MEDICAID CONSULTATION.

        (a) In General.--In carrying out the duties under this section, the
    CMI shall consult representatives of relevant Federal agencies, and
    clinical and analytical experts with expertise in medicine and health
    care management, specifically such experts with expertise in--
                (1) the health care needs of minority, rural, and
            underserved populations; and
                (2) the financial needs of safety net, community-based,
            rural, and critical access providers, including federally
            qualified health centers.
        (b) Open Door Forums.--The CMI shall use open door forums or other
    mechanisms to seek external feedback from interested parties and
    incorporate that feedback into the development of models.

    SEC. 445. 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
    2020''.

    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 2021.

      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, including the use of e-
                    cigarettes and vaping;
                        ``(E) alcohol and substance use;
                        ``(F) injury and violence;
                        ``(G) sexual health;
                        ``(H) mental health;
                        ``(I) musculoskeletal health and arthritis;
                        ``(J) prenatal and postnatal care;
                        ``(K) dental and oral health;
                        ``(L) understanding informed consent;
                        ``(M) stigma; and
                        ``(N) environmental hazards;
                ``(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 2021 through 2025.''.

    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 12-month 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, lifestyle,
                    or climate and weather-related 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
    2021, $6,000,000 for fiscal year 2022, $7,000,000 for fiscal year 2023,
    $8,000,000 for fiscal year 2024, and $9,000,000 for fiscal year 2025.

    SEC. 505. MOMMA'S ACT.

        (a) Short Title.--This section may be cited as the ``Mothers and
    Offspring Mortality and Morbidity Awareness Act'' or the ``MOMMA's
    Act''.
        (b) Findings.--Congress finds the following:
                (1) Every year, across the United States, 4,000,000 women
            give birth, about 700 women suffer fatal complications during
            pregnancy, while giving birth or during the postpartum period,
            and 70,000 women suffer near-fatal, partum-related
            complications.
                (2) The maternal mortality rate is often used as a proxy to
            measure the overall health of a population. While the infant
            mortality rate in the United States has reached its lowest
            point, the risk of death for women in the United States during
            pregnancy, childbirth, or the postpartum period is higher than
            such risk in many other developed nations. The estimated
            maternal mortality rate (per 100,000 live births) for the 48
            contiguous States and Washington, DC, increased from 18.8
            percent in 2000 to 23.8 percent in 2014 to 26.6 percent in
            2018. This estimated rate is on par with such rate for
            underdeveloped nations such as Iraq and Afghanistan.
                (3) International studies estimate the 2015 maternal
            mortality rate in the United States as 26.4 per 100,000 live
            births, which is almost twice the 2015 World Health
            Organization estimation of 14 per 100,000 live births.
                (4) It is estimated that more than 60 percent of maternal
            deaths in the United States are preventable.
                (5) According to the Centers for Disease Control and
            Prevention, the maternal mortality rate varies drastically for
            women by race and ethnicity. There are 12.7 deaths per 100,000
            live births for White women, 43.5 deaths per 100,000 live
            births for African-American women, and 14.4 deaths per 100,000
            live births for women of other ethnicities. While maternal
            mortality disparately impacts African-American women, this
            urgent public health crisis traverses race, ethnicity,
            socioeconomic status, educational background, and geography.
                (6) African-American women are 3 to 4 times more likely to
            die from causes related to pregnancy and childbirth compared to
            non-Hispanic White women.
                (7) The findings described in paragraphs (1) through (6)
            are of major concern to researchers, academics, members of the
            business community, and providers across the obstetrical
            continuum represented by organizations such as March of Dimes;
            the Preeclampsia Foundation; the American College of
            Obstetricians and Gynecologists; the Society for Maternal-Fetal
            Medicine; the Association of Women's Health, Obstetric, and
            Neonatal Nurses; the California Maternal Quality Care
            Collaborative; Black Women's Health Imperative; the National
            Birth Equity Collaborative; Black Mamas Matter Alliance;
            EverThrive Illinois; the National Association of Certified
            Professional Midwives; PCOS Challenge: The National Polycystic
            Ovary Syndrome Association; and the American College of Nurse
            Midwives.
                (8) Hemorrhage, cardiovascular and coronary conditions,
            cardiomyopathy, infection, embolism, mental health conditions,
            preeclampsia and eclampsia, polycystic ovary syndrome,
            infection and sepsis, and anesthesia complications are the
            predominant medical causes of maternal-related deaths and
            complications. Most of these conditions are largely preventable
            or manageable.
                (9) Oral health is an important part of perinatal health.
            Reducing bacteria in a woman's mouth during pregnancy can
            significantly reduce her risk of developing oral diseases and
            spreading decay-causing bacteria to her baby. Moreover, some
            evidence suggests that women with periodontal disease during
            pregnancy could be at greater risk for poor birth outcomes,
            such as preeclampsia, pre-term birth, and low-birth weight.
            Furthermore, a woman's oral health during pregnancy is a good
            predictor of her newborn's oral health, and since mothers can
            unintentionally spread oral bacteria to their babies, putting
            their children at higher risk for tooth decay, prevention
            efforts should happen even before children are born, as a
            matter of pre-pregnancy health and prenatal care during
            pregnancy.
                (10) The United States has not been able to submit a formal
            maternal mortality rate to international data repositories
            since 2007. Thus, no official maternal mortality rate exists
            for the United States. There can be no maternal mortality rate
            without streamlining maternal mortality-related data from the
            State level and extrapolating such data to the Federal level.
                (11) In the United States, death reporting and analysis is
            a State function rather than a Federal process. States report
            all deaths--including maternal deaths--on a semi-voluntary
            basis, without standardization across States. While the Centers
            for Disease Control and Prevention has the capacity and system
            for collecting death-related data based on death certificates,
            these data are not sufficiently reported by States in an
            organized and standard format across States such that the
            Centers for Disease Control and Prevention is able to identify
            causes of maternal death and best practices for the prevention
            of such death.
                (12) Vital statistics systems often underestimate maternal
            mortality and are insufficient data sources from which to
            derive a full scope of medical and social determinant factors
            contributing to maternal deaths. While the addition of
            pregnancy checkboxes on death certificates since 2003 have
            likely improved States' abilities to identify pregnancy-related
            deaths, they are not generally completed by obstetrical
            providers or persons trained to recognize pregnancy-related
            mortality. Thus, these vital forms may be missing information
            or may capture inconsistent data. Due to varying maternal
            mortality-related analyses, lack of reliability, and
            granularity in data, current maternal mortality informatics do
            not fully encapsulate the myriad medical and socially
            determinant factors that contribute to such high maternal
            mortality rates within the United States compared to other
            developed nations. Lack of standardization of data and data
            sharing across States and between Federal entities, health
            networks, and research institutions keep the Nation in the dark
            about ways to prevent maternal deaths.
                (13) Having reliable and valid State data aggregated at the
            Federal level is critical to the Nation's ability to quell
            surges in maternal death and imperative for researchers to
            identify long-lasting interventions.
                (14) Leaders in maternal wellness highly recommend that
            maternal deaths be investigated at the State level first, and
            that standardized, streamlined, de-identified data regarding
            maternal deaths be sent annually to the Centers for Disease
            Control and Prevention. Such data standardization and
            collection would be similar in operation and effect to the
            National Program of Cancer Registries of the Centers for
            Disease Control and Prevention and akin to the Confidential
            Enquiry in Maternal Deaths Programme in the United Kingdom.
            Such a maternal mortalities and morbidities registry and
            surveillance system would help providers, academicians,
            lawmakers, and the public to address questions concerning the
            types of, causes of, and best practices to thwart, pregnancy-
            related or pregnancy-associated mortality and morbidity.
                (15) The United Nations Millennium Development Goal 5a
            aimed to reduce by 75 percent, between 1990 and 2015, the
            maternal mortality rate, yet this metric has not been achieved.
            In fact, the maternal mortality rate in the United States has
            been estimated to have more than doubled between 2000 and 2014.
            Yet, because national data are not fully available, the United
            States does not have an official maternal mortality rate.
                (16) Many States have struggled to establish or maintain
            Maternal Mortality Review Committees (referred to in this
            section as ``MMRC''). On the State level, MMRCs have lagged
            because States have not had the resources to mount local
            reviews. State-level reviews are necessary as only the State
            departments of health have the authority to request medical
            records, autopsy reports, and police reports critical to the
            function of the MMRC.
                (17) The United Kingdom regards maternal deaths as a health
            systems failure and a national committee of obstetrics experts
            review each maternal death or near-fatal childbirth
            complication. Such committee also establishes the predominant
            course of maternal-related deaths from conditions such as
            preeclampsia. Consequently, the United Kingdom has been able to
            reduce its incidence of preeclampsia to less than one in 10,000
            women--its lowest rate since 1952.
                (18) The United States has no comparable, coordinated
            Federal process by which to review cases of maternal mortality,
            systems failures, or best practices. Many States have active
            MMRCs and leverage their work to impact maternal wellness. For
            example, the State of California has worked extensively with
            their State health departments, health and hospital systems,
            and research collaborative organizations, including the
            California Maternal Quality Care Collaborative and the Alliance
            for Innovation on Maternal Health, to establish MMRCs, wherein
            such State has determined the most prevalent causes of maternal
            mortality and recorded and shared data with providers and
            researchers, who have developed and implemented safety bundles
            and care protocols related to preeclampsia, maternal
            hemorrhage, and the like. In this way, the State of California
            has been able to leverage its maternal mortality review board
            system, generate data, and apply those data to effect changes
            in maternal care-related protocol. To date, the State of
            California has reduced its maternal mortality rate, which is
            now comparable to the low rates of the United Kingdom.
                (19) Hospitals and health systems across the United States
            lack standardization of emergency obstetrical protocols before,
            during, and after delivery. Consequently, many providers are
            delayed in recognizing critical signs indicating maternal
            distress that quickly escalate into fatal or near-fatal
            incidences. Moreover, any attempt to address an obstetrical
            emergency that does not consider both clinical and public
            health approaches falls woefully under the mark of excellent
            care delivery. State-based maternal quality collaborative
            organizations, such as the California Maternal Quality Care
            Collaborative or entities participating in the Alliance for
            Innovation on Maternal Health (AIM), have formed obstetrical
            protocols, tool kits, and other resources to improve system
            care and response as they relate to maternal complications and
            warning signs for such conditions as maternal hemorrhage,
            hypertension, and preeclampsia.
                (20) The Centers for Disease Control and Prevention reports
            that nearly half of all maternal deaths occur in the immediate
            postpartum period--the 42 days following a pregnancy--whereas
            more than one-third of pregnancy-related or pregnancy-
            associated deaths occur while a person is still pregnant. Yet,
            for women eligible for the Medicaid program on the basis of
            pregnancy, such Medicaid coverage lapses at the end of the
            month on which the 60th postpartum day lands.
                (21) The experience of serious traumatic events, such as
            being exposed to domestic violence, substance use disorder, or
            pervasive racism, can over-activate the body's stress-response
            system. Known as toxic stress, the repetition of high doses of
            cortisol to the brain can harm healthy neurological
            development, which can have cascading physical and mental
            health consequences, as documented in the Adverse Childhood
            Experiences study of the Centers for Disease Control and
            Prevention.
                (22) A growing body of evidence-based research has shown
            the correlation between the stress associated with one's race--
            the stress of racism--and one's birthing outcomes. The stress
            of sex and race discrimination and institutional racism has
            been demonstrated to contribute to a higher risk of maternal
            mortality, irrespective of one's gestational age, maternal age,
            socioeconomic status, or individual-level health risk factors,
            including poverty, limited access to prenatal care, and poor
            physical and mental health (although these are not nominal
            factors). African-American women remain the most at risk for
            pregnancy-associated or pregnancy-related causes of death. When
            it comes to preeclampsia, for example, which is related to
            obesity, African-American women of normal weight remain the
            most at risk of dying during the perinatal period compared to
            non-African-American obese women.
                (23) The rising maternal mortality rate in the United
            States is driven predominantly by the disproportionately high
            rates of African-American maternal mortality.
                (24) African-American women are 3 to 4 times more likely to
            die from pregnancy or maternal-related distress than are White
            women, yielding one of the greatest and most disconcerting
            racial disparities in public health.
                (25) Compared to women from other racial and ethnic
            demographics, African-American women across the socioeconomic
            spectrum experience prolonged, unrelenting stress related to
            racial and gender discrimination, contributing to higher rates
            of maternal mortality, giving birth to low-weight babies, and
            experiencing pre-term birth. Racism is a risk factor for these
            aforementioned experiences. This cumulative stress often
            extends across the life course and is situated in everyday
            spaces where African-American women establish livelihood.
            Structural barriers, lack of access to care, and genetic
            predispositions to health vulnerabilities exacerbate African-
            American women's likelihood to experience poor or fatal
            birthing outcomes, but do not fully account for the great
            disparity.
                (26) African-American women are twice as likely to
            experience postpartum depression, and disproportionately higher
            rates of preeclampsia compared to White women.
                (27) Racism is deeply ingrained in United States systems,
            including in health care delivery systems between patients and
            providers, often resulting in disparate treatment for pain,
            irreverence for cultural norms with respect to health, and
            dismissiveness. Research has demonstrated that patients respond
            more warmly and adhere to medical treatment plans at a higher
            degree with providers of the same race or ethnicity or with
            providers with great ability to exercise empathy. However, the
            provider pool is not primed with many people of color, nor are
            providers (whether student-doctors in training or licensed
            practitioners) consistently required to undergo implicit bias,
            cultural competency, or empathy training on a consistent, on-
            going basis.
        (c) Improving Federal Efforts With Respect to Prevention of
    Maternal Mortality.--
                (1) Technical assistance for states with respect to
            reporting maternal mortality.--Not later than one year after
            the date of enactment of this Act, the Director of the Centers
            for Disease Control and Prevention (referred to in this section
            as the ``Director''), in consultation with the Administrator of
            the Health Resources and Services Administration, shall provide
            technical assistance to States that elect to report
            comprehensive data on maternal mortality, including oral,
            mental, and breastfeeding health information, for the purpose
            of encouraging uniformity in the reporting of such data and to
            encourage the sharing of such data among the respective States.
                (2) Best practices relating to prevention of maternal
            mortality.--
                        (A) In general.--Not later than one year after the
                    date of enactment of this Act--
                                (i) the Director, in consultation with
                            relevant patient and provider groups, shall
                            issue best practices to State maternal
                            mortality review committees on how best to
                            identify and review maternal mortality cases,
                            taking into account any data made available by
                            States relating to maternal mortality,
                            including data on oral, mental, and
                            breastfeeding health, and utilization of any
                            emergency services; and
                                (ii) the Director, working in collaboration
                            with the Health Resources and Services
                            Administration, shall issue best practices to
                            hospitals, State professional society groups,
                            and perinatal quality collaboratives on how
                            best to prevent maternal mortality.
                        (B) Authorization of appropriations.--For purposes
                    of carrying out this subsection, there is authorized to
                    be appropriated $5,000,000 for each of fiscal years
                    2021 through 2025.
                (3) Alliance for innovation on maternal health grant
            program.--
                        (A) In general.--Not later than one year after the
                    date of enactment of this Act, the Secretary of Health
                    and Human Services (referred to in this subsection as
                    the ``Secretary''), acting through the Associate
                    Administrator of the Maternal and Child Health Bureau
                    of the Health Resources and Services Administration,
                    shall establish a grant program to be known as the
                    Alliance for Innovation on Maternal Health Grant
                    Program (referred to in this subsection as ``AIM'')
                    under which the Secretary shall award grants to
                    eligible entities for the purpose of--
                                (i) directing widespread adoption and
                            implementation of maternal safety bundles
                            through collaborative State-based teams; and
                                (ii) collecting and analyzing process,
                            structure, and outcome data to drive continuous
                            improvement in the implementation of such
                            safety bundles by such State-based teams with
                            the ultimate goal of eliminating preventable
                            maternal mortality and severe maternal
                            morbidity in the United States.
                        (B) Eligible entities.--In order to be eligible for
                    a grant under paragraph (1), an entity shall--
                                (i) submit to the Secretary an application
                            at such time, in such manner, and containing
                            such information as the Secretary may require;
                            and
                                (ii) demonstrate in such application that
                            the entity is an interdisciplinary, multi-
                            stakeholder, national organization with a
                            national data-driven maternal safety and
                            quality improvement initiative based on
                            implementation approaches that have been proven
                            to improve maternal safety and outcomes in the
                            United States.
                        (C) Use of funds.--An eligible entity that receives
                    a grant under paragraph (1) shall use such grant
                    funds--
                                (i) to develop and implement, through a
                            robust, multi-stakeholder process, maternal
                            safety bundles to assist States and health care
                            systems in aligning national, State, and
                            hospital-level quality improvement efforts to
                            improve maternal health outcomes, specifically
                            the reduction of maternal mortality and severe
                            maternal morbidity;
                                (ii) to ensure, in developing and
                            implementing maternal safety bundles under
                            subparagraph (A), that such maternal safety
                            bundles--
                                        (I) satisfy the quality improvement
                                    needs of a State or health care system
                                    by factoring in the results and
                                    findings of relevant data reviews, such
                                    as reviews conducted by a State
                                    maternal mortality review committee;
                                    and
                                        (II) address topics such as--
                                                (aa) obstetric hemorrhage;
                                                (bb) maternal mental
                                            health;
                                                (cc) the maternal venous
                                            system;
                                                (dd) obstetric care for
                                            women with substance use
                                            disorders, including opioid use
                                            disorder;
                                                (ee) postpartum care basics
                                            for maternal safety;
                                                (ff) reduction of
                                            peripartum racial and ethnic
                                            disparities;
                                                (gg) reduction of primary
                                            caesarean birth;
                                                (hh) severe hypertension in
                                            pregnancy;
                                                (ii) severe maternal
                                            morbidity reviews;
                                                (jj) support after a severe
                                            maternal morbidity event;
                                                (kk) thromboembolism;
                                                (ll) optimization of
                                            support for breastfeeding; and
                                                (mm) maternal oral health;
                                            and
                                (iii) to provide ongoing technical
                            assistance at the national and State levels to
                            support implementation of maternal safety
                            bundles under subparagraph (A).
                        (D) Maternal safety bundle defined.--For purposes
                    of this subsection, the term ``maternal safety bundle''
                    means standardized, evidence-informed processes for
                    maternal health care.
                        (E) Authorization of appropriations.--For purposes
                    of carrying out this subsection, there is authorized to
                    be appropriated $10,000,000 for each of fiscal years
                    2021 through 2025.
                (4) Funding for state-based perinatal quality
            collaboratives development and sustainability.--
                        (A) In general.--Not later than one year after the
                    date of enactment of this Act, the Secretary of Health
                    and Human Services (referred to in this subsection as
                    the ``Secretary''), acting through the Division of
                    Reproductive Health of the Centers for Disease Control
                    and Prevention, shall establish a grant program to be
                    known as the State-Based Perinatal Quality
                    Collaborative grant program under which the Secretary
                    awards grants to eligible entities for the purpose of
                    development and sustainability of perinatal quality
                    collaboratives in every State, the District of
                    Columbia, and eligible territories, in order to
                    measurably improve perinatal care and perinatal health
                    outcomes for pregnant and postpartum women and their
                    infants.
                        (B) Grant amounts.--Grants awarded under this
                    subsection shall be in amounts not to exceed $250,000
                    per year, for the duration of the grant period.
                        (C) State-based perinatal quality collaborative
                    defined.--For purposes of this subsection, the term
                    ``State-based perinatal quality collaborative'' means a
                    network of multidisciplinary teams that--
                                (i) work to improve measurable outcomes for
                            maternal and infant health by advancing
                            evidence-informed clinical practices using
                            quality improvement principles;
                                (ii) work with hospital-based or outpatient
                            facility-based clinical teams, experts, and
                            stakeholders, including patients and families,
                            to spread best practices and optimize resources
                            to improve perinatal care and outcomes;
                                (iii) employ strategies that include the
                            use of the collaborative learning model to
                            provide opportunities for hospitals and
                            clinical teams to collaborate on improvement
                            strategies, rapid-response data to provide
                            timely feedback to hospital and other clinical
                            teams to track progress, and quality
                            improvement science to provide support and
                            coaching to hospital and clinical teams; and
                                (iv) have the goal of improving population-
                            level outcomes in maternal and infant health.
                        (D) Authorization of appropriations.--For purposes
                    of carrying out this subsection, there is authorized to
                    be appropriated $14,000,000 per year for each of fiscal
                    years 2021 through 2025.
                (5) Expansion of medicaid and chip coverage for pregnant
            and postpartum women.--
                        (A) Requiring coverage of oral health services for
                    pregnant and postpartum women.--
                                (i) Medicaid.--Section 1905 of the Social
                            Security Act (42 U.S.C. 1396d) is amended--
                                        (I) in subsection (a)(4)--
                                                (aa) by striking ``; and
                                            (D)'' and inserting ``; (D)'';
                                            and
                                                (bb) by inserting ``; and
                                            (E) oral health services for
                                            pregnant and postpartum women
                                            (as defined in subsection
                                            (ee))'' after ``subsection
                                            (bb))''; and
                                        (II) by adding at the end the
                                    following new subsection:
        ``(ee) Oral Health Services for Pregnant and Postpartum Women.--
                ``(1) In general.--For purposes of this title, the term
            `oral health services for pregnant and postpartum women' means
            dental services necessary to prevent disease and promote oral
            health, restore oral structures to health and function, and
            treat emergency conditions that are furnished to a woman during
            pregnancy (or during the 1-year period beginning on the last
            day of the pregnancy).
                ``(2) Coverage requirements.--To satisfy the requirement to
            provide oral health services for pregnant and postpartum women,
            a State shall, at a minimum, provide coverage for preventive,
            diagnostic, periodontal, and restorative care consistent with
            recommendations for perinatal oral health care and dental care
            during pregnancy from the American Academy of Pediatric
            Dentistry and the American College of Obstetricians and
            Gynecologists.''.
                                (ii) CHIP.--Section 2103(c)(5)(A) of the
                            Social Security Act (42 U.S.C. 1397cc(c)(5)(A))
                            is amended by inserting ``or a targeted low-
                            income pregnant woman'' after ``targeted low-
                            income child''.
                        (B) Extending medicaid coverage for pregnant and
                    postpartum women.--Section 1902 of the Social Security
                    Act (42 U.S.C. 1396a) is amended--
                                (i) in subsection (e)--
                                        (I) in paragraph (5)--
                                                (aa) by inserting
                                            ``(including oral health
                                            services for pregnant and
                                            postpartum women (as defined in
                                            section 1905(ee))'' after
                                            ``postpartum medical assistance
                                            under the plan''; and
                                                (bb) by striking ``60-day''
                                            and inserting ``1-year''; and
                                        (II) in paragraph (6), by striking
                                    ``60-day'' and inserting ``1-year'';
                                    and
                                (ii) in subsection (l)(1)(A), by striking
                            ``60-day'' and inserting ``1-year''.
                        (C) Extending medicaid coverage for lawful
                    residents.--Section 1903(v)(4)(A) of the Social
                    Security Act (42 U.S.C. 1396b(v)(4)(A)) is amended by
                    striking ``60-day'' and inserting ``1-year''.
                        (D) Extending chip coverage for pregnant and
                    postpartum women.--Section 2112(d)(2)(A) of the Social
                    Security Act (42 U.S.C. 1397ll(d)(2)(A)) is amended by
                    striking ``60-day'' and inserting ``1-year''.
                        (E) Maintenance of effort.--
                                (i) Medicaid.--Section 1902(l) of the
                            Social Security Act (42 U.S.C. 1396a(l)) is
                            amended by adding at the end the following new
                            paragraph:
        ``(5) During the period that begins on the date of enactment of
    this paragraph and ends on the date that is five years after such date
    of enactment, as a condition for receiving any Federal payments under
    section 1903(a) for calendar quarters occurring during such period, a
    State shall not have in effect, with respect to women who are eligible
    for medical assistance under the State plan or under a waiver of such
    plan on the basis of being pregnant or having been pregnant,
    eligibility standards, methodologies, or procedures under the State
    plan or waiver that are more restrictive than the eligibility
    standards, methodologies, or procedures, respectively, under such plan
    or waiver that are in effect on the date of enactment of this
    paragraph.''.
                                (ii) CHIP.--Section 2105(d) of the Social
                            Security Act (42 U.S.C. 1397ee(d)) is amended
                            by adding at the end the following new
                            paragraph:
                ``(4) In eligibility standards for targeted low-income
            pregnant women.--During the period that begins on the date of
            enactment of this paragraph and ends on the date that is five
            years after such date of enactment, as a condition of receiving
            payments under subsection (a) and section 1903(a), a State that
            elects to provide assistance to women on the basis of being
            pregnant (including pregnancy-related assistance provided to
            targeted low-income pregnant women (as defined in section
            2112(d)), pregnancy-related assistance provided to women who
            are eligible for such assistance through application of section
            1902(v)(4)(A)(i) under section 2107(e)(1), or any other
            assistance under the State child health plan (or a waiver of
            such plan) which is provided to women on the basis of being
            pregnant) shall not have in effect, with respect to such women,
            eligibility standards, methodologies, or procedures under such
            plan (or waiver) that are more restrictive than the eligibility
            standards, methodologies, or procedures, respectively, under
            such plan (or waiver) that are in effect on the date of
            enactment of this paragraph.''.
                        (F) Information on benefits.--The Secretary of
                    Health and Human Services shall make publicly available
                    on the internet website of the Department of Health and
                    Human Services, information regarding benefits
                    available to pregnant and postpartum women and under
                    the Medicaid program and the Children's Health
                    Insurance Program, including information on--
                                (i) benefits that States are required to
                            provide to pregnant and postpartum women under
                            such programs;
                                (ii) optional benefits that States may
                            provide to pregnant and postpartum women under
                            such programs; and
                                (iii) the availability of different kinds
                            of benefits for pregnant and postpartum women,
                            including oral health and mental health
                            benefits, under such programs.
                        (G) Federal funding for cost of extended medicaid
                    and chip coverage for postpartum women.--
                                (i) Medicaid.--Section 1905 of the Social
                            Security Act (42 U.S.C. 1396d), as amended by
                            paragraph (1), is further amended--
                                        (I) in subsection (b), by striking
                                    ``and (aa)'' and inserting ``(aa), and
                                    (ff)''; and
                                        (II) by adding at the end the
                                    following:
        ``(ff) Increased FMAP for Extended Medical Assistance for
    Postpartum Women.--Notwithstanding subsection (b), the Federal medical
    assistance percentage for a State, with respect to amounts expended by
    such State for medical assistance for a woman who is eligible for such
    assistance on the basis of being pregnant or having been pregnant that
    is provided during the 305-day period that begins on the 60th day after
    the last day of her pregnancy (including any such assistance provided
    during the month in which such period ends), shall be equal to--
                ``(1) 100 percent for the first 20 calendar quarters during
            which this subsection is in effect; and
                ``(2) 90 percent for calendar quarters thereafter.''.
                                (ii) CHIP.--Section 2105(c) of the Social
                            Security Act (42 U.S.C. 1397ee(c)) is amended
                            by adding at the end the following new
                            paragraph:
                ``(12) Enhanced payment for extended assistance provided to
            pregnant women.--Notwithstanding subsection (b), the enhanced
            FMAP, with respect to payments under subsection (a) for
            expenditures under the State child health plan (or a waiver of
            such plan) for assistance provided under the plan (or waiver)
            to a woman who is eligible for such assistance on the basis of
            being pregnant (including pregnancy-related assistance provided
            to a targeted low-income pregnant woman (as defined in section
            2112(d)), pregnancy-related assistance provided to a woman who
            is eligible for such assistance through application of section
            1902(v)(4)(A)(i) under section 2107(e)(1), or any other
            assistance under the plan (or waiver) provided to a woman who
            is eligible for such assistance on the basis of being pregnant)
            during the 305-day period that begins on the 60th day after the
            last day of her pregnancy (including any such assistance
            provided during the month in which such period ends), shall be
            equal to--
                        ``(A) 100 percent for the first 20 calendar
                    quarters during which this paragraph is in effect; and
                        ``(B) 90 percent for calendar quarters
                    thereafter.''.
                        (H) Effective date.--
                                (i) In general.--Subject to subparagraph
                            (B), the amendments made by this subsection
                            shall take effect on the first day of the first
                            calendar quarter that begins on or after the
                            date that is one year after the date of
                            enactment of this Act.
                                (ii) Exception for state legislation.--In
                            the case of a State plan under title XIX of the
                            Social Security Act or a State child health
                            plan under title XXI of such Act that the
                            Secretary of Health and Human Services
                            determines requires State legislation in order
                            for the respective plan to meet any requirement
                            imposed by amendments made by this subsection,
                            the respective plan shall not be regarded as
                            failing to comply with the requirements of such
                            title solely on the basis of its failure to
                            meet such an 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 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 the session shall be
                            considered to be a separate regular session of
                            the State legislature.
                (6) Regional centers of excellence.--Part P of title III of
            the Public Health Service Act is amended by adding at the end
            the following new section:

