116 HR 6637 IH: Health Equity and Accountability Act of 2020 U.S. House of Representatives 2020-04-28 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 116th CONGRESS2d Session H. R. 6637 IN THE HOUSE OF REPRESENTATIVES April 28, 2020 Mr. García of Illinois (for himself, Ms. Pressley, Ms. Judy Chu of California, Mr. Richmond, Mr. Espaillat, Mr. Vela, Mr. Vargas, Ms. Barragán, 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. Sánchez, Ms. Escobar, Mr. Carbajal, Mr. Castro of Texas, Mr. Cárdenas, Mr. Grijalva, Ms. Castor of Florida, Mr. McNerney, Mr. Correa, Ms. Meng, Mr. Rush, Ms. Velázquez, 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.

1.

Short title

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

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.

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.

.

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.

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.

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: (kkk)

Language assistance services and related terms

(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.

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.

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.

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.

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.

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.

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.

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..