[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.
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