    ``SEC. 399V-7. REGIONAL CENTERS OF EXCELLENCE ADDRESSING IMPLICIT BIAS
                  AND CULTURAL COMPETENCY IN PATIENT-PROVIDER INTERACTIONS
                  EDUCATION.

        ``(a) In General.--Not later than one year after the date of
    enactment of this section, the Secretary, in consultation with such
    other agency heads as the Secretary determines appropriate, shall award
    cooperative agreements for the establishment or support of regional
    centers of excellence addressing implicit bias and cultural competency
    in patient-provider interactions education for the purpose of enhancing
    and improving how health care professionals are educated in implicit
    bias and delivering culturally competent health care.
        ``(b) Eligibility.--To be eligible to receive a cooperative
    agreement under subsection (a), an entity shall--
                ``(1) be a public or other nonprofit entity specified by
            the Secretary that provides educational and training
            opportunities for students and health care professionals, which
            may be a health system, teaching hospital, community health
            center, medical school, school of public health, dental school,
            social work school, school of professional psychology, or any
            other health professional school or program at an institution
            of higher education (as defined in section 101 of the Higher
            Education Act of 1965) focused on the prevention, treatment, or
            recovery of health conditions that contribute to maternal
            mortality and the prevention of maternal mortality and severe
            maternal morbidity;
                ``(2) demonstrate community engagement and participation,
            such as through partnerships with home visiting and case
            management programs; and
                ``(3) provide to the Secretary such information, at such
            time and in such manner, as the Secretary may require.
        ``(c) Diversity.--In awarding a cooperative agreement under
    subsection (a), the Secretary shall take into account any regional
    differences among eligible entities and make an effort to ensure
    geographic diversity among award recipients.
        ``(d) Dissemination of Information.--
                ``(1) Public availability.--The Secretary shall make
            publicly available on the internet website of the Department of
            Health and Human Services information submitted to the
            Secretary under subsection (b)(3).
                ``(2) Evaluation.--The Secretary shall evaluate each
            regional center of excellence established or supported pursuant
            to subsection (a) and disseminate the findings resulting from
            each such evaluation to the appropriate public and private
            entities.
                ``(3) Distribution.--The Secretary shall share evaluations
            and overall findings with State departments of health and other
            relevant State level offices to inform State and local best
            practices.
        ``(e) Maternal Mortality Defined.--In this section, the term
    `maternal mortality' means death of a woman that occurs during
    pregnancy or within the one-year period following the end of such
    pregnancy.
        ``(f) Authorization of Appropriations.--For purposes of carrying
    out this section, there is authorized to be appropriated $5,000,000 for
    each of fiscal years 2021 through 2025.''.
                (7) Special supplemental nutrition program for women,
            infants, and children.--Section 17(d)(3)(A)(ii) of the Child
            Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is
            amended--
                        (A) by striking the clause designation and heading
                    and all that follows through ``A State'' and inserting
                    the following:
                                ``(ii) Women.--
                                        ``(I) Breastfeeding women.--A
                                    State'';
                        (B) in subclause (I) (as so designated), by
                    striking ``1 year'' and all that follows through
                    ``earlier'' and inserting ``2 years postpartum''; and
                        (C) by adding at the end the following:
                                        ``(II) Postpartum women.--A State
                                    may elect to certify a postpartum woman
                                    for a period of 2 years.''.
                (8) Definitions.--In this section:
                        (A) Maternal mortality.--The term ``maternal
                    mortality'' means death of a woman that occurs during
                    pregnancy or within the one-year period following the
                    end of such pregnancy.
                        (B) Severe maternal morbidity.--The term ``severe
                    maternal morbidity'' includes unexpected outcomes of
                    labor and delivery that result in significant short-
                    term or long-term consequences to a woman's health.
        (d) Increasing Excise Taxes on Cigarettes and Establishing Excise
    Tax Equity Among All Tobacco Product Tax Rates.--
                (1) Tax parity for roll-your-own tobacco.--Section 5701(g)
            of the Internal Revenue Code of 1986 is amended by striking
            ``$24.78'' and inserting ``$49.56''.
                (2) Tax parity for pipe tobacco.--Section 5701(f) of the
            Internal Revenue Code of 1986 is amended by striking ``$2.8311
            cents'' and inserting ``$49.56''.
                (3) Tax parity for smokeless tobacco.--
                        (A) Section 5701(e) of the Internal Revenue Code of
                    1986 is amended--
                                (i) in paragraph (1), by striking ``$1.51''
                            and inserting ``$26.84'';
                                (ii) in paragraph (2), by striking ``50.33
                            cents'' and inserting ``$10.74''; and
                                (iii) by adding at the end the following:
                ``(3) Smokeless tobacco sold in discrete single-use
            units.--On discrete single-use units, $100.66 per thousand.''.
                        (B) Section 5702(m) of such Code is amended--
                                (i) in paragraph (1), by striking ``or
                            chewing tobacco'' and inserting ``, chewing
                            tobacco, or discrete single-use unit'';
                                (ii) in paragraphs (2) and (3), by
                            inserting ``that is not a discrete single-use
                            unit'' before the period in each such
                            paragraph; and
                                (iii) by adding at the end the following:
                ``(4) Discrete single-use unit.--The term `discrete single-
            use unit' means any product containing tobacco that--
                        ``(A) is not intended to be smoked; and
                        ``(B) is in the form of a lozenge, tablet, pill,
                    pouch, dissolvable strip, or other discrete single-use
                    or single-dose unit.''.
                (4) Tax parity for small cigars.--Paragraph (1) of section
            5701(a) of the Internal Revenue Code of 1986 is amended by
            striking ``$50.33'' and inserting ``$100.66''.
                (5) Tax parity for large cigars.--
                        (A) In general.--Paragraph (2) of section 5701(a)
                    of the Internal Revenue Code of 1986 is amended by
                    striking ``52.75 percent'' and all that follows through
                    the period and inserting the following: ``$49.56 per
                    pound and a proportionate tax at the like rate on all
                    fractional parts of a pound but not less than 10.066
                    cents per cigar.''.
                        (B) Guidance.--The Secretary of the Treasury, or
                    the Secretary's delegate, may issue guidance regarding
                    the appropriate method for determining the weight of
                    large cigars for purposes of calculating the applicable
                    tax under section 5701(a)(2) of the Internal Revenue
                    Code of 1986.
                (6) Tax parity for roll-your-own tobacco and certain
            processed tobacco.--Subsection (o) of section 5702 of the
            Internal Revenue Code of 1986 is amended by inserting ``, and
            includes processed tobacco that is removed for delivery or
            delivered to a person other than a person with a permit
            provided under section 5713, but does not include removals of
            processed tobacco for exportation'' after ``wrappers thereof''.
                (7) Clarifying tax rate for other tobacco products.--
                        (A) In general.--Section 5701 of the Internal
                    Revenue Code of 1986 is amended by adding at the end
                    the following new subsection:
        ``(i) Other Tobacco Products.--Any product not otherwise described
    under this section that has been determined to be a tobacco product by
    the Food and Drug Administration through its authorities under the
    Family Smoking Prevention and Tobacco Control Act shall be taxed at a
    level of tax equivalent to the tax rate for cigarettes on an estimated
    per use basis as determined by the Secretary.''.
                        (B) Establishing per use basis.--For purposes of
                    section 5701(i) of the Internal Revenue Code of 1986,
                    not later than 12 months after the later of the date of
                    the enactment of this Act or the date that a product
                    has been determined to be a tobacco product by the Food
                    and Drug Administration, the Secretary of the Treasury
                    (or the Secretary of the Treasury's delegate) shall
                    issue final regulations establishing the level of tax
                    for such product that is equivalent to the tax rate for
                    cigarettes on an estimated per use basis.
                (8) Clarifying definition of tobacco products.--
                        (A) In general.--Subsection (c) of section 5702 of
                    the Internal Revenue Code of 1986 is amended to read as
                    follows:
        ``(c) Tobacco Products.--The term `tobacco products' means--
                ``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco,
            and roll-your-own tobacco, and
                ``(2) any other product subject to tax pursuant to section
            5701(i).''.
                        (B) Conforming amendments.--Subsection (d) of
                    section 5702 of such Code is amended by striking
                    ``cigars, cigarettes, smokeless tobacco, pipe tobacco,
                    or roll-your-own tobacco'' each place it appears and
                    inserting ``tobacco products''.
                (9) Increasing tax on cigarettes.--
                        (A) Small cigarettes.--Section 5701(b)(1) of such
                    Code is amended by striking ``$50.33'' and inserting
                    ``$100.66''.
                        (B) Large cigarettes.--Section 5701(b)(2) of such
                    Code is amended by striking ``$105.69'' and inserting
                    ``$211.38''.
                (10) Tax rates adjusted for inflation.--Section 5701 of
            such Code, as amended by subsection (g), is amended by adding
            at the end the following new subsection:
        ``(j) Inflation Adjustment.--
                ``(1) In general.--In the case of any calendar year
            beginning after 2021, the dollar amounts provided under this
            chapter shall each be increased by an amount equal to--
                        ``(A) such dollar amount, multiplied by
                        ``(B) the cost-of-living adjustment determined
                    under section 1(f)(3) for the calendar year, determined
                    by substituting `calendar year 2017' for `calendar year
                    2016' in subparagraph (A)(ii) thereof.
                ``(2) Rounding.--If any amount as adjusted under paragraph
            (1) is not a multiple of $0.01, such amount shall be rounded to
            the next highest multiple of $0.01.''.
                (11) Floor stocks taxes.--
                        (A) Imposition of tax.--On tobacco products
                    manufactured in or imported into the United States
                    which are removed before any tax increase date and held
                    on such date for sale by any person, there is hereby
                    imposed a tax in an amount equal to the excess of--
                                (i) the tax which would be imposed under
                            section 5701 of the Internal Revenue Code of
                            1986 on the article if the article had been
                            removed on such date, over
                                (ii) the prior tax (if any) imposed under
                            section 5701 of such Code on such article.
                        (B) Credit against tax.--Each person shall be
                    allowed as a credit against the taxes imposed by
                    paragraph (1) an amount equal to $500. Such credit
                    shall not exceed the amount of taxes imposed by
                    paragraph (1) on such date for which such person is
                    liable.
                        (C) Liability for tax and method of payment.--
                                (i) Liability for tax.--A person holding
                            tobacco products on any tax increase date to
                            which any tax imposed by paragraph (1) applies
                            shall be liable for such tax.
                                (ii) Method of payment.--The tax imposed by
                            paragraph (1) shall be paid in such manner as
                            the Secretary shall prescribe by regulations.
                                (iii) Time for payment.--The tax imposed by
                            paragraph (1) shall be paid on or before the
                            date that is 120 days after the effective date
                            of the tax rate increase.
                        (D) Articles in foreign trade zones.--
                    Notwithstanding the Act of June 18, 1934 (commonly
                    known as the Foreign Trade Zone Act, 48 Stat. 998, 19
                    U.S.C. 81a et seq.), or any other provision of law, any
                    article which is located in a foreign trade zone on any
                    tax increase date shall be subject to the tax imposed
                    by paragraph (1) if--
                                (i) internal revenue taxes have been
                            determined, or customs duties liquidated, with
                            respect to such article before such date
                            pursuant to a request made under the 1st
                            proviso of section 3(a) of such Act; or
                                (ii) such article is held on such date
                            under the supervision of an officer of the
                            United States Customs and Border Protection of
                            the Department of Homeland Security pursuant to
                            the 2d proviso of such section 3(a).
                        (E) Definitions.--For purposes of this subsection--
                                (i) In general.--Any term used in this
                            subsection which is also used in section 5702
                            of such Code shall have the same meaning as
                            such term has in such section.
                                (ii) Tax increase date.--The term ``tax
                            increase date'' means the effective date of any
                            increase in any tobacco product excise tax rate
                            pursuant to the amendments made by this section
                            (other than subsection (j) thereof).
                                (iii) Secretary.--The term ``Secretary''
                            means the Secretary of the Treasury or the
                            Secretary's delegate.
                        (F) Controlled groups.--Rules similar to the rules
                    of section 5061(e)(3) of such Code shall apply for
                    purposes of this subsection.
                        (G) Other laws applicable.--All provisions of law,
                    including penalties, applicable with respect to the
                    taxes imposed by section 5701 of such Code shall,
                    insofar as applicable and not inconsistent with the
                    provisions of this subsection, apply to the floor
                    stocks taxes imposed by paragraph (1), to the same
                    extent as if such taxes were imposed by such section
                    5701. The Secretary may treat any person who bore the
                    ultimate burden of the tax imposed by paragraph (1) as
                    the person to whom a credit or refund under such
                    provisions may be allowed or made.
                (12) Effective dates.--
                        (A) In general.--Except as provided in paragraphs
                    (2) through (4), the amendments made by this section
                    shall apply to articles removed (as defined in section
                    5702(j) of the Internal Revenue Code of 1986) after the
                    last day of the month which includes the date of the
                    enactment of this Act.
                        (B) Discrete single-use units and processed
                    tobacco.--The amendments made by subsections (c)(1)(C),
                    (c)(2), and (f) shall apply to articles removed (as
                    defined in section 5702(j) of the Internal Revenue Code
                    of 1986) after the date that is 6 months after the date
                    of the enactment of this Act.
                        (C) Large cigars.--The amendments made by
                    subsection (e) shall apply to articles removed after
                    December 31, 2021.
                        (D) Other tobacco products.--The amendments made by
                    subsection (g)(1) shall apply to products removed after
                    the last day of the month which includes the date that
                    the Secretary of the Treasury (or the Secretary of the
                    Treasury's delegate) issues final regulations
                    establishing the level of tax for such product.

    SEC. 506. RURAL MATERNAL AND OBSTETRIC MODERNIZATION OF SERVICES.

        (a) Short Title.--This section may be cited as the ``Rural Maternal
    and Obstetric Modernization of Services Act'' or the ``Rural MOMS
    Act''.
        (b) Improving Rural Maternal and Obstetric Care Data.--
                (1) Maternal mortality and morbidity activities.--Section
            301 of the Public Health Service Act (42 U.S.C. 241) is
            amended--
                        (A) by redesignating subsections (e) through (h) as
                    subsections (f) through (i), respectively; and
                        (B) by inserting after subsection (d), the
                    following:
        ``(e) The Secretary, acting through the Director of the Centers for
    Disease Control and Prevention, shall expand, intensify, and coordinate
    the activities of the Centers for Disease Control and Prevention with
    respect to maternal mortality and morbidity.''.
                (2) Office of women's health.--Section 310A(b)(1) of the
            Public Health Service Act (42 U.S.C. 242s(b)(1)) is amended by
            inserting ``sociocultural (race, ethnicity, language, class,
            income), including among American Indians and Alaska Natives,
            as such terms are defined in section 4 of the Indian Health
            Care Improvement Act, and geographic contexts,'' after
            ``biological,''.
                (3) Safe motherhood.--Section 317K(b)(2) of the Public
            Health Service Act (42 U.S.C. 247b-12(b)(2)) is amended--
                        (A) in subparagraph (L), by striking ``and'' at the
                    end;
                        (B) by redesignating subparagraph (M) as
                    subparagraph (N); and
                        (C) by inserting after subparagraph (L), the
                    following:
                        ``(M) an examination of the relationship between
                    maternal health services in rural areas and outcomes in
                    delivery and postpartum care; and''.
                (4) Office of research on women's health.--Section 486 of
            the Public Health Service Act (42 U.S.C. 287d) is amended--
                        (A) in subsection (b)--
                                (i) by redesignating paragraphs (4) through
                            (9) as paragraphs (5) through (10),
                            respectively;
                                (ii) by inserting after paragraph (3) the
                            following:
                ``(4) carry out paragraphs (1) and (2) with respect to
            pregnancy, with priority given to deaths related to
            pregnancy;''; and
                                (iii) in paragraph (5) (as so
                            redesignated), by striking ``through (3)'' and
                            inserting ``through (4)''; and
                        (B) in subsection (d)(4)(A)(iv), by inserting ``,
                    including maternal mortality and other maternal
                    morbidity outcomes'' before the semicolon.
        (c) Rural Obstetric Network Grants.--The Public Health Service Act
    is amended by inserting after section 317L-1 (42 U.S.C. 247b-13a) the
    following:

    ``SEC. 317L-2. RURAL OBSTETRIC NETWORK GRANTS.

        ``(a) In General.--For the purpose of enabling the Secretary
    (through grants, contracts, or otherwise), acting through the
    Administrator of the Health Resources and Services Administration, to
    establish collaborative improvement and innovation networks (referred
    to in this section as `rural obstetric networks') to improve outcomes
    in birth and maternal morbidity and mortality, there is appropriated to
    the Secretary, out of any money in the Treasury not otherwise
    appropriated, $3,000,000 for each of fiscal years 2020 through 2024.
    Such amounts shall remain available until expended.
        ``(b) Use of Funds.--Amount appropriated under subsection (a) shall
    be used for the establishment of collaborative improvement and
    innovation networks to improve maternal health in rural areas by
    improving outcomes in birth and maternal morbidity and mortality. Rural
    obstetric networks established in accordance with this section shall--
                ``(1) assist pregnant women and individuals in rural areas
            connect with prenatal, labor and birth, and postpartum care to
            improve outcomes in birth and maternal mortality and morbidity;
                ``(2) identify successful prenatal, labor and birth, and
            postpartum health delivery models for individuals in rural
            areas, including evidence-based home visiting programs and
            successful, culturally competent models with positive maternal
            health outcomes that advance health equity;
                ``(3) develop a model for collaboration between health
            facilities that have an obstetric health unit and health
            facilities that do not have an obstetric health unit;
                ``(4) provide training and guidance for health facilities
            that do not have obstetric health units;
                ``(5) collaborate with academic institutions that can
            provide regional expertise and research on access, outcomes,
            needs assessments, and other identified data; and
                ``(6) measure and address inequities in birth outcomes
            among rural residents, with an emphasis on Black and American
            Indians and Alaska Native residents, as such terms are defined
            in section 4 of the Indian Health Care Improvement Act.
        ``(c) Requirements.--
                ``(1) Establishment.--Not later than October 1, 2020, the
            Secretary shall establish rural obstetric health networks in at
            least 5 regions.
                ``(2) Definitions.--In this section:
                        ``(A) Frontier area.--The term `frontier area'
                    means a frontier county, as defined in section
                    1886(d)(3)(E)(iii)(III) of the Social Security Act.
                        ``(B) Indian tribe.--The term `Indian tribe' has
                    the meaning given such term in section 4 of the Indian
                    Health Care Improvement Act.
                        ``(C) Native hawaiian health care system.--The term
                    `Native Hawaiian Health Care System' has the meaning
                    given such term in section 12 of the Native Hawaiian
                    Health Care Improvement Act.
                        ``(D) Region.--The term `region' means a State,
                    Indian tribe, rural area, or frontier area.
                        ``(E) Rural area.--The term `rural area' has the
                    meaning given that term in section 1886(d)(2)(D) of the
                    Social Security Act.
                        ``(F) Tribal organization.--The term `tribal
                    organization' has the meaning given such term in the
                    Indian Self-Determination Act.
                        ``(G) State.--The term `State' has the meaning
                    given that term for purposes of title V of the Social
                    Security Act.''.
        (d) Telehealth Network and Telehealth Resource Centers Grant
    Programs.--Section 330I of the Public Health Service Act (42 U.S.C.
    254c-14) is amended--
                (1) in subsection (f)(1)(B)(iii), by adding at the end the
            following:
                                        ``(XIII) Providers of maternal,
                                    including prenatal, labor and birth,
                                    and postpartum care services and
                                    entities operation obstetric care
                                    units.'';
                (2) in subsection (i)(1)(B), by inserting ``labor and
            birth, postpartum,'' before ``or prenatal''; and
                (3) in subsection (k)(1)(B), by inserting ``equipment
            useful for caring for pregnant women and individuals, including
            ultrasound machines and fetal monitoring equipment,'' before
            ``and other equipment''.
        (e) Rural Maternal and Obstetric Care Training Demonstration.--Part
    D of title VII of the Public Health Service Act is amended by inserting
    after section 760 (42 U.S.C. 294k) the following:

    ``SEC. 760A. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

        ``(a) In General.--The Secretary shall establish a training
    demonstration program to award grants to eligible entities to support--
                ``(1) training for physicians, medical residents, including
            family medicine and obstetrics and gynecology residents, and
            fellows to practice maternal and obstetric medicine in rural
            community-based settings;
                ``(2) training for licensed and accredited nurse
            practitioners, physician assistants, certified nurse midwives,
            certified midwives, certified professional midwives, home
            visiting nurses, or non-clinical professionals such as doulas
            and community health workers, to provide maternal care services
            in rural community-based settings; and
                ``(3) establishing, maintaining, or improving academic
            units or programs that--
                        ``(A) provide training for students or faculty,
                    including through clinical experiences and research, to
                    improve maternal care in rural areas; or
                        ``(B) develop evidence-based practices or
                    recommendations for the design of the units or programs
                    described in subparagraph (A), including curriculum
                    content standards.
        ``(b) Activities.--
                ``(1) Training for medical residents and fellows.--A
            recipient of a grant under subsection (a)(1)--
                        ``(A) shall use the grant funds--
                                ``(i) to plan, develop, and operate a
                            training program to provide obstetric care in
                            rural areas for family practice or obstetrics
                            and gynecology residents and fellows; or
                                ``(ii) to train new family practice or
                            obstetrics and gynecology residents and fellows
                            in maternal and obstetric health care to
                            provide and expand access to maternal and
                            obstetric health care in rural areas; and
                        ``(B) may use the grant funds to provide additional
                    support for the administration of the program or to
                    meet the costs of projects to establish, maintain, or
                    improve faculty development, or departments, divisions,
                    or other units necessary to implement such training.
                ``(2) Training for other providers.--A recipient of a grant
            under subsection (a)(2)--
                        ``(A) shall use the grant funds to plan, develop,
                    or operate a training program to provide maternal
                    health care services in rural, community-based
                    settings; and
                        ``(B) may use the grant funds to provide additional
                    support for the administration of the program or to
                    meet the costs of projects to establish, maintain, or
                    improve faculty development, or departments, divisions,
                    or other units necessary to implement such program.
                ``(3) Academic units or programs.--A recipient of a grant
            under subsection (a)(3) shall enter into a partnership with
            organizations such as an education accrediting organization
            (such as the Liaison Committee on Medical Education, the
            Accreditation Council for Graduate Medical Education, the
            Commission on Osteopathic College Accreditation, the
            Accreditation Commission for Education in Nursing, the
            Commission on Collegiate Nursing Education, the Accreditation
            Commission for Midwifery Education, or the Accreditation Review
            Commission on Education for the Physician Assistant) to carry
            out activities under subsection (a)(3).
                ``(4) Training program requirements.--The recipient of a
            grant under subsection (a)(1) or (a)(2) shall ensure that
            training programs carried out under the grant include
            instruction on--
                        ``(A) maternal mental health, including perinatal
                    depression and anxiety and postpartum depression;
                        ``(B) maternal substance use disorder;
                        ``(C) social determinants of health that impact
                    individuals living in rural communities, including
                    poverty, social isolation, access to nutrition,
                    education, transportation, and housing; and
                        ``(D) implicit bias.
        ``(c) Eligible Entities.--
                ``(1) Training for medical residents and fellows.--To be
            eligible to receive a grant under subsection (a)(1), an entity
            shall--
                        ``(A) be a consortium consisting of--
                                ``(i) at least one teaching health center;
                            or
                                ``(ii) the sponsoring institution (or
                            parent institution of the sponsoring
                            institution) of--
                                        ``(I) an obstetrics and gynecology
                                    or family medicine residency program
                                    that is accredited by the Accreditation
                                    Council of Graduate Medical Education
                                    (or the parent institution of such a
                                    program); or
                                        ``(II) a fellowship in maternal or
                                    obstetric medicine, as determined
                                    appropriate by the Secretary; or
                        ``(B) be an entity described in subparagraph
                    (A)(ii) that provides opportunities for medical
                    residents or fellows to train in rural community-based
                    settings.
                ``(2) Training for other providers.--To be eligible to
            receive a grant under subsection (a)(2), an entity shall be--
                        ``(A) a teaching health center (as defined in
                    section 749A(f));
                        ``(B) a federally qualified health center (as
                    defined in section 1905(l)(2)(B) of the Social Security
                    Act);
                        ``(C) a community mental health center (as defined
                    in section 1861(ff)(3)(B) of the Social Security Act);
                        ``(D) a rural health clinic (as defined in section
                    1861(aa) of the Social Security Act);
                        ``(E) a freestanding birth center (as defined in
                    section 1905(l)(3) of the Social Security Act);
                        ``(F) a health center operated by the Indian Health
                    Service, an Indian tribe, a tribal organization, or a
                    Native Hawaiian Health Care System (as such terms are
                    defined in section 4 of the Indian Health Care
                    Improvement Act and section 12 of the Native Hawaiian
                    Health Care Improvement Act); or
                        ``(G) an entity with a demonstrated record of
                    success in providing academic training for nurse
                    practitioners, physician assistants, certified nurse-
                    midwives, certified midwives, certified professional
                    midwives, home visiting nurses, or non-clinical
                    professionals, such as doulas and community health
                    workers.
                ``(3) Academic units or programs.--To be eligible to
            receive a grant under subsection (a)(3), an entity shall be a
            school of medicine or osteopathic medicine, a nursing school, a
            physician assistant training program, an accredited public or
            nonprofit private hospital, an accredited medical residency
            program, a school accredited by the Midwifery Education and
            Accreditation Council, or a public or private nonprofit entity
            which the Secretary has determined is capable of carrying out
            such grant.
                ``(4) Application.--To be eligible to receive a grant under
            subsection (a), an entity shall submit to the Secretary an
            application at such time, in such manner, and containing such
            information as the Secretary may require, including an estimate
            of the amount to be expended to conduct training activities
            under the grant (including ancillary and administrative costs).
        ``(d) Duration.--Grants awarded under this section shall be for a
    minimum of 5 years.
        ``(e) Study and Report.--
                ``(1) Study.--
                        ``(A) In general.--The Secretary, acting through
                    the Administrator of the Health Resources and Services
                    Administration, shall conduct a study on the results of
                    the demonstration program under this section.
                        ``(B) Data submission.--Not later than 90 days
                    after the completion of the first year of the training
                    program, and each subsequent year for the duration of
                    the grant, that the program is in effect, each
                    recipient of a grant under subsection (a) shall submit
                    to the Secretary such data as the Secretary may require
                    for analysis for the report described in paragraph (2).
                ``(2) Report to congress.--Not later than 1 year after
            receipt of the data described in paragraph (1)(B), the
            Secretary shall submit to Congress a report that includes--
                        ``(A) an analysis of the effect of the
                    demonstration program under this section on the
                    quality, quantity, and distribution of maternal,
                    including prenatal, labor and birth, and postpartum
                    care services and the demographics of the recipients of
                    those services;
                        ``(B) an analysis of maternal and infant health
                    outcomes (including quality of care, morbidity, and
                    mortality) before and after implementation of the
                    program in the communities served by entities
                    participating in the demonstration; and
                        ``(C) recommendations on whether the demonstration
                    program should be expanded.
        ``(f) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $5,000,000 for each of fiscal
    years 2020 through 2024.''.
        (f) GAO Report.--Not later than 1 year after the date of enactment
    of this Act, the Comptroller General of the United States shall submit
    to the appropriate committees of Congress a report on the maternal,
    including prenatal, labor and birth, and postpartum care in rural
    areas. Such report shall include the following:
                (1) The location of gaps in maternal and obstetric
            clinicians and health professionals, including non-clinical
            professionals such as doulas and community health workers.
                (2) The location of gaps in facilities able to provide
            maternal, including prenatal, labor and birth, and postpartum
            care in rural areas, including care for high-risk pregnancies.
                (3) The gaps in data on maternal mortality and
            recommendations to standardize the format on collecting data
            related to maternal mortality and morbidity.
                (4) The gaps in maternal health by race and ethnicity in
            rural communities, with a focus on racial inequities for Black
            residents and among Indian Tribes and American Indian/Alaska
            Native rural residents (as such terms are defined in section 4
            of the Indian Health Care Improvement Act).
                (5) A list of specific activities that the Secretary of
            Health and Human Services plans to conduct on maternal,
            including prenatal, labor and birth, and postpartum care.
                (6) A plan for completing such activities.
                (7) An explanation of Federal agency involvement and
            coordination needed to conduct such activities.
                (8) A budget for conducting such activities.
                (9) Other information that the Comptroller General
            determines appropriate.

    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 2021 through 2025.

    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 2021 through 2025.
        ``(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 2021 through 2025.
        ``(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 contraceptives.
                (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 promotores, 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 contraceptives and an explanation of the use,
                    safety, efficacy, affordability, and availability,
                    including over-the-counter access, of such
                    contraceptives and options for access without cost-
                    sharing through insurance and other programs;
                        (B) include emergency contraception to health care
                    providers, including pharmacists; and
                        (C) 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, including pharmacists, information on
            emergency contraceptives.
                (2) Information.--The information disseminated under
            paragraph (1) shall include, at a minimum--
                        (A) information describing the use, safety,
                    efficacy, and availability of emergency contraceptives,
                    and options for access without cost-sharing through
                    insurance and other programs;
                        (B) a recommendation regarding the use of such
                    contraceptives; 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) 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.
                (2) 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)).
                (3) 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 2021 through 2025.

    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 decision-making 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 1965 (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 2021 through 2026. 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) 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, 2021, 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 contraceptives--
                                        ``(I) has been approved by the Food
                                    and Drug Administration 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) Hospital defined.--For purposes of this paragraph,
            the term `hospital' includes a critical access hospital, as
            defined in section 1861(mm)(1).''.
        (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 (8) the following new paragraph:
                ``(9) with respect to any amount expended for care or
            services furnished under the plan by a hospital on or after
            January 1, 2021, 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 or a
            medication related to a contraceptive, including emergency
            contraception, that is in stock, the pharmacy shall ensure that
            the contraceptive is provided to the customer without delay.
                ``(2) If a customer requests a contraceptive or a
            medication related to 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 or a medication related to a
                    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 or a medication related
                            to a 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 or a medication related to a
                    contraceptive, the pharmacy shall obtain the
                    contraceptive or medication under the pharmacy's
                    standard procedure for expedited ordering of medication
                    and notify the customer when the contraceptive or
                    medication arrives.
                ``(3) The pharmacy shall ensure that--
                        ``(A) the pharmacy does not operate an environment
                    in which customers are intimidated, threatened, or
                    harassed in the delivery of services relating to a
                    request for contraception or a medication related to a
                    contraceptive;
                        ``(B) the pharmacy's employees do not interfere
                    with or obstruct the delivery of services relating to a
                    request for contraception or a medication related to a
                    contraceptive;
                        ``(C) the pharmacy's employees do not intentionally
                    misrepresent or deceive customers about the
                    availability of a contraceptive or a medication related
                    to a contraceptive, or the mechanism of action of such
                    contraceptive or medication;
                        ``(D) the pharmacy's employees do not breach
                    medical confidentiality with respect to a request for a
                    contraceptive or a medication related to a
                    contraceptive or threaten to breach such
                    confidentiality; or
                        ``(E) the pharmacy's employees do not refuse to
                    return a valid, lawful prescription for a contraceptive
                    or a medication related to a contraceptive 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 or
    a medication related to a contraceptive 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 or a medication related to a contraceptive to a customer
    in accordance with any of the following:
                ``(1) If it is unlawful to dispense the contraceptive or a
            medication related to a 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 or the medication related to a contraceptive.
                ``(3) If the employee of the pharmacy refuses to provide
            the contraceptive or a medication related to a contraceptive on
            the basis of a professional clinical judgment.
        ``(d) Relation to Other Law.--
                ``(1) 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.
                ``(2) Certain claims.--The Religious Freedom Restoration
            Act of 1993 shall not provide a claim concerning, or a defense
            to a claim under this section, or provide a basis for
            challenging the application or enforcement of this section.
        ``(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) Medication related to a contraceptive.--The term
            `medication related to a contraceptive' means any drug or
            device approved by the Food and Drug Administration that a
            medical professional determines necessary to use before or in
            conjunction with a contraceptive.
                ``(4) 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.
                ``(5) Product.--The term `product' means a Food and Drug
            Administration-approved drug or device.
                ``(6) 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.
                ``(7) 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;
                        ``(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 individuals; and
                        ``(G) developing measures that enable a more
                    robust, balanced set of standardized maternity care
                    measures, including performance and quality
                    measures;''.

    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 (such as quality and performance
                    measures) 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 2021 through 2025.''.
        (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 2020,
            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 2021 through 2023
    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. 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, and developing
            performance and quality measures for accountability;
                (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 complement
    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 2021 through 2025.

    SEC. 519. 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:
                                ``(xxviii) 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. 520. 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;
                (5) include cultural sensitivity and strategies to decrease
            disparities in maternity outcomes; and
                (6) include implicit bias training.
        (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 2021 and 2022, and such sums as are necessary for each of
    the fiscal years 2023 through 2025.

    SEC. 521. 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. 522. 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 organizations--
                (1) for fiscal year 2021, 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, including
                            barriers triggered by criminal records.
                                (ii) Entrance into the training program for
                            the profession.
                                (iii) Graduation from such training
                            program.
                                (iv) Entrance into practice, including
                            barriers triggered by criminal records.
                                (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 2021
    and $3,000,000 for each of the fiscal years 2022 through 2025.

    SEC. 523. 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. 524. 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 and social
    services 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 primary, behavioral, or other health care or social
            service provider or organization.
        ``(d) Pregnancy Intention Screening Initiative.--For purposes of
    this section, the term `pregnancy intention screening initiative' means
    any initiative by an eligible entity 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 and goals 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. Such
            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 goals 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.
                        ``(G) Measuring through rigorous methods the effect
                    of such initiatives on key health outcomes.
                ``(2) Consultation with independent, expert advisory
            panel.--In conducting evaluation under paragraph (1), the
            Director of the Centers for Disease Control and Prevention
            shall consult with physicians, physician assistants, advanced
            practice registered nurses, nurse midwives, and other health
            care providers who specialize in women's health, and other
            experts in public health, 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 $10,000,000 for
            each of fiscal years 2021 through 2025.
                ``(2) Limitation.--Not more than 20 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,
            inequities lie in the availability, accessibility, and quality
            of mental health services for racial and ethnic minorities and
            people with disabilities.
                (2) These inequities have powerful significance for
            minority groups and for society as a whole.
                (3) Racial and ethnic minorities and people with
            disabilities bear a greater burden from unmet mental health
            needs and thus suffer a greater loss to their overall health
            and productivity.
                (4) Improving community conditions and one's home
            environment, paired with high-quality, accessible, and
            culturally tailored mental health services, can reduce the
            likelihood, frequency, and intensity of challenges to one's
            mental health.
                (5) The presence of strong social connections and trust,
            opportunities to experience and share cultural identity, safe
            gathering places, and economic opportunity are community
            factors that benefit mental health.
                (6) The social, physical, and economic conditions in
            communities can have tremendous influence on daily stressors
            that shape mental health outcomes.
                (7) The foremost barriers include the cost of care,
            societal stigma, and the fragmented organization of services.
                (8) People with disabilities who are racial or ethnic
            minorities may have co-occurring mental health conditions
            which, without proper accommodations and support, further
            stigmatize them and limit their participation in society.
                (9) African-American, Latinx, Asian-American, Pacific
            Islander, Native, and other people of color have attitudes
            toward mental health challenges that are another barrier to
            seeking mental health care.
                (10) Mental illness retains considerable stigma in many
            communities of color, including those of Asian Americans and
            Pacific Islanders, and seeking treatment is not always
            encouraged.
                (11) Addressing mental health stigma and increasing
            culturally appropriate treatment modalities in communities will
            help to increase utilization of mental health services for
            people who have trouble functioning because of mental health
            challenges.
                (12) There is a link between mental health diagnosis and
            the likelihood of an individual committing suicide.
                (13) A comprehensive public health approach to behavioral
            health fosters protective factors in racial and ethnic
            communities that support mental health.
                (14) Approaches to mental health and addressing trauma must
            keep in mind the historical and cultural trauma that has
            impacted many communities of color.
                (15) Treatment modalities must keep individual communities'
            approaches to mental health in mind, for example--
                        (A) cultural healing practices; and
                        (B) the mental health professionals needed to
                    provide those services such as peer support
                    specialists.
                (16) Approaches to mental health and addressing trauma must
            keep in mind the concept of intersectionality of individuals;
            that individuals may have many inequities that shape the way
            they process and experience everyday life.

    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; Peer
                               Support Specialist

        ``(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, including but not
            limited to, clinical social workers and occupational
            therapists;
                ``(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, including clinical social
            workers and occupational therapists;
                ``(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.
        ``(7) The term `peer support specialist' means an individual who--
                ``(A) is an individual living in recovery with mental
            illness, addiction, or systems involvement;
                ``(B) has skills learned in formal training; and
                ``(C) delivers services in behavioral health settings to
            promote mind-body recovery and resiliency.''.
                (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 ``(DD)''; and
                        (B) by inserting before the semicolon at the end
                    the following: ``, and (EE) 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,
            mental health counselor services, and peer support specialist
            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)).
                ``(x) A peer support specialist (as defined in section
            1861(III)(7)).''.
        (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, 2021.

    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. 553. 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 women's health clinics behavioral health program
    (including any such program operated by a community-based organization)
    serving a high proportion of individuals from racial and ethnic
    minority groups (as defined in section 1707(g)).
        ``(c) Loan Forgiveness.--To encourage qualified allied health
    professionals to enter the mental health field, an eligible entity
    receiving a grant under this section shall agree to use at least
    $10,000 of the grant on a loan forgiveness program for practitioners
    who commit to working in the mental health field for a period of two
    years.
        ``(d) Scientifically and Culturally Based.--Integrated health care
    funded through this section shall be scientifically and culturally
    based, taking into consideration the results of the most recent peer-
    reviewed research available.
        ``(e) Authorization of Appropriations.--To carry out this section,
    there is authorized to be appropriated $20,000,000 for each of fiscal
    years 2021 through 2025.''.

    SEC. 604. ADDRESSING RACIAL AND ETHNIC 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 health outcomes in such racial and ethnic
                    minority groups; and
                        (B) the degree of the co-occurrence of mental
                    conditions with other disabilities in such racial and
                    ethnic groups, including physical disabilities, mental
                    disabilities, and mental disorders or mental health
                    conditions which co-occur with one another;
                        (C) a compilation of information on the impact of
                    exposure to community violence, community trauma,
                    adverse childhood experiences, weather extremes
                    worsened by climate change (such as heat waves,
                    hurricanes, and wildfires), substance use, and other
                    psychological traumas, on mental disorders in such
                    racial and minority groups, stratified by household
                    income level;
                        (D) a compilation of information on the impact of
                    the intersectionality of transgender men in racial and
                    ethnic minority groups; and
                        (E) a description of how protective factors
                    contrast and compare among different communities of
                    color, identifying cultural strengths.

    SEC. 605. HEALTH PROFESSIONS COMPETENCIES TO ADDRESS RACIAL AND ETHNIC
                  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 inequities 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, peer support, 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 and community-based
            settings 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, including input from communities of color with
            lived experience, 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 inequities among
            racial and ethnic groups, including participation from
            communities of color with lived experience of the impacts of
            mental health disparities.
        (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, occupational therapy, 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 2021 through 2025.

    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, PACIFIC ISLANDER, AND
                  HISPANIC AND LATINO 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. 554. 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, Pacific Islander, and
    Hispanic and Latino individuals or communities, develop and implement
    an outreach and education strategy to promote behavioral and mental
    health, clarify that behavioral and mental health conditions are
    treatable and that reasonable accommodations are required under section
    504 of the Rehabilitation Act of 1973 (29 U.S.C. 794) and titles II and
    III of the Americans with Disabilities Act of 1990 (42 U.S.C. 12131 et
    seq.), and reduce stigma associated with mental health conditions and
    substance abuse among the Asian American, Native Hawaiian, and Pacific
    Islander and Hispanic and Latino populations. Such strategy shall--
                ``(1) be designed to--
                        ``(A) meet the diverse cultural and language needs
                    of the various Asian American, Native Hawaiian, Pacific
                    Islander, and Hispanic and Latino populations; and
                        ``(B) ensure such strategies are developmentally
                    (with respect to the beneficiary's relative age and
                    experience) and age appropriate, as well as cognitively
                    accessible to persons with cognitive disabilities;
                ``(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, disability, and 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) Reports.--Beginning not later than 1 year after the date of
    the enactment of this section and annually thereafter, the Secretary,
    acting through the Assistant Secretary, shall submit to Congress, and
    make publicly available, a report on the extent to which the strategy
    developed and implemented under subsection (a) increased behavioral and
    mental health outcomes associated with mental health conditions and
    substance abuse among Asian American, Native Hawaiian, Pacific
    Islander, and Hispanic and Latino populations.
        ``(c) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $300,000 for fiscal year
    2021.''.

    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;
                (3) provide for comprehensive training to improve health
            and academic outcomes for children with, or at risk for, mental
            health conditions, for parents or guardians, siblings, and
            other family members of such children, and for concerned
            members of the community;
                (4) provide for comprehensive, universal, evidence-based
            screening to identify children and adolescents with potential
            mental health conditions or unmet emotional health needs;
                (5) recognize best practices for the delivery of mental
            health care in school-based settings, including school-based
            health centers;
                (6) provide for comprehensive training for parents or
            guardians, siblings, other family members, and concerned
            members of the community on behalf of children and adolescents
            experiencing mental health trauma, disorder, or disability; and
                (7) establish formal working relationships between health,
            human service, and educational entities that support the mental
            and emotional health of children and adolescents in the school
            setting.
        (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; CHILDREN AND ADOLESCENTS AND
                  TRAUMA.

        ``(a) In General.--The Secretary, in collaboration with the
    Secretary of Education, 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 developmentally
    appropriate services and supports, that are linguistically and
    culturally appropriate and trauma-informed, and incorporate
    developmentally appropriate strategies of positive behavioral
    interventions and supports. A comprehensive school mental health
    program funded under this section shall assist children in dealing with
    traumatic experiences, grief, bereavement, risk of suicide, violence,
    and individual and community trauma that children may experience, and
    shall be implemented with a focus on positive youth development. Causes
    of trauma for children may include but are not limited to exposure to
    multiple forms of violence and abuse, structural racism and
    discrimination, family housing instability, family job loss, and
    climate-related disasters.
        ``(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 developmentally appropriate,
            school-based mental health program that--
                        ``(A) builds awareness of multiple forms of trauma,
                    individual trauma, and intergenerational, continuum of
                    impacts of trauma, on populations;
                        ``(B) trains appropriate staff and educators to
                    identify, and screen for, signs of trauma exposure,
                    mental health conditions, or risk of suicide; and
                        ``(C) incorporates positive behavioral
                    interventions, family engagement, student treatment,
                    and multi-generational supports to foster the health
                    and development of children, prevent mental health
                    conditions, and ameliorate the impacts of trauma;
                ``(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 conditions;
                ``(4) facilitate community partnerships among families,
            students, law enforcement agencies, education agencies, mental
            health and substance use disorder systems, family-based mental
            health service systems, child welfare agencies, health care
            providers (including primary care physicians, mental health
            professionals, and other professionals who specialize in
            children's mental health such as child and adolescent
            psychiatrists), institutions of higher education, faith-based
            programs, trauma networks, public health, youth development and
            recreation, youth employment organizations, and other
            community-based systems; and
                ``(5) establish and promote trauma-informed, culturally
            based, and supportive mechanisms for children and adolescents
            to share their experiences of individual and community trauma,
            including their exposure to violence, with trusted adults.
        ``(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 includes--
                                ``(i) a State educational agency (as
                            defined in section 8101 of the Elementary and
                            Secondary Education Act of 1965) in
                            coordination with one or more local educational
                            agencies (as defined in section 8101 of such
                            Act) or a consortium of entities described in
                            subparagraph (B), (C), (D), or (E) of the
                            definition of a local educational agency in
                            section 8101 of such Act; and
                                ``(ii) in accordance with paragraph
                            (2)(A)(i), appropriate public or private
                            entities that employ interventions that are
                            evidence-based (as defined in section 8101 of
                            the Elementary and Secondary Education Act of
                            1965); and
                        ``(B) submit an application, endorsed by all
                    members of the partnership, that--
                                ``(i) specifies which members will serve as
                            the lead partners; and
                                ``(ii) contains the assurances described in
                            paragraph (2).
                ``(2) Required assurances.--An application under paragraph
            (1) shall contain assurances as follows:
                        ``(A) 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 2 entities from the
                            following categories: community-based, public
                            or private mental-health providers, health care
                            entities, public health entities, law
                            enforcement or juvenile justice entities, child
                            welfare agencies, family-based mental health
                            entities, trauma networks, community-based
                            entities, or other entities as determined by
                            the Secretary (which may include a human
                            services agency or institution of higher
                            education); and
                                ``(ii) that clearly states--
                                        ``(I) the responsibilities of each
                                    partner with respect to the activities
                                    to be carried out, including how family
                                    and community 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) The comprehensive school-based mental health
                    program carried out under this section supports the
                    flexible use of funds to address--
                                ``(i) universal prevention, through the
                            promotion of the social, emotional, mental, 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,
                            or behavioral health problems, or substance use
                            disorders;
                                ``(iii) the screening for, and early
                            identification of, social, emotional, mental,
                            and 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, and mental behavioral health
                            problems, or substance use disorders;
                                ``(v) the development and implementation of
                            evidence-based programs (including program
                            curricula, school supports, and after-school
                            programs) to assist children who are
                            experiencing or have been exposed to individual
                            and community trauma or exposed to multiple
                            forms of violence; and
                                ``(vi) the development and implementation
                            of evidence-based programs to assist children
                            who are grieving, which may include training
                            for school personnel on the impact of trauma
                            and bereavement on children, and services to
                            provide support to grieving children.
                        ``(C) 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
                            promote early identification of children with
                            trauma histories, children who are grieving,
                            and children with a mental health condition or
                            at risk of developing a mental health
                            condition, or who are at risk of suicide;
                                ``(ii) the use of referral mechanisms that
                            effectively link such children to appropriate
                            prevention, 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, including strategies
                            to prevent bullying, which includes cyber-
                            bullying;
                                ``(iv) strategies for promoting the social,
                            emotional, mental, and behavioral health of all
                            students;
                                ``(v) strategies for promoting the social,
                            emotional, mental, and behavioral health of all
                            students; and
                                ``(vi) strategies to increase the knowledge
                            and skills of school and community leaders
                            about the impact of individual and community
                            trauma and exposure to multiple forms of
                            violence on the application of a public health
                            approach to comprehensive school-based mental
                            health programs.
                        ``(D) The comprehensive school-based mental health
                    program carried out under this section will include
                    comprehensive training for parents or guardians,
                    siblings, and other family members of children with
                    mental health conditions, and for concerned members of
                    the community, in--
                                ``(i) the techniques and supports needed to
                            promote early identification of children with
                            trauma histories, children who are grieving,
                            children with a mental health condition or at
                            risk of developing a mental health condition,
                            and children who are at risk of suicide;
                                ``(ii) the use of referral mechanisms that
                            effectively link such children to appropriate
                            prevention, treatment, and intervention
                            services in the school and in the community and
                            followup when such services are not available;
                            and
                                ``(iii) strategies that promote a school-
                            and community-wide positive environment,
                            including strategies to prevent bullying,
                            including cyber-bullying.
                        ``(E) The comprehensive school-based mental health
                    program carried out under this section will demonstrate
                    the measures to be taken to sustain the program (which
                    may include seeking funding for the program under a
                    State Medicaid plan under title XIX of the Social
                    Security Act or a waiver of such a plan, or under a
                    State plan under subpart 1 of part B or part E of title
                    IV of the Social Security Act).
                        ``(F) The eligible entity is supported by the State
                    agency with primary responsibility for behavioral
                    health to ensure that comprehensive school-based mental
                    health program carried out under this section will be
                    sustainable after funding under this section
                    terminates.
                        ``(G) 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 or activities funded under part A of title IV of
                    the Elementary and Secondary Education Act of 1965.
                        ``(H) The comprehensive school-based mental health
                    program carried out under this section will be
                    coordinated with early intervening activities carried
                    out under the Individuals with Disabilities Education
                    Act.
                        ``(I) The comprehensive school-based mental health
                    program carried out under this section will be trauma
                    informed, evidence based, and developmentally,
                    culturally, and linguistically appropriate.
                        ``(J) The comprehensive school-based mental health
                    program carried out under this section will include a
                    broad needs assessment of youth who drop out or are
                    expelled from school due to policies of `zero
                    tolerance' with respect to drugs, alcohol, or weapons
                    and an inability to obtain appropriate services.
                        ``(K) 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--
                                ``(i) certified, credentialed, or licensed
                            by the State involved in compliance with
                            applicable Federal and State law; and
                                ``(ii) practicing within their area of
                            expertise.
                        ``(L) The comprehensive school-based mental health
                    program carried out under this section will permit
                    students to self-refer to the program for mental health
                    care and self-consent for mental health crisis care to
                    the extent permitted by State or other applicable law.
                ``(3) Coordinator.--Any entity that is a member of a
            partnership described in paragraph (1)(A) may serve as the
            coordinator of funding and activities under the grant if all
            members of the partnership agree.
                ``(4) Compliance with hipaa.--A grantee under this section
            shall be deemed to be a covered entity for purposes of
            compliance with the regulations promulgated under section
            264(c) of the Health Insurance Portability and Accountability
            Act of 1996 with respect to any patient records developed
            through activities under the grant.
                ``(5) Compliance with ferpa.--Section 444 of the General
            Education Provisions Act (commonly known as the `Family
            Educational Rights and Privacy Act of 1974') shall apply to any
            entity that is a member of the partnership in the same manner
            that such section applies to an educational agency or
            institution (as that term is defined in such section).
        ``(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 the award of a grant,
    contract, or cooperative agreement under subsection (a), the award
    shall be for a period of 5 years and may be renewed for subsequent 5-
    year periods.
        ``(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 and interventions carried out under a
                    program under this section, at a minimum include
                    provisions to evaluate whether the program is effective
                    in--
                                ``(i) enhancing the social skills and
                            emotional resilience of all students, as well
                            as providing support to students who experience
                            peer-inflicted bullying and isolation;
                                ``(ii) improving academic outcomes,
                            including as measured by proficiency on the
                            annual assessments under section 1111(b)(2) of
                            the Elementary and Secondary Education Act of
                            1965;
                                ``(iii) reducing the incidence of behaviors
                            that harm the self or others, or otherwise
                            disrupt the learning environment of other
                            students, when such behavior cannot be reduced
                            by the presence of reasonable accommodations;
                                ``(iv) improving participation and
                            engagement in classroom activities in children
                            with mental health conditions;
                                ``(v) reducing substance use disorders;
                                ``(vi) reducing rates of suicide;
                                ``(vii) reducing suspensions, truancy,
                            expulsions, and violence;
                                ``(viii) 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); and
                                ``(ix) improving attendance rates and rates
                            of chronic absenteeism;
                                ``(x) improving access to care for mental
                            health conditions, including access to mental
                            health services that are trauma-informed, and
                            developmentally, linguistically, and culturally
                            appropriate;
                                ``(xi) improving health outcomes; and
                                ``(xii) decreasing disparities among
                            vulnerable and protected populations in
                            outcomes described in clauses (i) through (xi).
                        ``(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;
                                ``(ix) reduced suicide rates;
                                ``(x) referrals to juvenile justice; and
                                ``(xi) increased educational equity.
                ``(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 20 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
            the first 5 fiscal years following the date of enactment of the
            Mental Health Services for Students Act of 2019. 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 the first 5 fiscal years following the date of
            enactment of the Immigrants' Mental Health Act of 2020.''.
        (d) Conforming Amendment.--Part G of title V of the Public Health
    Service Act (42 U.S.C. 290hh et seq.), as amended by this section, is
    further amended by striking the part heading and inserting the
    following:

                    ``PART G--SCHOOL-BASED MENTAL HEALTH''.

    SEC. 609. BUILDING AN EFFECTIVE WORKFORCE IN MENTAL HEALTH.

        (a) In General.--The Secretary of Health and Human Services, in
    coordination with the Assistant Secretary for Mental Health and
    Substance Use, the Administrator of the Health Resources and Services
    Administration, and the Secretary of Labor, shall, in coordination with
    advocacy and behavioral and mental health organizations serving people
    of color--
                (1) develop, strengthen, and implement strategies to
            bolster career pathways for mental health professionals; and
                (2) identify the breadth of settings where mental and
            behavioral health care can take place.
        (b) Contents.--Strategies under subsection (a) shall include--
                (1) the variety of settings where mental health
            professionals are needed, including community-based
            organizations, women's centers, shelters, organizations focused
            on youth development, workforce agencies, job placement and
            development centers, emergency rooms, the special supplemental
            nutrition program for women, infants, and children under
            section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786),
            food banks, legal aid, and benefit issuers as defined in
            section 3 of the Food and Nutrition Act of 2008 (7 U.S.C.
            2012);
                (2) defining career pathways in mental and behavioral
            health, to help communities understand the variety of careers
            in mental health that are available;
                (3) building career pathways in mental and behavioral
            health as part of the curriculum at the postsecondary education
            level;
                (4) providing accessible training and certification
            pathways for lay health workers such as community health
            workers and other peer support individuals to ensure that
            careers pay a living wage;
                (5) creating incentives for students in the fields of
            occupational therapy, social work, medicine, and nursing to
            learn more about mental health, and to include a mental health
            rotation as a part of the health professional curricula;
                (6) including training and education for teachers about the
            basics of section 504 of the Rehabilitation Act of 1973 (29
            U.S.C. 794) and individualized education programs (as defined
            in section 614(d) of the Individuals with Disabilities in
            Education Act (20 U.S.C. 1414(d));
                (7) researching, developing, and implementing programs for
            mental and behavioral health professionals to prevent burnout;
                (8) finding better and increased avenues to ensure equity
            by providing better loan forgiveness programs, including a
            focus area within the National Health Service Corps focused on
            community trauma.

    SEC. 610. MENTAL HEALTH AT THE BORDER.

        (a) Short Title.--This section may be cited as the ``Immigrants'
    Mental Health Act of 2020''.
        (b) Training for Certain CBP Personnel in Mental Health Issues.--
                (1) Training to identify risk factors and warning signs in
            immigrants and refugees.--
                        (A) In general.--The Commissioner of U.S. Customs
                    and Border Protection, in consultation with the
                    Assistant Secretary for Mental Health and Substance
                    Use, the Administrator of the Health Resources and
                    Services Administration, and nongovernmental experts in
                    the delivery of health care in humanitarian crises and
                    in the delivery of health care to children, shall
                    develop and implement a training curriculum for U.S.
                    Customs and Border Protection agents and officers
                    assigned to U.S. Customs and Border Protection
                    facilities to enable such agents and officers to
                    identify the risk factors and warning signs in
                    immigrants and refugees of mental health issues
                    relating to trauma.
                        (B) Requirements.--The training curriculum
                    described in subparagraph (A) shall--
                                (i) apply to all U.S. Customs and Border
                            Protection agents and officers working at U.S.
                            Customs and Border Protection facilities;
                                (ii) provide for crisis intervention using
                            a trauma-informed approach; and
                                (iii) provide for mental health screenings
                            for immigrants and refugees arriving at the
                            border in their preferred language or with
                            appropriate language assistance.
                (2) Training to address mental health and wellness of cbp
            agents and officers.--
                        (A) In general.--The Commissioner of U.S. Customs
                    and Border Protection, in consultation with the
                    Assistant Secretary for Mental Health and Substance
                    Use, the Administrator of the Health Resources and
                    Services Administration, and nongovernmental experts in
                    the delivery of mental health care, shall develop and
                    implement a training curriculum for U.S. Customs and
                    Border Protection agents and officers assigned to U.S.
                    Customs and Border Protection facilities to address the
                    mental health and wellness of individuals working at
                    such facilities.
                        (B) Requirement.--The training curriculum described
                    in subparagraph (A) shall be designed to help U.S.
                    Customs and Border Protection agents and officers
                    working at U.S. Customs and Border Protection
                    facilities to--
                                (i) better manage their own stress and the
                            stress of their coworkers; and
                                (ii) be more aware of the psychological
                            pressures experienced during their jobs.
                (3) Annual review of training.--Beginning with respect to
            fiscal year 2022, the Assistant Secretary for Mental Health and
            Substance Use shall--
                        (A) conduct an annual review of the training
                    implemented pursuant to paragraphs (1) and (2); and
                        (B) submit the results of each such review,
                    including any recommendations for improvement of such
                    training, to--
                                (i) the Commissioner of U.S. Customs and
                            Border Protection; and
                                (ii) the Committees on Appropriations,
                            Energy and Commerce, Homeland Security, and the
                            Judiciary of the House of Representatives and
                            the Committees on Appropriations, Health,
                            Education, Labor, and Pensions, and Homeland
                            Security and Governmental Affairs of the
                            Senate.
                (4) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated--
                        (A) for fiscal year 2021, $50,000 to develop the
                    training under paragraphs (1) and (2); and
                        (B) for each of fiscal years 2022 through 2026--
                                (i) $20,000 to implement such training
                            pursuant to paragraphs (1) and (2); and
                                (ii) such sums as may be necessary to
                            review and make recommendations for such
                            training pursuant to paragraph (3).
        (c) Staffing Border Facilities and Detention Centers.--
                (1) In general.--To adequately evaluate the mental health
            needs of immigrants, refugees, border patrol agents, and staff,
            the Commissioner of U.S. Customs and Border Protection shall
            assign at least one qualified mental or behavioral health
            expert to each U.S. Customs and Border Protection facility.
                (2) Qualifications.--To be qualified for purposes of
            paragraph (1), a mental or behavioral health expert shall be--
                        (A) bilingual;
                        (B) well-versed in culturally appropriate and
                    trauma-informed interventions; and
                        (C) have particular expertise in child or
                    adolescent mental health or family mental health.
                (3) Authorization of appropriations.--To carry out this
            subsection, there is authorized to be appropriated $3,000,000
            for each of fiscal years 2021 through 2025.
        (d) No Sharing of Department of Health and Human Services Mental
    Health Information for Asylum Determinations, Immigration Hearings, or
    Deportation Proceedings.--The officers, employees, and agents of the
    Department of Health and Human Services, including the Office of
    Refugee Resettlement, may not share with the Department of Homeland
    Security, and the officers, employees, and agents of the Department of
    Homeland Security may not request or receive from the Department of
    Health and Human Services, for the purposes of an asylum determination,
    immigration hearing, or deportation proceeding, any information or
    record that--
                (1) concerns the mental health of an alien; and
                (2) was obtained or produced by a mental or behavioral
            health professional while the alien was in a shelter or
            otherwise in the custody of the Federal Government.
        (e) Definitions.--In this section:
                (1) The term ``U.S. Customs and Border Protection
            facility'' means any of the following facilities that typically
            detain migrants on behalf of U.S. Customs and Border
            Protection:
                        (A) U.S. Border Patrol stations.
                        (B) Ports of entry.
                        (C) Checkpoints.
                        (D) Forward operating bases.
                        (E) Secondary inspection areas.
                        (F) Short-term custody facilities.
                (2) The term ``forward operating base'' means a permanent
            facility established by U.S. Customs and Border Protection in
            forward or remote locations, and designated as such by U.S.
            Customs and Border Protection.

              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 2020''.
        (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 2020, 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 2020, 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 2020 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 2021 and such sums as
            may be necessary for each of fiscal years 2022 through 2025.
                (2) Lung cancer mortality reduction program.--The amounts
            appropriated under paragraph (1) shall be allocated as follows:
                        (A) $25,000,000 for fiscal year 2021, and such sums
                    as may be necessary for each of fiscal years 2022
                    through 2025, 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 2021, and such sums
                    as may be necessary for each of fiscal years 2022
                    through 2025, for the activities described in section
                    417H(b)(1)(C) of the Public Health Service Act;
                        (C) $10,000,000 for fiscal year 2021, and such sums
                    as may be necessary for each of fiscal years 2022
                    through 2025, for the activities described in section
                    417H(b)(1)(D) of the Public Health Service Act; and
                        (D) $15,000,000 for fiscal year 2021, and such sums
                    as may be necessary for each of fiscal years 2022
                    through 2025, 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 2020'' 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, 2025.
        (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 2021
            through 2025 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 2021 through 2025 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. PROSTATE RESEARCH, IMAGING, AND MEN'S EDUCATION (PRIME).

        (a) Short Title.--This section may be cited as the ``Prostate
    Research, Imaging, and Men's Education Act of 2020'' or the ``PRIME Act
    of 2020''.
        (b) Findings.--Congress makes the following findings:
                (1) Prostate cancer has reached epidemic proportions,
            particularly among African-American men, and strikes and kills
            men in numbers comparable to the number of women who lose their
            lives from breast cancer.
                (2) Life-saving breakthroughs in screening, diagnosis, and
            treatment of breast cancer resulted from the development of
            advanced imaging technologies led by the Federal Government.
                (3) Men should have accurate and affordable prostate cancer
            screening exams and minimally invasive treatment tools, similar
            to what women have for breast cancer.
                (4) While it is important for men to take advantage of
            current prostate cancer screening techniques, a recent NCI-
            funded study demonstrated that the most common available
            methods of detecting prostate cancer (PSA blood test and
            physical exams) are not foolproof, causing numerous false
            alarms and false reassurances.
                (5) The absence of advanced imaging technologies for
            prostate cancer causes the lack of accurate information
            critical for clinical decisions, resulting in missed cancers
            and lost lives, as well as unnecessary and costly medical
            procedures, with related complications.
                (6) With prostate imaging tools, men and their families
            would face less physical, psychological, financial and
            emotional trauma and billions of dollars could be saved in
            private and public health care systems.
        (c) Research and Development of Prostate Cancer Imaging
    Technologies.--
                (1) Expansion of research.--The Secretary of Health and
            Human Services (referred to in this section as the
            ``Secretary''), acting through the Director of the National
            Institutes of Health and the Administrator of the Health
            Resources and Services Administration, and in consultation with
            the Secretary of Defense, shall carry out a program to expand
            and intensify research to develop innovative advanced imaging
            technologies for prostate cancer detection, diagnosis, and
            treatment comparable to state-of-the-art mammography
            technologies.
                (2) Early stage research.--In implementing the program
            under paragraph (1), the Secretary, acting through the
            Administrator of the Health Resources and Services
            Administration, shall carry out a grant program to encourage
            the early stages of research in prostate imaging to develop and
            implement new ideas, proof of concepts, and pilot studies for
            high-risk technologic innovation in prostate cancer imaging
            that would have a high potential impact for improving patient
            care, including individualized care, quality of life, and cost-
            effectiveness.
                (3) Large-scale later stage research.--In implementing the
            program under paragraph (1), the Secretary, acting through the
            Director of the National Institutes of Health, shall utilize
            the National Institute of Biomedical Imaging and Bioengineering
            and the National Cancer Institute for advanced stages of
            research in prostate imaging, including technology development
            and clinical trials for projects determined by the Secretary to
            have demonstrated promising preliminary results and proof of
            concept.
                (4) Interdisciplinary private-public partnerships.--In
            developing the program under paragraph (1), the Secretary,
            acting through the Administrator of the Health Resources and
            Services Administration, shall establish interdisciplinary
            private-public partnerships to develop and implement research
            strategies for expedited innovation in imaging and image-guided
            treatment and to conduct such research.
                (5) Racial disparities.--In developing the program under
            paragraph (1), the Secretary shall recognize and address--
                        (A) the racial disparities in the incidences of
                    prostate cancer and mortality rates with respect to
                    such disease; and
                        (B) any barriers in access to care and
                    participation in clinical trials that are specific to
                    racial minorities.
                (6) Authorization of appropriations.--
                        (A) In general.--Subject to subparagraph (B), there
                    is authorized to be appropriated to carry out this
                    section $100,000,000 for each of the fiscal years 2021
                    through 2025.
                        (B) Specific allocations.--Of the amount authorized
                    to be appropriated under subparagraph (A) for each of
                    the fiscal years described in such paragraph--
                                (i) no less than 10 percent may be
                            appropriated to carry out the grant program
                            under paragraph (2); and
                                (ii) no more than 1 percent may be
                            appropriated to carry out paragraph (4).
        (d) Public Awareness and Education Campaign.--
                (1) National campaign.--The Secretary shall carry out a
            national campaign to increase the awareness and knowledge of
            Americans with respect to the need for prostate cancer
            screening and for improved detection technologies.
                (2) Requirements.--The national campaign conducted shall
            include--
                        (A) roles for the Health Resources Services
                    Administration, the Office on Minority Health of the
                    Department of Health and Human Services, the Centers
                    for Disease Control and Prevention, and the Office of
                    Minority Health of the Centers for Disease Control and
                    Prevention; and
                        (B) the development and distribution of written
                    educational materials, and the development and placing
                    of public service announcements, that are intended to
                    encourage men to seek prostate cancer screening and to
                    create awareness of the need for improved imaging
                    technologies for prostate cancer screening and
                    diagnosis, including in-vitro blood testing and imaging
                    technologies.
                (3) Racial disparities.--In developing the national
            campaign under paragraph (1), the Secretary shall recognize and
            address--
                        (A) the racial disparities in the incidences of
                    prostate cancer and mortality rates with respect to
                    such disease; and
                        (B) any barriers in access to care and
                    participation in clinical trials that are specific to
                    racial minorities.
                (4) Grants.--The Secretary shall establish a program to
            award grants to nonprofit private entities to enable such
            entities to test alternative outreach and education strategies
            to increase the awareness and knowledge of Americans with
            respect to the need for prostate cancer screening and improved
            imaging technologies.
                (5) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section $10,000,000 for
            each of the fiscal years 2021 through 2025.
        (e) Improving Prostate Cancer Screening Blood Tests.--
                (1) In general.--The Secretary, in coordination with the
            Secretary of Defense, shall carry out research to develop an
            improved prostate cancer screening blood test using in-vitro
            detection.
                (2) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this section, $20,000,000 for
            each of fiscal years 2021 through 2025.
        (f) Reporting and Compliance.--
                (1) Report and strategy.--Not later than 12 months after
            the date of the enactment of this Act, the Secretary shall
            submit to Congress a report that details the strategy of the
            Secretary for implementing the requirements of this section and
            the status of such efforts.
                (2) Full compliance.--Not later than 36 months after the
            date of the enactment of this Act, and annually thereafter, the
            Secretary shall submit to Congress a report that--
                        (A) describes the research and development and
                    public awareness and education campaigns funded under
                    this section;
                        (B) provides evidence that projects involving high-
                    risk, high-impact technologic innovation, proof of
                    concept, and pilot studies are prioritized;
                        (C) provides evidence that the Secretary recognizes
                    and addresses any barriers in access to care and
                    participation in clinical trials that are specific to
                    racial minorities in the implementation of this
                    section;
                        (D) contains assurances that all the other
                    provisions of this section are fully implemented; and
                        (E) certifies compliance with the provisions of
                    this section, or in the case of a Federal agency that
                    has not complied with any of such provisions, an
                    explanation as to such failure to comply.

    SEC. 704. PROSTATE CANCER DETECTION RESEARCH AND EDUCATION.

        (a) Short Title.--This section may be cited as the ``Prostate
    Cancer Detection Research and Education Act''.
        (b) Plan To Develop and Validate a Test or Tests for Prostate
    Cancer.--
                (1) In general.--The Secretary of Health and Human Services
            (referred to in this section as the ``Secretary''), acting
            through the Director of the National Institutes of Health,
            shall establish an advisory council on prostate cancer
            (referred to in this section as the ``advisory council'') to
            draft a plan for the development and validation of an accurate
            test or tests, such as biomarkers or imaging, to detect and
            diagnose prostate cancer.
                (2) Advisory council.--
                        (A) Membership.--
                                (i) Federal members.--The advisory council
                            shall be comprised of the following experts:
                                        (I) A designee of the Centers for
                                    Disease Control and Prevention.
                                        (II) A designee of the Centers for
                                    Medicare & Medicaid Services.
                                        (III) A designee of the Office of
                                    the Director of the National Cancer
                                    Institute.
                                        (IV) A designee of the Director of
                                    the Department of Defense
                                    Congressionally Directed Medical
                                    Research Program.
                                        (V) A designee of the Director of
                                    the National Institute of Biomedical
                                    Imaging and Bioengineering.
                                        (VI) A designee of the Director of
                                    the National Institute of General
                                    Medical Sciences.
                                        (VII) A designee of the Director of
                                    the National Institute on Minority
                                    Health and Health Disparities.
                                        (VIII) A designee of the Office of
                                    the Director of the National Institutes
                                    of Health.
                                        (IX) A designee of the Food and
                                    Drug Administration.
                                        (X) A designee of the Agency for
                                    Healthcare Research and Quality.
                                        (XI) A designee of the Director of
                                    the Telemedicine and Advanced
                                    Technology Research Center of the
                                    Department of Defense.
                                (ii) Non-federal members.--In addition to
                            the members described in clause (i), the
                            advisory council shall include 8 expert members
                            from outside the Federal Government to be
                            appointed by the Secretary, which shall
                            include--
                                        (I) 2 prostate cancer patient
                                    advocates;
                                        (II) 2 health care providers with a
                                    range of expertise and experience in
                                    prostate cancer; and
                                        (III) 4 leading researchers with
                                    prostate cancer-related expertise in a
                                    range of clinical disciplines.
                        (B) Meetings.--The advisory council shall meet
                    quarterly and such meetings shall be open to the
                    public.
                        (C) Advice.--The advisory council shall advise the
                    Secretary or the Secretary's designee.
                        (D) Annual report.--Not later than 1 year after the
                    date of enactment of this Act, the advisory council
                    shall provide to the Secretary, or the Secretary's
                    designee, and Congress--
                                (i) an initial evaluation of all federally
                            funded efforts in prostate cancer research
                            relating to the development and validation of
                            an accurate test or tests to detect and
                            diagnose prostate cancer;
                                (ii) a plan for the development and
                            validation of a reliable test or tests for the
                            detection and accurate diagnosis of prostate
                            cancer; and
                                (iii) a set of standards for prostate
                            cancer screening, developed in coordination
                            with the United States Preventive Services Task
                            Force, to ensure that any tools for screening,
                            detection, and diagnosis developed in
                            accordance with the plan under clause (ii) will
                            meet the requirements of the Task Force for
                            recommendation as a proven preventive or
                            diagnostic service.
                        (E) Termination.--The advisory council shall
                    terminate on December 31, 2024.
                (3) Funding.--The Secretary may make available $1,000,000
            from amounts appropriated to the National Institutes of Health
            for each of fiscal years 2021 through 2025 to carry out this
            subsection.
        (c) Coordination and Intensification of Prostate Cancer Research.--
                (1) In general.--The Director of the National Institutes of
            Health, in consultation with the Secretary of Defense, shall
            coordinate and intensify research in accordance with the plan,
            with particular attention provided to leveraging existing
            research to develop and validate a test or tests, such as
            biomarkers or imaging, to detect and accurately diagnose
            prostate cancer in order to improve quality of life for
            millions of Americans, and decrease health care system costs.
                (2) Funding.--The Secretary may make available $30,000,000
            from amounts appropriated to the National Institutes of Health
            for each of fiscal years 2022 through 2026 to carry out this
            subsection.
        (d) Public Awareness and Education Campaign.--
                (1) National campaign.--The Secretary, in coordination with
            the Director of the National Institutes of Health and the
            Director of the Centers for Disease Control and Prevention,
            shall carry out a national campaign to increase the awareness
            and knowledge of prostate cancer.
                (2) Requirements.--The national campaign conducted under
            paragraph (1) shall include--
                        (A) roles for the National Cancer Institute, the
                    National Institute on Minority Health and Health
                    Disparities, the Office on Minority Health of the
                    Department of Health and Human Services, and the Office
                    of Minority Health of the Centers for Disease Control
                    and Prevention; and
                        (B) the development and distribution of written
                    educational materials, and the development and placing
                    of public service announcements, that are intended to
                    encourage men to seek prostate cancer screening when
                    symptoms are present, when they have a family history
                    of prostate cancer, or if they belong to a high-risk
                    population.
                (3) Racial disparities.--In developing the national
            campaign under paragraph (1), the Secretary shall recognize and
            address--
                        (A) the racial disparities in the incidences of
                    prostate cancer and mortality rates with respect to
                    such disease; and
                        (B) any barriers in access to patient care and
                    participation in clinical trials that are specific to
                    racial minorities.
                (4) Grants.--The Secretary shall establish a program to
            award grants to nonprofit private entities to enable such
            entities to test alternative outreach and education strategies
            to increase the awareness and knowledge of Americans with
            respect to prostate cancer.
                (5) Authorization of appropriations.--There is authorized
            to be appropriated to carry out this subsection $5,000,000 for
            each of fiscal years 2021 through 2025.

    SEC. 705. NATIONAL PROSTATE CANCER COUNCIL.

        (a) Short Title.--This section may be cited as the ``National
    Prostate Cancer Plan Act''.
        (b) National Prostate Cancer Council.--
                (1) Establishment.--There is established in the Office of
            the Secretary of Health and Human Services (referred to in this
            section as the ``Secretary'') the National Prostate Cancer
            Council on Screening, Early Detection, Assessment, and
            Monitoring of Prostate Cancer (referred to in this section as
            the ``Council'').
                (2) Purpose of the council.--The Council shall--
                        (A) develop and implement a national strategic plan
                    for the accelerated creation, advancement, and testing
                    of diagnostic tools to improve screening, early
                    detection, assessment, and monitoring of prostate
                    cancer, including--
                                (i) early detection of aggressive prostate
                            cancer to save lives;
                                (ii) monitoring of tumor response to
                            treatment, including recurrence and
                            progression; and
                                (iii) accurate assessment and surveillance
                            of indolent disease to reduce unnecessary
                            biopsies and treatment;
                        (B) provide information and coordination of
                    prostate cancer research and services across all
                    Federal agencies;
                        (C) review diagnostic tools and their overall
                    effectiveness at screening, detecting, assessing, and
                    monitoring of prostate cancer;
                        (D) evaluate all programs in prostate cancer that
                    are in existence on the date of enactment of this Act,
                    including Federal budget requests and approvals and
                    public-private partnerships;
                        (E) submit an annual report to the Secretary and
                    Congress on the creation and implementation of the
                    national strategic plan under subparagraph (A); and
                        (F) ensure the inclusion of men at high risk for
                    prostate cancer, including men from ethnic and racial
                    populations and men who are least likely to receive
                    care, in clinical, research, and service efforts, with
                    the purpose of decreasing health disparities.
                (3) Membership.--
                        (A) Federal members.--The Council shall be led by
                    the Secretary or designee and comprised of the
                    following experts:
                                (i) Two representatives of the National
                            Institutes of Health, including 1
                            representative of the National Institute of
                            Biomedical Imaging and Bioengineering and 1
                            representative of the National Cancer
                            Institute.
                                (ii) A representative of the Centers for
                            Disease Control and Prevention.
                                (iii) A representative of the Centers for
                            Medicare & Medicaid Services.
                                (iv) A designee of the Director of the
                            Department of Defense Congressionally Directed
                            Medical Research Program.
                                (v) A designee of the Director of the
                            Office of Minority Health.
                                (vi) A representative of the Food and Drug
                            Administration.
                                (vii) A representative of the Agency for
                            Healthcare Research and Quality.
                        (B) Non-federal members.--In addition to the
                    members described in subparagraph (A), the Council
                    shall include 14 expert members from outside the
                    Federal Government, which shall include--
                                (i) 6 prostate cancer patient advocates,
                            including--
                                        (I) 2 patient-survivors;
                                        (II) 2 caregivers of prostate
                                    cancer patients; and
                                        (III) 2 representatives from
                                    national prostate cancer disease
                                    organizations that fund research or
                                    have demonstrated experience in
                                    providing assistance to patients,
                                    families, and medical professionals,
                                    including information on health care
                                    options, education, and referral; and
                                (ii) 8 health care stakeholders with
                            specific expertise in prostate cancer research
                            in the critical areas of clinical expertise,
                            including medical oncology, radiology,
                            radiation oncology, urology, and pathology.
                (4) Meetings.--The Council shall meet quarterly and
            meetings shall be open to the public.
                (5) Advice.--The Council shall advise the Secretary, or the
            Secretary's designee.
                (6) Annual report.--The Council shall submit annual
            reports, beginning not later than 1 year after the date of
            enactment of this Act, to the Secretary or the Secretary's
            designee and to Congress. The annual report shall include--
                        (A) in the first year--
                                (i) an evaluation of all federally funded
                            efforts in prostate cancer research and gaps
                            relating to the development and validation of
                            diagnostic tools for prostate cancer; and
                                (ii) recommendations for priority actions
                            to expand, eliminate, coordinate, or condense
                            programs based on the performance, mission, and
                            purpose of the programs; and
                        (B) annually thereafter for 5 years--
                                (i) an outline for the development and
                            implementation of a national research plan for
                            creation and validation of accurate diagnostic
                            tools to improve prostate cancer care in
                            accordance with paragraph (1);
                                (ii) roles for the National Cancer
                            Institute, National Institute on Minority
                            Health and Health Disparities, and the Office
                            on Minority Health of the Department of Health
                            and Human Services;
                                (iii) an analysis of the disparities in the
                            incidence and mortality rates of prostate
                            cancer in men at high risk of the disease,
                            including individuals with family history,
                            increasing age, or African-American heritage;
                            and
                                (iv) a review of the progress towards the
                            realization of the proposed strategic plan.
                (7) Termination.--The Council shall terminate on December
            31, 2025.

    SEC. 706. 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 2021, 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, 2021.

    SEC. 707. 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. 708. 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).

    SEC. 709. CANCER CLINICAL TRIALS.

        (a) Short Title.--This section may be cited as the ``Henrietta
    Lacks Enhancing Cancer Research Act of 2020''.
        (b) Findings.--Congress finds as follows:
                (1) Only a small percent of patients participate in cancer
            clinical trials, even though most express an interest in
            clinical research. There are several obstacles that restrict
            individuals from participating including lack of available
            local trials, restrictive eligibility criteria, transportation
            to trial sites, taking time off from work, and potentially
            increased medical and nonmedical costs. Ultimately, about 1 in
            5 cancer clinical trials fail because of lack of patient
            enrollment.
                (2) Groups that are generally underrepresented in clinical
            trials include racial and ethnic minorities and older, rural,
            and lower-income individuals.
                (3) Henrietta Lacks, an African-American woman, was
            diagnosed with cervical cancer at the age of 31, and despite
            receiving painful radium treatments, passed away on October 4,
            1951.
                (4) Medical researchers took samples of Henrietta Lacks'
            tumor during her treatment and the HeLa cell line from her
            tumor proved remarkably resilient.
                (5) HeLa cells were the first immortal line of human cells.
            Henrietta Lacks' cells were unique, growing by the millions,
            commercialized and distributed worldwide to researchers,
            resulting in advances in medicine.
                (6) Henrietta Lacks' prolific cells continue to grow and
            contribute to remarkable advances in medicine, including the
            development of the polio vaccine, as well as drugs for treating
            the effects of cancer, HIV/AIDS, hemophilia, leukemia, and
            Parkinson's disease. These cells have been used in research
            that has contributed to our understanding of the effects of
            radiation and zero gravity on human cells. These immortal cells
            have informed research on chromosomal conditions, cancer, gene
            mapping, and precision medicine.
                (7) Henrietta Lacks and her immortal cells have made a
            significant contribution to global health, scientific research,
            quality of life, and patient rights.
                (8) For more than 20 years, the advances made possible by
            Henrietta Lacks' cells were without her or her family's
            consent, and the revenues they generated were not known to or
            shared with her family.
                (9) Henrietta Lacks and her family's experience is
            fundamental to modern and future bioethics policies and
            informed consent laws that benefit patients nationwide by
            building patient trust; promoting ethical research that
            benefits all individuals, including traditionally
            underrepresented populations; and protecting research
            participants.
        (c) GAO Study on Barriers to Participation in Federally Funded
    Cancer Clinical Trials by Populations That Have Been Traditionally
    Underrepresented in Such Trials.--
                (1) In general.--Not later than 2 years after the date of
            enactment of this Act, the Comptroller General of the United
            States shall--
                        (A) complete a study that--
                                (i) reviews what actions Federal agencies
                            have taken to help to address barriers to
                            participation in federally funded cancer
                            clinical trials by populations that have been
                            traditionally underrepresented in such trials,
                            and identifies challenges, if any, in
                            implementing such actions; and
                                (ii) identifies additional actions that can
                            be taken by Federal agencies to address
                            barriers to participation in federally funded
                            cancer clinical trials by populations that have
                            been traditionally underrepresented in such
                            trials; and
                        (B) submit a report to the Congress on the results
                    of such study, including recommendations on potential
                    changes in practices and policies to improve
                    participation in such trials by such populations.
                (2) Inclusion of clinical trials.--The study under
            paragraph (1)(A) should include review of cancer clinical
            trials that are largely funded by Federal agencies, including
            the National Institutes of Health, the Department of Defense,
            the Department of Veterans Affairs, the Agency for Health
            Research and Quality, the Food and Drug Administration, and
            such other Federal agencies as the Comptroller General of the
            United States may identify.

      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 2020''.
        (b) Findings.--Congress finds the following:
                (1) In the United States, nearly 5,000,000 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, the second deadliest and fastest
            growing cancer 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
            21,000 deaths per year in the United States can be attributed
            to chronic HBV and HCV. Chronic HCV is also a leading cause of
            death in Americans living with HIV/AIDS; many of those living
            with HIV/AIDS are coinfected with chronic HBV, chronic HCV, or
            both.
                (3) According to the Centers for Disease Control and
            Prevention (referred to in this section as the ``CDC''),
            approximately 2 percent of the population of the United States
            is living with chronic HBV, chronic HCV, or both. The CDC has
            recognized HCV as the Nation's most common chronic bloodborne
            virus infection and HBV as the deadliest vaccine-preventable
            disease.
                (4) HBV is transmitted through contact with infectious
            blood, semen, or other bodily fluids and is 100 times more
            infectious than HIV. 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 for
            HCV. 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, and in 2019, reaffirmed this
            grade.
                (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 and appropriate medical care 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. While
            there is no cure for chronic HBV, available treatments can
            effectively suppress viral replication in the overwhelming
            majority of those treated, thereby reducing the risk of
            transmission and progression to liver scarring or liver cancer.
                (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 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.
                (21) 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.
        (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 linguistically
            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, 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 or at risk of 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 18
                            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 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 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 2021, $90,000,000 for fiscal year 2022,
    $110,000,000 for fiscal year 2023, $130,000,000 for fiscal year 2024,
    and $150,000,000 for fiscal year 2025.''.

               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 2020''.
        (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 317V (as added by section 110) the
    following:

    ``SEC. 317W. 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 2021 through 2025.''.
        (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 2021 through 2025.
        (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 317W(d).
        ``(e) Authorization of Appropriations.--There is authorized to be
    appropriated to carry out this section $2,000,000 for each of fiscal
    years 2021 through 2025.''.
        (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 2021 through 2025.
        (g) Definition.--In this section, the term ``acquired bone marrow
    failure disease'' has the meaning given such term in section 317W(d) of
    the Public Health Service Act, as added by subsection (c).

    Subtitle D--Cardiovascular Disease, Chronic Disease, Obesity, 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 2021 through 2025.

    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 2021, $25,300,000 for fiscal year 2022,
            $27,800,000 for fiscal year 2023, $30,800,000 for fiscal year
            2024, and $34,000,000 for fiscal year 2025.''.

    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, 2021, 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 (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 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, 2021.

    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 (86);
                (2) by striking the period at the end of paragraph (87) and
            inserting ``; and''; and
                (3) by inserting after paragraph (87) the following new
            paragraph:
                ``(88) 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, 2020.
                (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 (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 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.

    SEC. 737. GUIDE ON EVIDENCE-BASED STRATEGIES FOR PUBLIC HEALTH
                  DEPARTMENT OBESITY PREVENTION PROGRAMS.

        (a) Development and Dissemination of an Evidence-Based Strategies
    Guide.--The Secretary of Health and Human Services (referred to in this
    section as the ``Secretary''), acting through the Director of the
    Centers for Disease Control and Prevention, not later than 2 years
    after the date of enactment of this Act, shall--
                (1) develop a guide on evidence-based strategies for State,
            territorial, and local health departments to use to build and
            maintain effective obesity prevention and reduction programs,
            and, in consultation with stakeholders that have expertise in
            Tribal health, a guide on such evidence-based strategies with
            respect to Indian Tribes and Tribal organizations for such
            Indian Tribes and Tribal organizations to use for such purpose,
            both of which guides shall--
                        (A) describe an integrated program structure for
                    implementing interventions proven to be effective in
                    preventing and reducing the incidence of obesity; and
                        (B) recommend--
                                (i) optimal resources, including staffing
                            and infrastructure, for promoting nutrition and
                            obesity prevention and reduction; and
                                (ii) strategies for effective obesity
                            prevention programs for State and local health
                            departments, Indian Tribes, and Tribal
                            organizations, including strategies related
                            to--
                                        (I) the application of evidence-
                                    based and evidence-informed practices
                                    to prevent and reduce obesity rates;
                                        (II) the development,
                                    implementation, and evaluation of
                                    obesity prevention and reduction
                                    strategies for specific communities and
                                    populations;
                                        (III) demonstrated knowledge of
                                    obesity prevention practices that
                                    reduce associated preventable diseases,
                                    health conditions, death, and health
                                    care costs;
                                        (IV) best practices for the
                                    coordination of efforts to prevent and
                                    reduce obesity and related chronic
                                    diseases;
                                        (V) addressing the underlying risk
                                    factors and social determinants of
                                    health that impact obesity rates; and
                                        (VI) interdisciplinary coordination
                                    between relevant public health
                                    officials specializing in fields such
                                    as nutrition, physical activity,
                                    epidemiology, communications, and
                                    policy implementation, and
                                    collaboration between public health
                                    officials and community-based
                                    organizations; and
                (2) disseminate the guides and current research, evidence-
            based practices, tools, and educational materials related to
            obesity prevention, consistent with the guide, to State and
            local health departments, Indian Tribes, and Tribal
            organizations.
        (b) Technical Assistance.--The Secretary, acting through the
    Director of the Centers for Disease Control and Prevention, shall
    provide technical assistance to State and local health departments,
    Indian Tribes, and Tribal organizations to support such health
    departments in implementing the guide developed under subsection
    (a)(1).
        (c) Indian Tribes; Tribal Organizations.--In this section, the
    terms ``Indian Tribe'' and ``Tribal organization'' have the meanings
    given the terms ``Indian tribe'' and ``tribal organization'',
    respectively, in section 4 of the Indian Self-Determination and
    Education Assistance Act (25 U.S.C. 5304).

                              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 and immediately link people to
            continuous and coordinated high-quality care when they learn
            they are living 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 communities disproportionately impacted by
            HIV, particularly communities of color;
                (3) ensure laws, policies, and regulations do not impede
            access to prevention, treatment, and care for people living
            with HIV or disproportionately impacted by 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.

    SEC. 742. FINDINGS.

        The Congress finds the following:
                (1) Over 1,100,000 people are estimated to be living with
            HIV in the United States according to the Centers for Disease
            Control and Prevention, 14 percent of whom are unaware they are
            living with HIV.
                (2) Annually there are about 37,600 new HIV infections and
            15,800 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 2017, there were approximately 38,700 people
            newly diagnosed with HIV. The estimated number of annual new
            HIV infections declined 9 percent from 2010 to 2016. However,
            the number of new infections is increasing among certain
            populations, such as Latino gay and bisexual men, where annual
            infections increase 21 percent.
                (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 (42 percent) of all people living with
            HIV in the United States. African-American men who have sex
            with men account for 26 percent of all new HIV infections and
            have remained stable from 2010 to 2016.
                (5) Disparities continue to exist among Latinos and
            Hispanics; in 2017, Latinos and Hispanics made up 18 percent of
            the United States population and 26 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 2010
            to 2016, the annual number of HIV diagnoses increased 46
            percent among AI/AN overall and 81 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.
            Between 2010 and 2016, the number of Asians receiving an HIV
            diagnosis increased by 42 percent.
                (8) The latest data from the Centers for Disease Control
            and Prevention indicates that new infections among women
            declined 21 percent between 2010 and 2016.
                (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) Among the 3 million HIV testing events reported to the
            Centers for Disease Control and Prevention in 2017, the
            percentage of transgender people who received a new HIV
            diagnosis was 3 times the national average. A 2019 systematic
            review and meta-analysis found that an estimated 14 percent of
            transgender women have HIV. By race/ethnicity, an estimated 44
            percent of Black/African-American transgender women, 26 percent
            of Hispanic/Latina transgender women, and 7 percent of White
            transgender women have HIV. 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
            treatment and prevention efforts and that early diagnosis is
            critical in order for people with HIV 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.
                (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) In January 2019, the Department of Health and Human
            Services began implementing the ``Ending the HIV Epidemic: A
            Plan for America''. The initiative seeks to reduce the number
            of new HIV infections in the United States by 75 percent by
            2025, and then by at least 90 percent by 2030, for an estimated
            250,000 total HIV infection averted.
                (16) 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.
                (17) 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.
                (18) Due to advances in treatment, many people living with
            HIV 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.
                (19) 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 people living with
            HIV, 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
            people living with HIV 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.
                (20) In July 2012, the Food and Drug Administration
            approved the first drug to be used as pre-exposure prophylaxis
            (PrEP). PrEP reduces the risk of HIV infection in HIV-negative
            individuals. Studies have shown that PrEP reduces HIV
            transmission from sex by about 99 percent when taken
            consistently. Despite increases in PrEP uptake, PrEP use
            remains low among gay and bisexual men of color. The Centers
            for Disease Control and Prevention found that uptake was lower
            among African-American (26 percent) and Latino (30 percent) men
            compared with White men (42 percent). Similarly, PrEP awareness
            was lower among African-American (86 percent) and Latino (87
            percent) men compared with White men (95 percent). While
            clinical research on transgender populations and PrEP is
            currently limited, the Centers for Disease Control and
            Prevention recommends PrEP use in transgender populations. In
            September 2019, the Food and Drug Administration approved the
            second drug to be used as PrEP.
                (21) Syringe service programs have been associated with
            lowered HIV infections, lower hepatitis C infections, and
            increased linkage to substance use treatment.
                (22) 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 2021 through 2024.''.

    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 2021 through 2024.

    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 2021 through 2024.

    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 living with HIV;
                (2) prevented millions from new diagnoses; 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 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 when 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 2021 through 2024.

    SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND ETHNIC MINORITY
                  COMMUNITIES.

        (a) In General.--For the purpose of reducing new HIV diagnoses 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 prevention and
            testing activities;
                (2) HIV prevention activities; and
                (3) HIV 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 2021 through 2024.

    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
            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 2021 and such sums as may be necessary for each of fiscal
    years 2022 through 2025.

    SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDIVIDUALS WITH HIV.

        (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
    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.
                (3) Training health care professionals to provide care to
            individuals living with HIV.
                (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 living with HIV, with
            particular emphasis on treatment to racial and ethnic
            minorities, men who have sex with men, and women, young people,
            and children living with HIV.
                (5) Development and implementation of programs to increase
            the use of telehealth to respond to HIV-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 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 2021 through 2024.

    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; 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 2021 through 2024.

    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; 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 2021 through 2024.

    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 2021 through 2024.

    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 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 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 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
            testing, policy, and advocacy;
                (2) to become aware, engaged, and empowered on the HIV
            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, 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.--In this section:
                (1) HIV.--The term ``HIV'' has the meaning given to the
            term 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.--It is the sense of Congress that Federal and
    State laws, policies, and regulations regarding people living with
    HIV--
                (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;
                        (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;
                    and
                        (F) the current science on HIV prevention and
                    treatment, including pre-exposure prophylaxis (PrEP),
                    post-exposure prophylaxis (PEP), and viral suppression.
        (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, 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, 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 service
                            organizations that work with people living with
                            HIV;
                                (vii) nongovernmental health organizations
                            that work on behalf of people living with HIV;
                            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, 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, 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.
                                (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;
                                        (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; and
                                        (VI) the current science on HIV
                                    prevention and treatment, including
                                    pre-exposure prophylaxis (PrEP), post-
                                    exposure prophylaxis (PEP), and viral
                                    suppression.
                                (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 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
                    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.
                (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.
                        (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.
                        (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 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,
                    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;
                                (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; and
                                (vi) the current science on HIV prevention
                            and treatment, including pre-exposure
                            prophylaxis (PrEP), post-exposure prophylaxis
                            (PEP), and viral suppression.
                (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 section.
            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;
                                        (VI) legal advocacy and HIV service
                                    organizations that work with people
                                    living with HIV; and
                                        (VII) nongovernmental health
                                    organizations that work on behalf of
                                    people living with HIV.
                                (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;
                                        (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; and
                                        (VI) the current science on HIV
                                    prevention and treatment, including
                                    pre-exposure prophylaxis (PrEP), post-
                                    exposure prophylaxis (PEP), and viral
                                    suppression.
                (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 2021
                    through 2024.
                        (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, 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.--Not later than 1 year after the date of the
            enactment of this Act, and annually thereafter, 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 2021 through 2025.
                (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 HIV IN PRISON.

        (a) Short Title.--This section may be cited as the ``Stop HIV 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 among inmates.
                (2) To protect prison guards and other personnel from HIV
            infection.
                (3) To provide comprehensive medical treatment to inmates
            who are living with HIV.
                (4) To promote HIV 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 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, 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 prevention education.--
                        (A) Health care personnel shall improve HIV
                    awareness through frequent educational programs for all
                    inmates. HIV educational programs may be provided by
                    community-based organizations, local health
                    departments, and inmate peer educators.
                        (B) HIV 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 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.
                        (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, 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, 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; 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 HIV 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,
                            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 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.
                        (D) Consultation.--The Director shall consult with
                    appropriate officials of the Department of Health and
                    Human Services, the Office of National Drug Control
                    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
    Infectious Disease and HIV/AIDS 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 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 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
            programs to ensure that only essential data are collected.

    SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF ENDING THE HIV
                  EPIDEMIC: A PLAN FOR AMERICA.

        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, the Secretary may transfer up to 1 percent
    of such appropriations to the Office of the Assistant Secretary for
    Health for implementation of the Ending the HIV Epidemic: A Plan for
    America.
        ``(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, the term `Ending the HIV
    Epidemic: A Plan for America' means the initiative that seeks to reduce
    the number of new HIV infections in the United States by 75 percent by
    2025, and then by at least 90 percent by 2030, for an estimated 250,000
    total HIV infections averted.''.

                              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 317W the following section:

    ``SEC. 317X. 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
                    Americans, Native Hawaiians, 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 2021 through 2025 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 2021 through 2025.

    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 2021 through 2025.

                            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, 9,025 people were diagnosed with
            tuberculosis (referred to in this section as ``TB'') in 2018.
                (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 70 percent of people diagnosed with TB in
            2018 self-identified as racial and ethnic minorities.
                (3) African Americans comprised 20 percent of people
            diagnosed with TB during 2018. The population-adjusted rate of
            TB among African Americans is 1.7 times higher than the
            national total, and 8.0 times higher than among Whites.
                (4) Asian Americans, Native Hawaiians, and other Pacific
            Islanders comprised 37 percent of people diagnosed with TB
            during 2018. The population-adjusted rate of TB among Asian
            Americans is 6.2 times higher than the national total, and 31
            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 26 percent of people
            diagnosed with TB during 2018. The population-adjusted rate of
            TB among Hispanics and Latinos is 1.6 times higher than the
            national total, and 8.0 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 97 people in the United States were
            diagnosed with MDR-TB in 2018. One person was diagnosed with
            XDR-TB in the same year.
                (12) In the United States, $480 million was spent in 2018
            to treat TB; direct treatment costs average $19,000 to treat a
            patient with DS-TB, $175,000 to treat a patient with MDR-TB,
            and $544,000 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.
                (15) The right to health, and the right to science as a
            necessary human right to help achieve the right to health, is
            enshrined in Articles 25 and 27 of the Universal Declaration of
            Human Rights. These fundamental human rights cannot be achieved
            when anyone lacks access to TB prevention or treatment, and
            when the benefits of scientific innovation are not extended to
            people with all forms of TB.

    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 2020 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 and development, and pathways to approval, for
            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 2021 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 2021 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 2021 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--Kidney Disease Research, Surveillance, Prevention, and
                                   Treatment

    SEC. 797. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, PREVENTION, AND
                  TREATMENT.

        (a) Short Title.--This section may be cited as the ``Kidney Disease
    Research, Surveillance, Prevention and Treatment Improvement Act of
    2020''.
        (b) Findings.--Congress makes the following findings:
                (1) Kidney diseases impact 37 million Americans.
                (2) African Americans comprise just 13 percent of the
            United States population, but 33 percent of the United States
            dialysis patient population. Compared to Caucasians, kidney
            failure prevalence is about 3.7 times greater in African
            Americans, 1.4 times greater in Native Americans, and 1.5 times
            greater in Asian Americans.
                (3) Peritoneal dialysis and home hemodialysis use is 40-50
            percent lower among African Americans and Hispanics.
                (4) Every racial/ethnic minority group in the United States
            is significantly less likely to be treated with home dialysis
            than Whites, and demographic and clinical characteristics are
            insufficient to explain this differential use.
                (5) African Americans on dialysis, irrespective of dialysis
            modality, and Hispanics undergoing PD or in-center HD, are
            significantly less likely than their White counterparts to
            receive a kidney transplant.
                (6) African Americans, Hispanics, and Asian Americans are
            less likely to receive living donor kidney transplants than
            Whites. Efforts to reduce disparities in live donor kidney
            transplantation for African-American, Hispanic, and Asian
            patients with kidney failure have been unsuccessful.
                (7) Medicare and Medicaid patients are less likely to
            receive a preemptive transplant from a deceased donor compared
            to private insurance patients (5 percent and 11 percent versus
            24 percent), and Black and Hispanic patients are less likely to
            receive a preemptive transplant from a deceased donor compared
            with White patients even after changes to the kidney allocation
            system (5 percent of Black patients and 5 percent of Hispanic
            patients compared with 18 percent of White patients).
                (8) Low-income populations are significantly more likely to
            progress to kidney failure.
                (9) Low socioeconomic status is associated with increased
            incidence of chronic kidney disease, progression to kidney
            failure, inadequate dialysis treatment, and reduced access to
            kidney transplantation.
                (10) The three goals of the recent Executive Order on
            Advancing American Kidney Health recognizes the need for more
            transplants, better prevention and education and improved
            access to treatment modalities.

    SEC. 798. KIDNEY DISEASE RESEARCH IN MINORITY POPULATIONS.

        (a) In General.--The Director of the National Institutes of Health
    shall expand, intensify, and support ongoing research and other
    activities with respect to kidney disease in minority populations.
        (b) Research.--
                (1) Description.--Research under subsection (a) shall
            include investigation into--
                        (A) the causes of kidney disease, including
                    socioeconomic, geographic, clinical, environmental,
                    genetic, and other factors that may contribute to
                    increased rates of kidney disease in minority
                    populations; and
                        (B) the causes of increased incidence of kidney
                    disease 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 the National Institutes of Health shall seek to include
            minority participants as study subjects in clinical trials.
        (c) Report; Comprehensive Plan.--
                (1) In general.--The Secretary of Health and Human Services
            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 kidney disease 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 kidney
                    disease in minority populations.
                (2) Contents.--The report under paragraph (1)(A) shall at
            minimum address each of the following:
                        (A) Research on kidney disease 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 kidney disease.
                        (B) Surveillance and data collection on kidney
                    disease in minority populations, including with respect
                    to--
                                (i) efforts to better determine the
                            prevalence of kidney disease 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 kidney
                    disease 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 kidney disease.
                        (D) Education and training programs for health
                    professionals (including community health workers) on
                    the prevention and management of kidney disease and its
                    related complications that are supported by the Health
                    Resources and Services Administration, including such
                    programs supported by the Bureau of Health Workforce,
                    the Bureau of Primary Health Care, and the Healthcare
                    Systems Bureau.

    SEC. 799. KIDNEY DISEASE ACTION PLAN.

        (a) 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 kidney disease.
        (b) National Action Plan.--
                (1) Development.--Not later than 2 years after the date of
            the enactment of this Act, the Director of the National
            Institute of Diabetes and Digestive and Kidney Disease, in
            consultation with the Director of the Centers for Disease
            Control and Prevention, shall develop a national action plan to
            address kidney 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 kidney disease; and
                        (C) inclusion of kidney disease in the health data
                    collections of all Federal agencies.
        (c) Kidney Disease Prevention Programs.--The Director of the
    National Institute of Diabetes and Digestive and Kidney Disease 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 kidney
            disease. To the extent known and relevant, such public
            education and awareness activities shall reflect differences in
            kidney disease by cause (such as hypertension, diabetes, and
            polycystic kidney disease) and include a focus on outreach to
            undiagnosed and, as appropriate, minority populations.
                (2) Supplement and expand upon the activities of the
            National Institute of Diabetes and Digestive and Kidney Disease
            by making grants to nonprofit organizations, State and local
            jurisdictions, and Indian tribes for the purpose of reducing
            the burden of kidney 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 kidney disease.
                (4) Develop improved techniques and identify best
            practices, in coordination with the Secretary of Veterans
            Affairs, for assisting kidney disease patients.
        (d) Data Collection.--Not later than 180 days after the date of
    enactment of this Act, the Director of the National Institute of
    Diabetes and Digestive and Kidney Disease and the Director of the
    Centers for Disease Control and Prevention, acting jointly, shall
    assess the depth and quality of information on kidney 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 Institute of Diabetes and
    Digestive and Kidney Disease shall include the results of such
    assessment in the national action plan under subsection (b).
        (e) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $1,000,000 for fiscal year 2021,
    $1,000,000 for fiscal year 2022, $1,000,000 for fiscal year 2023,
    $1,000,000 for fiscal year 2024, and $1,000,000 for fiscal year 2025.

    SEC. 799A. HOME DIALYSIS AND INCREASING END-STAGE RENAL DISEASE
                  TREATMENT MODALITIES IN MINORITY COMMUNITIES ACTION PLAN.

        (a) National Action Plan.--
                (1) Development.--Not later than 2 years after the date of
            the enactment of this Act, the Director of the National
            Institute of Diabetes and Digestive and Kidney Disease, in
            consultation with the Director of the Centers for Disease
            Control and Prevention, shall develop a national action plan to
            increase the number of home dialyzers and choice in dialysis
            treatment modality in the United States with participation from
            patients, caregivers, health professionals, patient advocacy
            organizations, researchers, providers, public health
            professionals, and other stakeholders in the minority
            community.
                (2) Contents.--At a minimum, such plan shall include
            recommendations for--
                        (A) public health officials for the purpose of
                    implementation of the national plan;
                        (B) biomedical, health services, and public health
                    research on home dialysis and modalities in minority
                    communities; and
                        (C) inclusion of dialysis location and modality in
                    the health data collections of all Federal agencies.
        (b) Authorization of Appropriations.--There are authorized to be
    appropriated to carry out this section $1,000,000 for fiscal year 2021,
    $1,000,000 for fiscal year 2022, $1,000,000 for fiscal year 2023,
    $1,000,000 for fiscal year 2024, and $1,000,000 for fiscal year 2025.

    SEC. 799B. INCREASING KIDNEY TRANSPLANTS IN MINORITY COMMUNITIES.

        (a) In General.--The Director of the National Institutes of Health
    shall expand, intensify, and support ongoing research and other
    activities with respect to kidney transplants in minority populations.
        (b) Research.--Research under subsection (a) shall include
    investigation into--
                (1) the causes of lower rates of kidney transplants in
            minority communities, including socioeconomic, geographic,
            clinical, environmental, genetic, and other factors that may
            contribute to lower rates of kidney transplants in minority
            populations; and
                (2) possible interventions to increase kidney transplants.
        (c) Report; Comprehensive Plan.--
                (1) In general.--The Secretary of Health and Human Services
            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 kidney transplants as a
                    treatment for end-stage renal disease in minority
                    populations; and
                        (B) develop and submit to the Congress, not later
                    than 1 year after the date of enactment of this
                    section, an effective and comprehensive Federal plan
                    (including all appropriate Federal health programs) to
                    increase the number of kidney transplants in minority
                    populations.
                (2) Contents.--The report under paragraph (1)(A) shall at a
            minimum address each of the following:
                        (A) Research on kidney transplants in minority
                    populations, including such research on financial,
                    insurance coverage, genetic, behavioral, and
                    environmental factors.
                        (B) Surveillance and data collection on kidney
                    transplants in minority populations, including with
                    respect to--
                                (i) efforts to increase kidney transplants
                            disease among Asian-American and Pacific
                            Islander subgroups with end-stage renal
                            disease; and
                                (ii) efforts to increase kidney transplants
                            in the American Indian population.
                        (C) Community-based efforts to increase kidney
                    transplants targeting minority populations, including--
                                (i) the evidence base for such increases;
                                (ii) the cultural appropriateness of such
                            increases; and
                                (iii) efforts to educate the public on the
                            kidney transplants.
                        (D) Education and training programs for health
                    professionals (including community health workers) on
                    the kidney transplants that are supported by the Health
                    Resources and Services Administration, including such
                    programs supported by the Bureau of Health Workforce,
                    the Bureau of Primary Health Care, and the Healthcare
                    Systems Bureau.

    SEC. 799C. 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 kidney disease; and
                (2) develop and disseminate public health interventions
            that will lessen the impact of environmental and occupational
            causes of kidney disease.

    SEC. 799D. UNDERSTANDING THE TREATMENT PATTERNS ASSOCIATED WITH
                  PROVIDING CARE AND TREATMENT OF KIDNEY FAILURE IN
                  MINORITY POPULATIONS.

        (a) Study.--The Secretary of Health and Human Services (in this
    section referred to as the ``Secretary'') shall conduct a study on
    treatment patterns associated with providing care, under the Medicare
    program under title XVIII of the Social Security Act (42 U.S.C. 1395 et
    seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396
    et seq.), and through private health insurance, to minority populations
    that are disproportionately affected by kidney failure.
        (b) Report.--Not later than 1 year after the date of the enactment
    of this Act, the Secretary shall submit to Congress a report on the
    study conducted under subsection (a), together with such
    recommendations as the Secretary determines to be appropriate.

    SEC. 799E. IMPROVING ACCESS IN UNDERSERVED AREAS.

        (a) Definition of Primary Care Services.--Section 331(a)(3)(D) of
    the Public Health Service Act (42 U.S.C. 254d(a)(3)(D)) is amended by
    inserting ``renal dialysis,'' after ``dentistry,''.
        (b) National Health Service Corps Scholarship Program.--Section
    338A(a)(2) of the Public Health Service Act (42 U.S.C. 254l(a)(2)) is
    amended by inserting ``, which may include nephrology health
    professionals'' before the period at the end.
        (c) National Health Service Corps Loan Repayment Program.--Section
    338B(a)(2) of the Public Health Service Act (42 U.S.C. 254l-1(a)(2)) is
    amended by inserting ``, which may include nephrology health
    professionals'' before the period at the end.

                   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.
                (3) Interoperability.--The term ``interoperability'' has
            the meaning given such term in section 3000 of the Public
            Health Service Act (42 U.S.C. 300jj). Evaluation and
            measurement of interoperability shall consider exchange of
            electronic health information, usability of exchanged
            electronic health information, effective application and use of
            the exchanged electronic health information, and impact on
            outcomes of interoperability.
                (4) Access.--The term ``access'' has the meaning given such
            term within the definition of ``interoperability'' in section
            3000 of the Public Health Service Act (42 U.S.C. 300jj) and
            within HIPAA's Privacy Rule (45 C.F.R. 164.524).
                (5) Certified electronic health record technology; ehr.--
            The term ``certified electronic health record technology'' and
            the term ``EHR'' both include the health information
            infrastructure for interoperability, access, exchange, and use
            of electronic health information required by sections 4003 and
            4006 of the 21st Century Cures Act, and are not limited solely
            to doctors' electronic health records.

           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.--Not
    later than 18 months after the date of enactment of this Act, the
    National Coordinator for Health Information Technology (referred to in
    this section as the ``National Coordinator'') shall--
                (1) conduct an evaluation of the level of interoperability,
            access, 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 the degree to which patients in such
            communities can access, exchange, and use without special
            effort their health information in those electronic health
            records, and indicating whether such providers--
                        (A) 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);
                        (B) have received incentive payments or incentive
                    payment adjustments under Medicare and Medicaid
                    Electronic Health Records Incentive Programs (as
                    defined in subsection (c)(2));
                        (C) 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
                        (D) 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);
                (2) publish the results of such evaluation including the
            race and ethnicity of such providers and the populations served
            by such providers; and
                (3) not later than 12 months after the enactment of this
            Act, shall promulgate a certification criterion and module of
            certified EHR technology that stratifies quality measures by
            disparity characteristics, including race, ethnicity, language,
            gender, gender identity, sexual orientation, socio-economic
            status, and disability status, as those characteristics are
            defined in certified EHR technology; and reports to Centers for
            Medicare & Medicaid Services the quality measures stratified by
            race and at least two other disparity characteristics.
    The term ``quality measures'' refers to the quality measures specified
    in MIPS.
        (b) National Center for Health Statistics.--As soon as practicable
    after the date of enactment of this Act, the Director of the National
    Center for Health Statistics shall provide to Congress a more detailed
    analysis of the data presented in 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 2020,
                                    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.''.

    SEC. 803. NONDISCRIMINATION AND HEALTH EQUITY IN HEALTH INFORMATION
                  TECHNOLOGY.

        Covered entities shall ensure that electronic and information
    technology in their health programs or activities does not exclude
    individuals from participation in, deny them the benefits of, or
    subject them to discrimination under any health program or activity on
    the basis of race, color, national origin, sex, age, or disability. The
    term ``covered entity'' means--
                (1) an entity that operates a health program or activity,
            any part of which receives Federal financial assistance;
                (2) an entity established under title I of the Patient
            Protection and Affordable Care Act that administers a health
            program or activity; and
                (3) the U.S. Department of Health and Human Services.

    SEC. 804. LANGUAGE ACCESS IN HEALTH INFORMATION TECHNOLOGY.

        The National Coordinator shall--
                (1) not later than 18 months following enactment of this
            Act, require the Office of the National Coordinator to provide
            access to certified EHR technology to provide patients access
            to their personal health information in a computable format,
            including using patient portals or third-party applications (as
            described in the 21st Century Cures Act), in the ten (10) most
            common non-English languages;
                (2) hold a public hearing to identify best practices for
            such a requirement listed in paragraph (1); and
                (3) not later than 6 months after the public hearing,
            promulgate a regulation and subsequent proposed rulemaking.

        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 2021 through 2026''.

                  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) survey a cross-section of individuals in medically
            underserved areas and report their opinions about the various
            topics of study;
                (3) examine the degree of interoperability among health
            information technology and users of health information
            technology in medically underserved areas, including patients,
            providers, and community services;
                (4) 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;
                (5) examine the impact of health information technology on
            improving health care-related decisions by both patients and
            providers in such areas;
                (6) 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;
                (7) assess the feasibility and costs associated with the
            use of health information technology in such areas;
                (8) 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;
                (9) 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
                (10) 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.

    SEC. 823. ASSESSMENT OF USE AND MISUSE OF DE-IDENTIFIED HEALTH DATA.

        (a) In General.--Not later than 18 months after the date of
    enactment of this Act, the Secretary of Health and Human Services
    shall--
                (1) enter into an agreement with the Office of the National
            Coordinator to conduct a study on the impact of digital health
            technology on medically underserved areas (as described in
            section 822(c) of the Health Equity and Accountability Act of
            2020) in consultation with relevant stakeholders; 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) examine the overall prevalence, and historical and
            existing practices and their respective prevalence, of use and
            misuse of de-identified protected health information, as it is
            defined in section 160.103, title 45, Code of Federal
            Regulations, to discriminate against or benefit medically
            underserved areas;
                (2) identify best practices and tools to leverage the
            benefits and prevent misuse of de-identified protected health
            information to discriminate against medically underserved
            areas;
                (3) examine the overall prevalence, and historical and
            existing practices and their respective prevalence, of use and
            misuse of de-identified personal health information other than
            protected health information, as it is defined in section
            160.103, title 45, Code of Federal Regulations, to discriminate
            against or benefit medically underserved areas; and
                (4) identify best practices and tools to leverage the
            benefits and prevent misuse of de-identified personal health
            information other than protected health information to
            discriminate against medically underserved areas.

          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)); 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
                  (INCLUDING SEX ORIENTATION, GENDER IDENTITY, AND
                  PREGNANCY, INCLUDING TERMINATION OF PREGNANCY), 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 (including sex orientation, gender identity, and pregnancy,
    including termination of pregnancy), 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, including credits, subsidies,
    or contracts of insurance or any health program or activity that is
    administered by an executive agency.
        (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. Such review shall include an
            assessment of health disparities in communities with a
            combination of these classes.
                ``(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, 2021, 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 2021 through 2026.

    ``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 2021, and such sums as may be necessary for
    each of the fiscal years 2022 through 2026.''.

    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 on Minority Health
            and 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 2022;
                (4) adequate funding by fiscal year 2022, 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 2022 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 2022; 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, 2009, and ending December 31, 2019.
                        (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 2024, 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'', ``socioeconomic determinants
                    of health'', ``environmental determinants of health'',
                    ``social drivers of inequality'', and ``personal
                    determinants of health'').
                (2) Environmental determinants of health.--The term
            ``environmental determinants of health'' means the broad
            physical (including manmade and natural environments),
            psychological, social, spiritual, cultural and aesthetic
            environment.
                (3) 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.
                (4) Personal determinants of health.--The term ``personal
            determinants of health'' means an individual's behavior,
            biology, and genetics.
                (5) 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.
                (6) Economic determinants of health.--The term ``economic
            determinants of health'' refers to income and social status.
            Higher income and socioeconomic status (SES) are linked to
            decreased rates of morbidity and mortality. The higher your
            SES, the healthier you are the longer you'll live. Low SES
            leads to an increased risk of illness and death.

    SEC. 1002. FINDINGS.

        Congress finds as follows:
                (1) Social determinants of health are the largest
            predictors of health outcomes.
                (2) Social determinants of health, including health-related
            behaviors, social and economic factors, and physical
            environment factors account for 80 percent of health outcomes,
            whereas clinical care accounts for 20 percent of improved
            health outcomes. Yet, in 2017, public health spending only
            represented 2.5 percent of all health spending in the United
            States.
                (3) 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.
                (4)(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.
                        (iv) Historical and institutional racism 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 people of color
                    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) Individuals with lower levels of educational
                    attainment are much more likely to report to be current
                    smokers. In 2017, smoking prevalence was 36.8 percent
                    among adults with a GED diploma, 23.1 percent with less
                    than a high school diploma, and 18.7 percent with a
                    high school diploma, while dropping significantly to
                    7.1 percent among adults with an undergraduate college
                    degree and 4.1 percent with a postgraduate college
                    degree.
                        (ix) Income inequality 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), increased food insecurity, and more
                    psychological stress. These experiences culminate in
                    worse adult health as compared with children with
                    higher socioeconomic status. Specifically, children
                    living in lower socioeconomic neighborhoods have higher
                    rates of asthma due to higher rates of psychological
                    stress resulting from higher rates of violence. Food
                    insecurity is associated with obesity and racial and
                    ethnic minorities have higher rates of food insecurity.
                        (x) Lesbian, gay, bisexual, transgender, queer,
                    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.
                        (xi) 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
                    contaminated drinking water, 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.
                        (xii) Individuals with disabilities, as a group,
                    experience health disparities in routine public health
                    arenas such as health behaviors, clinical preventive
                    services, and chronic conditions. Compared with
                    individuals without disabilities, individuals with
                    disabilities are--
                                (I) less likely to receive recommended
                            preventive health care services, such as
                            routine teeth cleanings and cancer screenings;
                                (II) at a high risk for poor health
                            outcomes such as obesity, hypertension, falls-
                            related injuries, and mood disorders such as
                            depression; and
                                (III) more likely to engage in unhealthy
                            behaviors that put their health at risk, such
                            as cigarette smoking and inadequate physical
                            activity (from Healthy People 2020).
                (5) 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.
                (6) The global public health community has reached
            consensus through the Rio Political Declaration of Social
            Determinants of Health adopted by the World Health Organization
            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 fosters community leadership,
            ownership and participation in decision-making processes.
                (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
            decision-making 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) Director.--The term `Director' means the Director of
            the Centers for Disease Control and Prevention.
                ``(3) 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.
                ``(4) 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;
            citizenship status; 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 2020,
            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, climate forecasting,
                    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 decision-making 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.
                                        ``(XIII) Drinking water quality and
                                    accessibility.
                                ``(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 leaders,
            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 decision-making 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 2020, 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 transportation options; and
                ``(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 and access to information;
                        (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 decision-
                            making processes.
                                (iii) Duties.--A PPC shall--
                                        (I) identify key stakeholders and
                                    engage and coordinate potential
                                    partners in the planning process;
                                        (II) establish a formal advisory
                                    group to plan for the establishment of
                                    services;
                                        (III) conduct an in-depth review of
                                    the nature and extent of the need for
                                    an environmental health assessment,
                                    including a local epidemiological
                                    profile, an evaluation of the service
                                    provider capacity of the community, and
                                    a profile of any target populations;
                                    and
                                        (IV) define the components of care
                                    and form essential programmatic
                                    linkages with related providers in the
                                    community.
                        (C) Environmental health assessment.--
                                (i) In general.--A PPC shall carry out an
                            environmental health assessment to identify
                            environmental health concerns.
                                (ii) Assessment process.--The PPC shall--
                                        (I) define the goals of the
                                    assessment;
                                        (II) generate the environmental
                                    health issue list;
                                        (III) analyze issues with a systems
                                    framework;
                                        (IV) develop appropriate community
                                    environmental health indicators;
                                        (V) rank the environmental health
                                    issues;
                                        (VI) set priorities for action;
                                        (VII) develop an action plan;
                                        (VIII) implement the plan; and
                                        (IX) evaluate progress and planning
                                    for the future.
                        (D) Evaluation.--Each eligible entity that receives
                    a grant under this paragraph shall evaluate, report,
                    and disseminate program findings and outcomes.
                        (E) Technical assistance.--The Director may provide
                    such technical and other non-financial assistance to
                    eligible entities as the Director determines to be
                    necessary.
                (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) violence;
                                        (IX) socioeconomic status;
                                        (X) ethnicity, social construct and
                                    language preference;
                                        (XI) educational attainment;
                                        (XII) employment;
                                        (XIII) food safety, accessibility,
                                    and affordability;
                                        (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 2021; and
                (2) such sums as may be necessary for fiscal years 2022
            through 2024.

    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 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.

    SEC. 1009. ESTABLISH AN INTERAGENCY COUNSEL AND GRANT PROGRAMS ON
                  SOCIAL DETERMINANTS OF HEALTH.

        (a) Short Title.--This section may be cited as the ``Social
    Determinants Accelerator Act of 2020''.
        (b) Findings; Purposes.--
                (1) Findings.--Congress finds the following:
                        (A) There is a significant body of evidence showing
                    that economic and social conditions have a powerful
                    impact on individual and population health outcomes and
                    well-being, as well as medical costs.
                        (B) State, local, and Tribal governments and the
                    service delivery partners of such governments face
                    significant challenges in coordinating benefits and
                    services delivered through the Medicaid program and
                    other social services programs because of the
                    fragmented and complex nature of Federal and State
                    funding and administrative requirements.
                        (C) The Federal Government should prioritize and
                    proactively assist State and local governments to
                    strengthen the capacity of State and local governments
                    to improve health and social outcomes for individuals,
                    thereby improving cost-effectiveness and return on
                    investment.
                (2) Purposes.--The purposes of this Act are as follows:
                        (A) To establish effective, coordinated Federal
                    technical assistance to help State and local
                    governments to improve outcomes and cost-effectiveness
                    of, and return on investment from, health and social
                    services programs.
                        (B) To build a pipeline of State and locally
                    designed, cross-sector interventions and strategies
                    that generate rigorous evidence about how to improve
                    health and social outcomes, and increase the cost-
                    effectiveness of, and return on investment from,
                    Federal, State, local, and Tribal health and social
                    services programs.
                        (C) To enlist State and local governments and the
                    service providers of such governments as partners in
                    identifying Federal statutory, regulatory, and
                    administrative challenges in improving the health and
                    social outcomes of, cost-effectiveness of, and return
                    on investment from, Federal spending on individuals
                    enrolled in Medicaid.
                        (D) To develop strategies to improve health and
                    social outcomes without denying services to, or
                    restricting the eligibility of, vulnerable populations.
        (c) Social Determinants Accelerator Council.--
                (1) Establishment.--The Secretary of Health and Human
            Services (referred to in this Act as the ``Secretary''), in
            coordination with the Administrator of the Centers for Medicare
            & Medicaid Services (referred to in this Act as the
            ``Administrator''), shall establish an interagency council, to
            be known as the Social Determinants Accelerator Interagency
            Council (referred to in this Act as the ``Council'') to achieve
            the purposes listed in subsection (b)(1).
                (2) Membership.--
                        (A) Federal composition.--The Council shall be
                    composed of at least one designee from each of the
                    following Federal agencies:
                                (i) The Office of Management and Budget.
                                (ii) The Department of Agriculture.
                                (iii) The Department of Education.
                                (iv) The Indian Health Service.
                                (v) The Department of Housing and Urban
                            Development.
                                (vi) The Department of Labor.
                                (vii) The Department of Transportation.
                                (viii) Any other Federal agency the Chair
                            of the Council determines necessary.
                        (B) Designation.--
                                (i) In general.--The head of each agency
                            specified in subparagraph (A) shall designate
                            at least one employee to serve as a member of
                            the Council.
                                (ii) Responsibilities.--An employee
                            described in this clause shall be a senior
                            employee of the agency--
                                        (I) whose responsibilities relate
                                    to authorities, policies, and
                                    procedures with respect to the health
                                    and well-being of individuals receiving
                                    medical assistance under a State plan
                                    (or a waiver of such plan) under title
                                    XIX of the Social Security Act (42
                                    U.S.C. 1396 et seq.); or
                                        (II) who has authority to implement
                                    and evaluate transformative initiatives
                                    that harness data or conducts rigorous
                                    evaluation to improve the impact and
                                    cost-effectiveness of federally funded
                                    services and benefits.
                        (C) HHS representation.--In addition to the
                    designees under subparagraph (A), the Council shall
                    include designees from at least three agencies within
                    the Department of Health and Human Services, including
                    the Centers for Medicare & Medicaid Services, at least
                    one of whom shall meet the criteria under this section.
                        (D) OMB role.--The Director of the Office of
                    Management and Budget shall facilitate the timely
                    resolution of Governmentwide and multiagency issues to
                    help the Council achieve consensus recommendations
                    described under this section.
                        (E) Non-federal composition.--The Comptroller
                    General of the United States may designate up to 6
                    Council designees--
                                (i) who have relevant subject matter
                            expertise, including expertise implementing and
                            evaluating transformative initiatives that
                            harness data and conduct evaluations to improve
                            the impact and cost-effectiveness of Federal
                            Government services; and
                                (ii) that each represent--
                                        (I) State, local, and Tribal health
                                    and human services agencies;
                                        (II) public housing authorities or
                                    State housing finance agencies;
                                        (III) State and local government
                                    budget offices;
                                        (IV) State Medicaid agencies; or
                                        (V) national consumer advocacy
                                    organizations.
                        (F) Chair.--
                                (i) In general.--The Secretary shall select
                            the Chair of the Council from among the members
                            of the Council.
                                (ii) Initiating guidance.--The Chair, on
                            behalf of the Council, shall identify and
                            invite individuals from diverse entities to
                            provide the Council with advice and information
                            pertaining to addressing social determinants of
                            health, including--
                                        (I) individuals from State and
                                    local government health and human
                                    services agencies;
                                        (II) individuals from State
                                    Medicaid agencies;
                                        (III) individuals from State and
                                    local government budget offices;
                                        (IV) individuals from public
                                    housing authorities or State housing
                                    finance agencies;
                                        (V) individuals from nonprofit
                                    organizations, small businesses, and
                                    philanthropic organizations;
                                        (VI) advocates;
                                        (VII) researchers; and
                                        (VIII) any other individuals the
                                    Chair determines to be appropriate.
                (3) Duties.--The duties of the Council are--
                        (A) to make recommendations to the Secretary and
                    the Administrator regarding the criteria for making
                    awards under this section;
                        (B) to identify Federal authorities and
                    opportunities for use by States or local governments to
                    improve coordination of funding and administration of
                    Federal programs, the beneficiaries of whom include
                    individuals, and which may be unknown or underutilized
                    and to make information on such authorities and
                    opportunities publicly available;
                        (C) to provide targeted technical assistance to
                    States developing a social determinants accelerator
                    plan under this section, including identifying
                    potential statutory or regulatory pathways for
                    implementation of the plan and assisting in identifying
                    potential sources of funding to implement the plan;
                        (D) to report to Congress annually on the subjects
                    set forth in this section;
                        (E) to develop and disseminate evaluation
                    guidelines and standards that can be used to reliably
                    assess the impact of an intervention or approach that
                    may be implemented pursuant to this Act on outcomes,
                    cost-effectiveness of, and return on investment from
                    Federal, State, local, and Tribal governments, and to
                    facilitate technical assistance, where needed, to help
                    to improve State and local evaluation designs and
                    implementation;
                        (F) to seek feedback from State, local, and Tribal
                    governments, including through an annual survey by an
                    independent third party, on how to improve the
                    technical assistance the Council provides to better
                    equip State, local, and Tribal governments to
                    coordinate health and social service programs;
                        (G) to solicit applications for grants under this
                    section; and
                        (H) to coordinate with other cross-agency
                    initiatives focused on improving the health and well-
                    being of low-income and at-risk populations in order to
                    prevent unnecessary duplication between agency
                    initiatives.
                (4) Schedule.--Not later than 60 days after the date of the
            enactment of this Act, the Council shall convene to develop a
            schedule and plan for carrying out the duties described in this
            section, including solicitation of applications for the grants
            under this section.
                (5) Report to congress.--The Council shall submit an annual
            report to Congress, which shall include--
                        (A) a list of the Council members;
                        (B) activities and expenditures of the Council;
                        (C) summaries of the interventions and approaches
                    that will be supported by State, local, and Tribal
                    governments that received a grant under this section,
                    including--
                                (i) the best practices and evidence-based
                            approaches such governments plan to employ to
                            achieve the purposes listed in this section;
                            and
                                (ii) a description of how the practices and
                            approaches will impact the outcomes, cost-
                            effectiveness of, and return on investment
                            from, Federal, State, local, and Tribal
                            governments with respect to such purposes;
                        (D) the feedback received from State and local
                    governments on ways to improve the technical assistance
                    of the Council, including findings from a third-party
                    survey and actions the Council plans to take in
                    response to such feedback; and
                        (E) the major statutory, regulatory, and
                    administrative challenges identified by State, local,
                    and Tribal governments that received a grant under
                    subsection (d), and the actions that Federal agencies
                    are taking to address such challenges.
                (6) FACA applicability.--The Federal Advisory Committee Act
            (5 U.S.C. App.) shall not apply to the Council.
                (7) Council procedures.--The Secretary, in consultation
            with the Comptroller General of the United States and the
            Director of the Office of Management and Budget, shall
            establish procedures for the Council to--
                        (A) ensure that adequate resources are available to
                    effectively execute the responsibilities of the
                    Council;
                        (B) effectively coordinate with other relevant
                    advisory bodies and working groups to avoid unnecessary
                    duplication;
                        (C) create transparency to the public and Congress
                    with regard to Council membership, costs, and
                    activities, including through use of modern technology
                    and social media to disseminate information; and
                        (D) avoid conflicts of interest that would
                    jeopardize the ability of the Council to make decisions
                    and provide recommendations.
        (d) Social Determinants Accelerator Grants to States or Local
    Governments.--
                (1) Grants to states, local governments, and tribes.--Not
            later than 180 days after the date of the enactment of this
            Act, the Administrator, in consultation with the Secretary and
            the Council, shall award on a competitive basis not more than
            25 grants to eligible applicants described in this section, for
            the development of social determinants accelerator plans, as
            described in this section.
                (2) Eligible applicant.--An eligible applicant described in
            this section is a State, local, or Tribal health or human
            services agency that--
                        (A) demonstrates the support of relevant parties
                    across relevant State, local, or Tribal jurisdictions;
                    and
                        (B) in the case of an applicant that is a local
                    government agency, provides to the Secretary a letter
                    of support from the lead State health or human services
                    agency for the State in which the local government is
                    located.
                (3) Amount of grant.--The Administrator, in coordination
            with the Council, shall determine the total amount that the
            Administrator will make available to each grantee under this
            section.
                (4) Application.--An eligible applicant seeking a grant
            under this section shall include in the application the
            following information:
                        (A) The target population (or populations) that
                    would benefit from implementation of the social
                    determinants accelerator plan proposed to be developed
                    by the applicant.
                        (B) A description of the objective or objectives
                    and outcome goals of such proposed plan, which shall
                    include at least one health outcome and at least one
                    other important social outcome.
                        (C) The sources and scope of inefficiencies that,
                    if addressed by the plan, could result in improved
                    cost-effectiveness of or return on investment from
                    Federal, State, local, and Tribal governments.
                        (D) A description of potential interventions that
                    could be designed or enabled using such proposed plan.
                        (E) The State, local, Tribal, academic, nonprofit,
                    community-based organizations, and other private sector
                    partners that would participate in the development of
                    the proposed plan and subsequent implementation of
                    programs or initiatives included in such proposed plan.
                        (F) Such other information as the Administrator, in
                    consultation with the Secretary and the Council,
                    determines necessary to achieve the purposes of this
                    Act.
                (5) Use of funds.--A recipient of a grant under this
            section may use funds received through the grant for the
            following purposes:
                        (A) To convene and coordinate with relevant
                    government entities and other stakeholders across
                    sectors to assist in the development of a social
                    determinant accelerator plan.
                        (B) To identify populations of individuals
                    receiving medical assistance under a State plan (or a
                    waiver of such plan) under title XIX of the Social
                    Security Act (42 U.S.C. 1396 et seq.) who may benefit
                    from the proposed approaches to improving the health
                    and well-being of such individuals through the
                    implementation of the proposed social determinants
                    accelerator plan.
                        (C) To engage qualified research experts to advise
                    on relevant research and to design a proposed
                    evaluation plan, in accordance with the standards and
                    guidelines issued by the Administrator.
                        (D) To collaborate with the Council to support the
                    development of social determinants accelerator plans.
                        (E) To prepare and submit a final social
                    determinants accelerator plan to the Council.
                (6) Contents of plans.--A social determinant accelerator
            plan developed under this section shall include the following:
                        (A) A description of the target population (or
                    populations) that would benefit from implementation of
                    the social determinants accelerator plan, including an
                    analysis describing the projected impact on the well-
                    being of individuals described in paragraph (5)(B).
                        (B) A description of the interventions or
                    approaches designed under the social determinants
                    accelerator plan and the evidence for selecting such
                    interventions or approaches.
                        (C) The objectives and outcome goals of such
                    interventions or approaches, including at least one
                    health outcome and at least one other important social
                    outcome.
                        (D) A plan for accessing and linking relevant data
                    to enable coordinated benefits and services for the
                    jurisdictions described in this section and an
                    evaluation of the proposed interventions and
                    approaches.
                        (E) A description of the State, local, Tribal,
                    academic, nonprofit, or community-based organizations,
                    or any other private sector organizations that would
                    participate in implementing the proposed interventions
                    or approaches, and the role each would play to
                    contribute to the success of the proposed interventions
                    or approaches.
                        (F) The identification of the funding sources that
                    would be used to finance the proposed interventions or
                    approaches.
                        (G) A description of any financial incentives that
                    may be provided, including outcome-focused contracting
                    approaches to encourage service providers and other
                    partners to improve outcomes of, cost-effectiveness of,
                    and return on investment from, Federal, State, local,
                    or Tribal government spending.
                        (H) The identification of the applicable Federal,
                    State, local, or Tribal statutory and regulatory
                    authorities, including waiver authorities, to be
                    leveraged to implement the proposed interventions or
                    approaches.
                        (I) A description of potential considerations that
                    would enhance the impact, scalability, or
                    sustainability of the proposed interventions or
                    approaches and the actions the grant awardee would take
                    to address such considerations.
                        (J) A proposed evaluation plan, to be carried out
                    by an independent evaluator, to measure the impact of
                    the proposed interventions or approaches on the
                    outcomes of, cost-effectiveness of, and return on
                    investment from, Federal, State, local, and Tribal
                    governments.
                        (K) Precautions for ensuring that vulnerable
                    populations will not be denied access to Medicaid or
                    other essential services as a result of implementing
                    the proposed plan.
        (e) Funding.--
                (1) In general.--Out of any money in the Treasury not
            otherwise appropriated, there is appropriated to carry out this
            Act $25,000,000, of which up to $5,000,000 may be used to carry
            out this Act, to remain available for obligation until the date
            that is 5 years after the date of enactment of this Act.
                (2) Reservation of funds.--
                        (A) In general.--Of the funds made available under
                    paragraph (1), the Secretary shall reserve not less
                    than 20 percent to award grants to eligible applicants
                    for the development of social determinants accelerator
                    plans under this section intended to serve rural
                    populations.
                        (B) Exception.--In the case of a fiscal year for
                    which the Secretary determines that there are not
                    sufficient eligible applicants to award up to 25 grants
                    under section 4 that are intended to serve rural
                    populations and the Secretary cannot satisfy the 20-
                    percent requirement, the Secretary may reserve an
                    amount that is less than 20 percent of amounts made
                    available under paragraph (1) to award grants for such
                    purpose.
                (3) Rule of construction.--Nothing in this Act shall
            prevent Federal agencies represented on the Council from
            contributing additional funding from other sources to support
            activities to improve the effectiveness of the Council.

    SEC. 1010. CORRECTING HURTFUL AND ALIENATING NAMES IN GOVERNMENT
                  EXPRESSION (CHANGE).

        (a) Short Title.--This section may be cited as the ``Correcting
    Hurtful and Alienating Names in Government Expression (CHANGE) Act''.
        (b) Modernization of Language Referring to Individuals Who Are Not
    Citizens or Nationals of the United States.--An Executive agency (as
    defined in section 105 of title 5, United States Code) shall not use
    the following terms in any proposed or final rule, regulation,
    interpretation, publication, other document, display, or sign issued by
    the agency after the date of the enactment of this Act, except to the
    extent that the term is used in quoting or reproducing text written by
    a source other than an officer (as defined in section 2104 of title 5,
    United States Code) or employee (as defined in section 2105 of title 5,
    United States Code) of the agency:
                (1) The term ``alien'', when used to refer to an individual
            who is not a citizen or national of the United States.
                (2) The term ``illegal alien'' when used to refer to an
            individual who is unlawfully present in the United States or
            who lacks a lawful immigration status in the United States.
        (c) Uniform Definition.--
                (1) In general.--Chapter 1 of title 1, United States Code,
            is amended by adding at the end the following:
    ``Sec. 9. Definition of `foreign national'
        ``In determining the meaning of any Act of Congress, or of any
    ruling, regulation, or interpretation of various administrative bureaus
    and agencies of the United States, the term `foreign national' means
    any individual other than an individual--
                ``(1) who is a citizen of the United States; or
                ``(2) though not a citizen of the United States, who owes
            permanent allegiance to the United States.''.
                (2) Technical amendment.--The table of sections for chapter
            1 of title 1, United States Code, is amended by adding at the
            end the following:

    ``9. Definition of `foreign national'.''.
        (d) References.--
                (1) In general.--Any reference in any Federal statute,
            rule, regulation, Executive order, publication, or other
            document of the United States--
                        (A) to the term ``alien'', when used to refer to an
                    individual who is not a citizen or national of the
                    United States, is deemed to refer to the term ``foreign
                    national''; and
                        (B) to the term ``illegal alien'', when used to
                    refer to an individual who is unlawfully present in the
                    United States or who lacks a lawful immigration status
                    in the United States, is deemed to refer to the term
                    ``undocumented foreign national''.
                (2) Conforming amendments.--
                        (A) Section 421(5)(A)(ii)(II) of the Congressional
                    Budget and Impoundment Control Act of 1974 (2 U.S.C.
                    658(5)(A)(ii)(II)) is amended by striking ``illegal
                    aliens'' and inserting ``undocumented foreign
                    nationals''.
                        (B) Section 432(e) of the Homeland Security Act of
                    2002 (6 U.S.C. 240(e)) is amended by striking ``illegal
                    alien'' and inserting ``undocumented foreign
                    national''.
                        (C) Section 439 of the Antiterrorism and Effective
                    Death Penalty Act of 1996 (8 U.S.C. 1252c) is amended
                    in the section heading by striking ``illegal aliens''
                    and inserting ``undocumented foreign nationals''.
                        (D) Section 280(b)(3)(A)(iii) of the Immigration
                    and Nationality Act (8 U.S.C. 1330(b)(3)(A)(iii)) is
                    amended by striking ``illegal aliens'' and inserting
                    ``undocumented foreign nationals''.
                        (E) Section 286(r)(3)(ii) of the Immigration and
                    Nationality Act (8 U.S.C. 1356(r)(3)(ii)) is amended by
                    striking ``illegal aliens'' and inserting
                    ``undocumented foreign nationals''.
                        (F) Section 501 of the Immigration Reform and
                    Control Act of 1986 (8 U.S.C. 1365) is amended--
                                (i) in the section heading, by striking
                            ``illegal aliens'' and inserting ``undocumented
                            foreign nationals'';
                                (ii) in the subsection heading for
                            subsection (b), by striking ``Illegal Aliens''
                            and inserting ``Undocumented Foreign
                            Nationals''; and
                                (iii) by striking ``illegal alien'' each
                            place such term appears and inserting
                            ``undocumented foreign national''.
                        (G) Section 332 of the Omnibus Consolidated
                    Appropriations Act, 1997 (8 U.S.C. 1366) is amended by
                    striking ``illegal aliens'' each place such term
                    appears and inserting ``undocumented foreign
                    nationals''.
                        (H) Section 411(d) of the Personal Responsibility
                    and Work Opportunity Reconciliation Act of 1996 (8
                    U.S.C. 1621(d)) is amended in the subsection heading by
                    striking ``Illegal Aliens'' and inserting
                    ``Undocumented Foreign Nationals''.
                        (I) Section 106(e) of the Public Works Employment
                    Act of 1976 (42 U.S.C. 6705(e)) is amended in the
                    subsection heading by striking ``Illegal Aliens'' and
                    inserting ``Undocumented Foreign Nationals''.
                        (J) Section 40125(a)(2) of title 49, United States
                    Code, is amended by striking ``illegal aliens'' and
                    inserting ``undocumented foreign nationals''.

                            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 39,773 people were killed by guns in 2017,
            of which two-thirds committed suicide.
                (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.
                                     <all>